The role of humor for men with testicular cancer

Humor-Based Messaging in Testicular Cancer Awareness Campaigns: A Comparative Critical Review

Extensive research showcases the extent and efficacy of humor-based messaging in general health promotion. However, the work describing humor's use within testicular cancer (TC) awareness is less developed. The aim of this comparative critical review was to determine the impact of using humor-based messaging in TC awareness campaigns to achieve a baseline assessment from which future research can be modeled. A literature search was conducted using seven databases to locate relevant literature. Three research questions guided this investigation: (1) To what extent has humor been used in TC awareness campaigns? (2) What does the literature reveal about the use of humor-based messaging on relevant health outcomes? (3) What are the limitations within current TC awareness strategies? Six studies were included in the review, of which three directly assessed the use of humor in TC awareness vis-à-vis intervention designs. Humor-based strategies were implemented to enhance knowledge of TC and testicular self-examination (TSE) procedures, reduce anxiety surrounding detection threat, and promote TSE. The rhetoric provided to men via various health interventions relied on humor and slang to promote TSE among males. Despite the small sample size of the included studies, this review determined that humor may be useful in reducing uncomfortable feelings surrounding TSE, increasing awareness of TC, and promoting TSE. When using humor-based messaging, however, the audience and type of humor implemented must be considered. Limited research exists assessing the long-term impact humor in TC promotion on health behavioral changes, easing anxieties related to detection, and increased self-efficacy surrounding TSE.

The impact of testicular cancer and its treatment on masculinity: A systematic review

OBJECTIVE

The purpose of this review was to synthesise the literature on the topic of masculinity and testicular cancer (TC) and investigate the relative impact of TC on men's view of their masculinity.

METHODS

Searches were conducted across four databases (MEDline, PsycInfo, CINAHL Plus and Scopus) for articles published before April 2022 that included (1) TC and (2) masculinity. Two researchers independently rated studies for inclusion with a third resolving conflicts. Of the 6464 articles screened, 24 articles (10 quantitative and 14 qualitative) were included in the review. Articles were rated for quality and a narrative synthesis was performed.

RESULTS

Overall, results indicated some men experience a shift in the way they relate to their sense of masculinity following diagnosis and treatment for TC. Being single and without children was related to the experience of negative masculinity-related outcomes, possibly due to a compounding lack of relational support and being unable to conform to protector, provider traditions. Men who described testicle loss as symbolic of their diminished masculinity were also negatively impacted. However, recent, high-quality literature on the topic using standardised masculinity measures was limited.

CONCLUSION

Some men experience a reduced sense of masculinity after TC, however the impact of TC on masculinity remains person dependent. Further research using validated masculinity measures is required to uncover psycho-social variables that may account for whether and how meaning is made between TC and its treatment and any subsequent impact on perceived masculinity. Such factors may better support these men in life beyond cancer.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO. International Prospective Register of Systematic Reviews: CRD42020185649.

The Development and Validation of the Colonoscopy Joking Scale

Joking is an important communication behavior that helps people cope with colorectal cancer and colonoscopy screening. However, whether joking serves a beneficial or maladaptive function in the context of colorectal cancer screening remains unknown. The lack of a valid scale impedes our understanding of how joking influences colonoscopy uptake. This study aims to develop and validate the Colonoscopy Joking Scale, a scale of joking behaviors in colonoscopy screening. A sample of Mturk participants aged 50-75 (N = 105) who were not compliant with colonoscopy screening recommendations was recruited to rate items for three joking factors and a measure of colonoscopy screening intentions. Two joking factors (i.e., screening-related and sexual connotation) related to colonoscopy screening and one related to general health were identified in the analysis. The psychometric analysis demonstrated strong convergent, predictive, and discriminant validity. The Colonoscopy Joking Scale will be helpful to understand what joking factor is associated with specific barriers to colonoscopy for different patients so that effective educational and interventional programs can be implemented.

"It's Hard, but We Could Kind of Laugh About It": Exploring the Role of Humor in Brain Cancer Caregiving

Research exploring the benefits of humor for caregivers is limited and, to date, no qualitative studies have explored the role of humor in brain cancer caregiving. To address this gap, we analyzed transcripts from twenty-one in-depth telephone interviews conducted with brain cancer caregivers from a strengths perspective. Thematic analysis using Braun and Clarke's method revealed that humor functions as (1) an innate element of the self and relationship, (2) an expression of mutual connection and understanding, (3) a way of managing difficult or awkward moments, (4) a form of avoidance or a welcome distraction, and may be (5) helpful, or unhelpful, depending on where someone is in the brain cancer trajectory. Findings suggest that humor represents an important yet complex individual and family strength for health service providers to identify and build upon.

Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

PURPOSE

Body image, self-esteem, and masculinity are three interconnected constructs in men with prostate cancer, with profound effects on quality of life. This meta-synthesis aimed to evaluate all known qualitative studies published studying the effect of prostate cancer on these constructs.

METHODS

A systematic review utilising PubMed, Embase, MEDLINE, and PsycINFO databases up to May 2020 was conducted in line with PRISMA and ENTREQ guidelines. All qualitative studies of men's experiences with body image, self-esteem, and masculinity whilst living with prostate cancer were included. A thematic meta-synthesis was conducted to identify emergent descriptive and analytical themes under the main study constructs.

RESULTS

Of 2188 articles identified, 68 were included. Eight descriptive themes were identified under two analytical themes: 'Becoming a Prostate Cancer Patient' and 'Becoming a Prostate Cancer Survivor'. These described the distress caused by changes to body image, sexual functioning, sense of masculinity, and self-esteem, and the subsequent discourses men engaged with to cope with and manage their disease. A key element was increased flexibility in masculinity definitions, and finding other ways to re-affirm masculinity.

CONCLUSIONS

Prostate cancer has an important effect on men's health post-diagnosis, and we identified strong relationships between each construct evaluated. The role of hegemonic masculinity is important when considering men's coping mechanisms and is also a key factor when addressing these constructs in counselling post-treatment.

IMPLICATIONS FOR CANCER SURVIVORS

This meta-synthesis provides key topics that uniquely affect prostate cancer survivors, enabling these patients to be effectively counselled, and have their concerns recognised by clinicians.

Breast Cancer and Hair Loss: Experiential Similarities and Differences in Men's and Women's Narratives

BACKGROUND

There are relatively few studies comparing men's and women's breast cancer experiences. Furthermore, men's experiences of cancer treatment-induced alopecia have received scant academic attention compared with those of women.

OBJECTIVE

To explore experiences of treatment-induced alopecia in both sexes and highlight ways in which they might be supported when undergoing breast cancer treatment.

METHODS

Qualitative interviews and photographic data taken from 2 separate experiential inquiries were analyzed together, focusing on references made to treatment-induced alopecia in women's and men's breast cancer accounts.

RESULTS

Hair loss was described as distressing by both sexes, affecting gendered identities and relationships. Men typically discussed loss of body hair, whereas women rarely referred to body hair explicitly, underlining gendered aspects of their experiences. Differences were also noted in coping strategies, with men using humor and asserting their masculinity. Women were better able to disguise hair loss, whereas men were forced to reveal their hairlessness.

CONCLUSIONS

The findings contribute a nuanced understanding of the experience of treatment-induced alopecia for both men and women, which will help to improve their care during cancer treatment.

IMPLICATIONS FOR PRACTICE

Healthcare professionals should provide information about the possible implications of cancer-related alopecia for identities and social relationships for both sexes. Highlighting marked gender differences in cancer-related hair loss, advice and support specific to men's needs would be particularly beneficial, enabling greater gender equality in clinical practice. Understanding the coping strategies employed by both sexes in relation to hair loss will help healthcare professionals to identify and address any underlying patient distress.

Perceived changes in psychological and physical symptoms after hospital clown performances in a cancer setting

Background: The therapeutic role of humor and hospital clowns has become a focus of interest in recent decades. Most of the research in the area has focused on children; here, we explore the influence of clown performances on adult cancer patients, their companions, and health-care staff.Methods: Ninety-nine cancer patients and 113 companions were assessed pre- and post-interventions performed by professional clowns; 31 health professionals were asked about the possible influence of the presence of clowns in hospital on their work.Results: Patients felt that clowning performances helped to reduce their level of psychological symptoms, but not their physical symptoms. Companions reported improvements in all the psychological symptoms explored. Health professionals reported that the presence of clowns in the workplace improved their well-being.Conclusions: Clowning performances helped to improve psychological functioning in all the populations studied, especially in companions. Adult hospitals should consider promoting clowning interventions to improve general well-being.

Personal and social influences on the use of humour in the interactions of student nurses in UK clinical settings

Humour is a centuries-old phenomenon studied by many disciplines. Social and personal identity play a role in the creation, recognition, understanding, appreciation and use of humour. This study, which used interpretative phenomenological analysis to explore preregistration nursing students' experiences of the use of humour in the UK clinical setting, highlights what affects the students' use of humour. The influence of sex, age, and culture and ethnicity on the participants' use of humour with patients and healthcare staff is evidenced and explored; the influence of sex did not strictly follow traditional expectations.

Joking about cancer as an avoidance strategy among US adults

Findings from years of research on fear appeals suggest that individuals with low efficacy utilize avoidance strategies when they perceive a significant threat-a process called fear control. Some research suggests that joking could be an avoidance strategy. The current study identifies conditions in which people are more likely to joke about colorectal cancer and explores how this behavior may be associated with screening avoidance. Older adults (N = 209) recruited from eight different worksites completed a survey measuring fear appeal constructs and enactment of colorectal cancer-related joking. Results of a moderated mediation analysis suggest that men were more likely to joke about colorectal cancer than women, particularly if they perceived significant threat but had limited self-efficacy, signifying fear control. Results support prior fear appeal research, suggesting that an increase in joking behavior concerning colorectal cancer may be indicative of screening avoidance, and describe belief-based mechanisms that explain differences between biological sex and joking.

The Social Functionality of Humor in Group-Based Research

Citizens' juries provide deliberative fora within which members of the public can debate complex policy issues. In this article, we reflect on our experience of undertaking three citizens' juries addressing health inequalities, to explore the positive and facilitative role that humor can play within group-based research focusing on sensitive health policy issues. We demonstrate how both participants and researchers engaged in the production of humor in ways which troubled prevailing power dynamics and facilitated positive relationships. We conclude by recommending that researchers, particularly health policy researchers and those pursuing the kind of lengthy group-based fora associated with deliberative research, consider the positive role humor can play when engaged reflexively. In so doing, we make a major contribution to extant literature on both deliberative fora (which is yet to consider humor's facilitative capacities) and the role of humor in qualitative (health) research (which rarely explores researcher complicity in humor production).

"My Insides Feel Like Keith Richards' Face": A Narrative Analysis of Humor and Biographical Disruption in Young Adults' Cancer Blogs

In this thematic narrative analysis, I examine how three young adult (YA) cancer survivors use humor and the five functions of illness-related storytelling in personal blogs maintained across the cancer trajectory to describe and counter their age-distinct biographical disruption. In 370 blog entries, YA narrators employed humor to facilitate biographical reconstruction and achieve "aligning moments" with audiences. Researchers and practitioners can use YA blogs to better understand the interpersonal health communication challenges associated with medical decision-making, altered social identities, the "void" following the completion of primary treatment, uncertainty about disclosure, and social isolation from other YA survivors.

Coping Humor of Entrepreneurs: Interaction Between Social Culture and Entrepreneurial Experience

It is feasible to deal with the high pressures in entrepreneurship using humor. This paper studies the effect of interaction between entrepreneurs' perception of social culture and entrepreneurial experience (including experience with entrepreneurial failure and current company performance) on coping humor of entrepreneurs with a sample of 171 entrepreneurs from Bohai Rim in China. Regression analysis revealed that entrepreneurs would be more likely to adopt coping humor when they perceived supportive social culture to entrepreneurship and had experienced entrepreneurial failure or when they perceived supportive social culture to entrepreneurship and had good current business. This study contributes to the literature of the theory of humor, the culture of entrepreneurship, and entrepreneurial failure.

The Use of Humor in Palliative Care: A Systematic Literature Review

BACKGROUND

Humor has its own place in the context of medicine. Nevertheless, its acceptance by terminal stage patients and health-care professionals has not been studied in depth and is not free from controversy.

OBJECTIVES

To understand the significance, appropriateness, and pertinence of the use of humor in palliative care and to analyze its applicability.

DESIGN

A narrative systematic review was undertaken and included in PROSPERO.

DATA SOURCES

Online searches were carried out on PUBMED, PSYCINFO, EBSCO (CINHAL), EMBASE, SCIELO, SCOPUS, TESEO, WEB of SCIENCE, and COCHRANE between their launch date and December 31, 2015, complemented with manual searches with queries to experts. A total of 156 studies were identified, which were then filtered in pairs by means of an established hierarchy, selecting studies that discussed the use of humor specifically in palliative care from all perspectives and designs, and finally published in Spanish, English, French, or Portuguese. Critical reading of all the selected studies took place, with no exclusions due to quality evaluation.

RESULTS

Thirty-four studies were included. Five main topics were identified: (1) definition of humor, (2) use and functions of humor in palliative care, (3) how to use humor, (4) when not to use humor, and (5) humor before and after the diagnosis of terminal illness.

CONCLUSIONS

Humor plays an unquestionable role in palliative care, but its use needs training and appropriate use.

Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories

PURPOSE

Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men's experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors.

METHODS

In-depth qualitative interviews were conducted with testicular cancer survivors over two time points approximately 6 months apart in the year following treatment completion. Interviews were analysed using a grounded theory approach.

RESULTS

The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men's ability to dismantle the present and future threats of cancer, involving the key transitions of gaining a sense of perspective and striving to get on with life and restore normality. These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented.

CONCLUSIONS

These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men's lives and have implications for the provision of support to testicular cancer survivors. Further investigation into the feasibility of one-on-one peer support interventions is warranted, as well as informal support that respects men's desire for independence.

IMPLICATIONS FOR CANCER SURVIVORS

Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness beliefs, encouraging emotional disclosure and facilitating peer mentoring.

'I've used the word cancer but it's actually good news': discursive performativity of cancer and the identity of urological cancer services

Drawing on the ethnographic study of urological cancer services, this article explores how a set of particular discourses embedded in the everyday clinical work in a large teaching hospital in the UK helps materialise particular configurations of cancer and related professional identities. Emerging on the intersection of specific socio-material arrangements (cancer survival rates, treatment regimens, cancer staging classifications, metaphors, clinical specialities) and operating across a number of differential relations (curable/incurable, treatable/untreatable, aggressive/nonaggressive), these configurations help constitute the categories of 'good' and 'bad' cancers as separate and contrasting entities. These categories help materialise particular distributions of power and are thus implicated in the making of specific claims about the identity of urological cancer services as unique and privileged. Exploring these issues in view of feminist and material-semiotic approaches to studying science, technology and medicine, this article seeks to move away from the understanding of cancer discourses as primarily linguistic performances, proposing to see them instead as arrangements of practices and relations simultaneously material and semiotic through which particular categories, entities and phenomena acquire their determinate nature. In doing so, it seeks to contribute to sociology's broader concern with discursive performativity of cancer.

The need to be Superman: the psychosocial support challenges of young men affected by cancer

PURPOSE/OBJECTIVES

To investigate how gender-specific issues shape the experiences of young adult men with cancer and what they report to be problematic.

RESEARCH APPROACH

A qualitative, descriptive approach.

SETTING

Website, focus group in the southwestern United States, and phone interviews throughout the United States.

PARTICIPANTS

Text from an online forum (N=3,000 posts), focus group of six men, and separate interviews with four men.

METHODOLOGIC APPROACH

Data analysis took place over two months through constant comparison of online text as well as a focus group and interview transcripts.

FINDINGS

Men face challenges being both a receiver and provider of support in relationships with their peers, romantic partners, and children. Cultural expectations to "be strong" drive their support-seeking beliefs and behaviors.

CONCLUSIONS

Men report conflict between desires to show strength and to be honest that present a barrier to support, as well as contribute to inadequate relationships with male peers and greater difficulty in exchanging support with romantic partners.

INTERPRETATION

The authors identified attitudes about and barriers to men's experiences with social support, which healthcare providers, such as nurses, should be sensitive to when developing and providing support.

Developing cartoons for long-term condition self-management information

BACKGROUND

Advocating the need to adopt more self-management policies has brought with it an increasing demand for information about living with and making decisions about long-term conditions, with a significant potential for using cartoons. However, the purposeful use of cartoons is notably absent in many areas of health care as is evidence of their acceptability to patients and lay others. This paper outlines the process used to develop and evaluate cartoons and their acceptability for a series of self-management guidebooks for people with inflammatory bowel disease, irritable bowel syndrome, diabetes, chronic obstructive pulmonary disease and chronic kidney disease (CKD).

METHODS

Principles for a process to develop information and cartoons were developed. Cartoon topics were created using qualitative research methods to obtain lay views and experiences. The CKD guidebook was used to provide a detailed exemplar of the process. Focus group and trial participants were recruited from primary care CKD registers. The book was part of a trial intervention; selected participants evaluated the cartoons during in-depth interviews which incorporated think-aloud methods.

RESULTS

In general, the cartoons developed by this process depict patient experiences, common situations, daily management dilemmas, making decisions and choices and the uncertainties associated with conditions. CKD cartoons were developed following two focus groups around the themes of getting a diagnosis; understanding the problem; feeling that facts were being withheld; and setting priorities. Think-aloud interviews with 27 trial participants found the CKD cartoons invoked amusement, recognition and reflection but were sometimes difficult to interpret.

CONCLUSION

Humour is frequently utilised by people with long-term conditions to help adjustment and coping. Cartoons can help provide clarity and understanding and could address concerns related to health literacy. Using cartoons to engage and motivate people is a consideration untapped by conventional theories with the potential to improve information to support self-management.

A time to weep and a time to laugh: humour in the nurse-patient relationship in an adult cancer setting

PURPOSE

The literature highlights the value of humour in health-care settings. Humour impacts on the physiological, psychosocial and cognitive well-being of a person. The diagnosis of cancer is extremely stressful, and treatments are difficult. Patients and nurses may use humour as a coping mechanism to contend with the stresses caused directly or indirectly by cancer. This study investigated the use of humour during interactions between patients and nurses in an adult cancer ward.

METHODS

This study used a modified ethnographic methodology that included fieldwork participant observation and informal interviews (n=30 h) and formal interviews (n=10). In total, 9 nurses and 12 patients participated in participant observation. From these, five nurses and five patients were interviewed. Data were analysed using thematic analysis.

RESULTS

Findings highlighted the importance of humour in the nurse-patient relationship. Patients consciously use humour during nurse-patient interactions in an attempt to help nurses cope with the stress they encounter in clinical practice. Patients perceive having a sense of humour as a positive nurse attribute. Nurses expressed concerns regarding compromising professionalism when using humour and felt the need for guidance from senior staff. Constant assessment and reflection help ensure humour is used appropriately in the adult health-care setting.

CONCLUSION

The benefits of humour are recognised by both adult cancer patients and nurses. A deeper understanding of patient and nurse perceptions of the use of humour can inform strategies for its therapeutic use in the clinical setting.

Weight management for overweight and obese men delivered through professional football clubs: a pilot randomized trial

Background

The prevalence of male obesity is increasing, but men are less likely than women to attend existing weight management programmes. We have taken a novel approach to reducing perceived barriers to weight loss for men by using professional football (soccer) clubs to encourage participation in a weight management group programme, gender-sensitised in content and style of delivery. Football Fans in Training (FFIT) provides 12 weeks of weight loss, physical activity and healthy eating advice at top professional football clubs in Scotland. This pilot randomized trial explored the feasibility of using these clubs as a setting for a randomized controlled trial of 12 month weight loss following men’s participation in FFIT.

Methods

A two-arm pilot trial at two Scottish Premier League football clubs (one large, one smaller), with 103 men (aged 35–65, body mass index (BMI) ≥27 kg/m²) individually randomized to the intervention (n=51, received the pilot programme (p-FFIT) immediately) and waitlist comparison (n=52, received p-FFIT after four months) groups. Feasibility of recruitment, randomization, data collection and retention were assessed. Objective physical measurements (weight, waist circumference, blood pressure, body composition) and questionnaires (self-reported physical activity, diet, alcohol consumption, psychological outcomes) were obtained from both groups by fieldworkers trained to standard protocols at baseline and 12 weeks, and from the intervention group at 6 and 12 months. Qualitative methods elicited men’s experiences of participation in the pilot trial.

Results

Following a short recruitment period, the recruitment target was achieved at the large, but not smaller, club. Participants’ mean age was 47.1±8.4 years; mean BMI 34.5±5.0 kg/m². Retention through the trial was good (>80% at 12 weeks and 6 months; >75% at 12 months), and 76% attended at least 80% of available programme delivery sessions. At 12 weeks, the intervention group lost significantly more weight than the comparison group (4.6% c.f. -0.6%, p<.001) and many maintained this to 12 months (intervention group baseline-12 month weight loss: 3.5%, p<.001). There were also improvements in self-reported physical activity and diet, many sustained long term.

Conclusions

The results demonstrated the feasibility of trial procedures and the potential of FFIT to engage men in sustained weight loss and positive lifestyle change. They supported the conduct of a fully-powered randomized controlled trial.

Football Fans in Training: the development and optimization of an intervention delivered through professional sports clubs to help men lose weight, become more active and adopt healthier eating habits

Background

The prevalence of obesity in men is rising, but they are less likely than women to engage in existing weight management programmes. The potential of professional sports club settings to engage men in health promotion activities is being increasingly recognised. This paper describes the development and optimization of the Football Fans in Training (FFIT) programme, which aims to help overweight men (many of them football supporters) lose weight through becoming more active and adopting healthier eating habits.

Methods

The MRC Framework for the design and evaluation of complex interventions was used to guide programme development in two phases. In Phase 1, a multidisciplinary working group developed the pilot programme (p-FFIT) and used a scoping review to summarize previous research and identify the target population. Phase 2 involved a process evaluation of p-FFIT in 11 Scottish Premier League (SPL) clubs. Participant and coach feedback, focus group discussions and interviews explored the utility/acceptability of programme components and suggestions for changes. Programme session observations identified examples of good practice and problems/issues with delivery. Together, these findings informed redevelopment of the optimized programme (FFIT), whose components were mapped onto specific behaviour change techniques using an evidence-based taxonomy.

Results

p-FFIT comprised 12, weekly, gender-sensitised, group-based weight management classroom and ‘pitch-side’ physical activity sessions. These in-stadia sessions were complemented by an incremental, pedometer-based walking programme. p-FFIT was targeted at men aged 35-65 years with body mass index ≥ 27 kg/m². Phase 2 demonstrated that participants in p-FFIT were enthusiastic about both the classroom and physical activity components, and valued the camaraderie and peer-support offered by the programme. Coaches appreciated the simplicity of the key healthy eating and physical activity messages. Suggestions for improvements that were incorporated into the optimized FFIT programme included: more varied in-stadia physical activity with football-related components; post-programme weight management support (emails and a reunion session); and additional training for coaches in SMART goal setting and the pedometer-based walking programme.

Conclusions

The Football Fans in Training programme is highly acceptable to participants and SPL coaches, and is appropriate for evaluation in a randomised controlled trial.

Police officers' experiences of supportive and unsupportive social interactions following traumatic incidents

BACKGROUND

Police officers are routinely exposed to potentially traumatic incidents yet the majority do not develop post-traumatic stress disorder (PTSD). Social support has been identified as one factor that may maintain wellbeing in this population, although what constitutes supportive or unsupportive interactions is unclear.

OBJECTIVE

To explore police officers' experiences of supportive and unsupportive interactions following distressing incidents.

METHOD

Semi-structured interviews were conducted with 19 police officers. Transcripts were analysed using Braun and Clarke's (2006) thematic analysis approach.

RESULTS

Participants described a range of supportive interactions with colleagues, friends, and family, as well as social constraints that hindered interactions. Ambivalence about talking about the impact of distressing events was striking throughout the accounts. The context and source of available support, as well as beliefs about talking, influenced their interactions. Humour was a central feature of interactions with colleagues; more emotional talk occurred with partners and close family, albeit with officers limiting details in order to protect others.

CONCLUSIONS

The findings provide tentative insights into the processes of social support that may contribute to the resilience of police officers following traumatic incidents. Further research is needed to examine whether the experiences of supportive and unsupportive interactions differ for those with and without PTSD.

Humour in adult cancer care: a concept analysis

AIMS

To report an analysis of the concept of humour in adult cancer care.

BACKGROUND

Humour is a form of communication which is present in the adult cancer setting. Numerous studies show the multi-dimensional value of humour in cancer care. A clear conceptual understanding, however, of what it represents is lacking.

DESIGN

Walker and Avant's framework was used to guide this concept analysis.

DATA SOURCES

Literature searches included bibliographic databases, internet, and manual searches.

REVIEW METHODS

Literature published from 1990 to the present was reviewed. Thematic analysis was carried out to identify critical attributes and antecedents.

RESULTS

Based on the analysis, a definition of humour in adult cancer nursing is proposed. Humour is a subjective emotional response, resulting from the recognition and expression of incongruities of a comic, absurd and impulsive situation, remark, character, or action, which enhances feelings of closeness or togetherness when shared in the context of trust between the patient and nurse and may be used as a coping mechanism in a stressful situation such as the adult cancer care setting.

CONCLUSION

The analysis provides an understanding of the concept of humour in the adult cancer setting and includes a theoretical illustration of its critical attributes. This concept analysis provides a forum for discussion with reference to the use of humour in adult cancer nursing care. Further exploration is recommended to determine the meaning of humour and its nature across different care settings.

Words matter: a qualitative investigation of which weight status terms are acceptable and motivate weight loss when used by health professionals

Background

Health professionals have an important role to play in the management of obesity, but may be unsure how to raise weight issues with patients. The societal stigma associated with excess weight means that weight status terms may be misunderstood, cause offence and risk upsetting patient-professional relationships. This study investigated the views of people who were overweight or obese on the acceptability of weight status terms and their potential to motivate weight loss when used by health professionals.

Methods

A qualitative study comprising 34 semi-structured interviews with men and women in their mid-to-late 30s and 50s who were overweight or obese and had recently been informed of their weight status. Thematic framework analysis was conducted to allow the systematic comparison of views by age, gender and apparent motivation to lose weight.

Results

Although many people favoured 'Overweight' to describe their weight status, there were doubts about its effectiveness to motivate weight loss. Terms including 'BMI' ('Body Mass Index') or referring to the unhealthy nature of their weight were generally considered acceptable and motivational, although a number of men questioned the validity of BMI as an indicator of excess weight. Participants, particularly women, felt that health professionals should avoid using 'Fat'. Whilst response to 'Obese' was largely negative, people recognised that it could be appropriate in a health consultation. Some younger people, particularly those who appeared motivated to lose weight, felt 'Obese' could encourage weight loss, but it was also clear the term could provoke negative emotions if used insensitively.

Conclusions

Although most people who are overweight or obese accept that it is appropriate for health professionals to discuss weight issues with patients, there is great variation in response to the terms commonly used to describe excess weight. There is no one-size-fits-all approach to discussing weight status: some men and younger people may appreciate a direct approach, whilst others need to be treated more sensitively. It is therefore important that health professionals use their knowledge and understanding to select the terms that are most likely to be acceptable, but at the same time have most potential to motivate each individual patient.

Laughter and humor as complementary and alternative medicines for dementia patients

BACKGROUND

The number of dementia patients has increased worldwide, with an estimated 13.7 million dementia patients in the Asia Pacific region alone. This number is expected to increase to 64.6 million by the year 2050.

DISCUSSION

As a result of advances in research, there several pharmacological therapies available for the treatment of dementia patients. However, current treatments do not suppress the disease process and cannot prevent dementia, and it will be some time before these goals are realized. In the meantime, complementary and alternative medicine (CAM) is an important aspect in the treatment of dementia patients to improve their quality of life throughout the long course of the disease. Considering the individuality of dementia patients, applicability of laughter and humor therapy is discussed. Even though there are many things that need to be elucidated regarding the mechanisms underlying the beneficial effects of laughter and humor, both may be good CAM for dementia patients if they are applied carefully and properly.

SUMMARY

In this debate article, the physiological basis and actual application of laughter and humor in the treatment of dementia patients are presented for discussion on the applicability to dementia patients.

The social meaning and function of humour in physiotherapy practice: An ethnography

An ethnographic study was undertaken over a period of 8 months to explore the social meaning and function of humour in the practice of a team of physiotherapists in a UK National Health Service hospital. Interviews were carried out following the observations to gain the therapists' perspectives in an open critical exploration of assumptions and ideas. The analysis was iterative and followed a systematic recognised ethnographic approach. The findings revealed explicit and implicit meanings of the team's humorous interactions. Explicitly, they appeared light-hearted and enhanced camaraderie but implicitly they demonstrated the team leadership and management skills of the most senior member of the team who had an authoritative influence on the other members, and facilitated this explicit marker of membership. By hiding their concerns in humour, the team members were able to avoid a real confrontation with issues of authority and hierarchy that underscored these activities. Humour, in this instance, was used as a stabilising force to give the team a sense of certainty juxtaposed by the prevailing unpredictability of their daily activities; it was part of their professional culture to allow them to handle stressful situations and to build up a socialisation process. By creating a collective identity, the individual members came to understand the team's underlying philosophy of practice. As a resource, humour was seen to be used as a vehicle of negotiation and a catalyst for change.

'Having a laugh': masculinities, health and humour

There is longstanding interest within anthropology and sociology in the meaning of humour, but little research that examines humour within fathers' health experiences. This paper specifically analyses fathers' stories about humour shared with other men, and the links between gender and health, in order to identify the implications for health-care and future research. Findings indicate that humour is an important aspect of fathers' experiences of social connectedness with other men. Indeed, for African-Caribbean fathers specifically, humour was an important aspect of their relationships with other ethnic minority men. Humour was also used to objectify, humiliate or ridicule others, for example in the form of sexualised or racist humour. However, fathers' stories were also mediated by masculinities, it that masculinities enabled fathers to avoid disclosure of vulnerability regarding health experiences to others. The links between masculinities and health, the implications for interviewing fathers, and the implications for future research and healthcare practice with fathers are also discussed.

Disclosing a cancer diagnosis to friends and family: a gendered analysis of young men's and women's experiences

Little is known about how young adults disclose their cancer diagnosis to family and friends, and whether there are similarities or differences between men and women. This article compares young adults' experiences of disclosing a cancer diagnosis, drawing on narrative interviews with 37 respondents aged 18 to 34 years. Most respondents were open about their diagnosis, and there were striking similarities in the difficulties that men and women described and in their desire to protect relatives. However, men made up most of the minority of respondents who were more secretive about their diagnosis. Men also made more explicit connections between their gendered identity and disclosure; worries about being perceived differently by peers resulted in some men hiding their diagnosis and others using humor to pre-empt sympathy. These findings are discussed in the context of gender stereotypes of "expressive" women and "stoical" men.

Physical exercise and psychological well-being among people with chronic illness and disability: a grounded approach

This qualitative study describes the effect of exercise on psychological well-being among individuals with chronic illnesses and disabilities such as stroke, cancer, diabetes and arthritis. Eleven users of a physical disability daycentre completed a novel, six-month, group-based programme of seated exercise provided by the first author. Results from grounded analyses of in-depth interviews provide evidence that exercise offers a powerful means to actively manage mood problems associated with disability, to preserve and cultivate personal identity in a positive manner and to connect with others and one's own body in ways which limit the development of illness-related psychological distress. Implications for the development of further research and future provision of similar services are discussed.

The purpose and function of humour in health, health care and nursing: a narrative review

AIM

This paper is a report of a review conducted to identify, critically analyse and synthesize the humour literature across a number of fields related to health, health care and nursing.

BACKGROUND

The humour-health hypothesis suggests that there is a positive link between humour and health. Humour has been a focus of much contention and deliberation for centuries, with three theories dominating the field: the superiority or tendentious theory, the incongruity theory and the relief theory.

DATA SOURCES

A comprehensive literature search was carried out in January 2007 using a number of databases, keywords, manual recursive searching and journal alerts (January 1980-2007) cross-referenced with the bibliographic databases of the International Society of Humor Studies. An inclusion and exclusion criterion was identified.

REVIEW METHODS

A narrative review of evidence- and non-evidence-based papers was conducted, using a relevant methodological framework with additional scrutiny of secondary data sources in the latter. Humour theories, incorporating definition, process and impact constituted a significant part of the appraisal process.

RESULTS

A total of 1630 papers were identified, with 220 fully sourced and 88 included in the final review. There is a dearth of humour research within nursing yet, ironically, an abundance of non-evidence-based opinion citing prerequisites and exclusion zones. Examination of physician-patient interaction and the humour-health hypothesis demonstrates that use of humour by patients is both challenging and revealing, particularly with regard to self-deprecating humour.

CONCLUSION

Nurses and nursing should adopt a circumspect and evidenced-based approach to humour use in their work.

Making sense of qualitative data analysis: an introduction with illustrations from DIPEx (personal experiences of health and illness)

OBJECTIVES

This paper outlines an approach to analysing qualitative textual data from interviews and discusses how to ensure analytic procedures are appropriately rigorous.

OVERVIEW

Qualitative data analysis should begin at an early stage in data collection and be highly systematic. It is important to identify issues that emerge during the data collection and analysis as well as those that the researcher may have anticipated (from reading or experience). Analysis is very time-consuming, but careful sampling, the collection of rich material and analytic depth mean that a relatively small number of cases can generate insights that apply well beyond the confines of the study. One particular approach to thematic analysis is introduced with examples from the DIPEx (personal experiences of health and illness) project, which collects video- and audio-taped interviews that are freely accessible through http://www.dipex.org.

EVALUATION

Qualitative analysis of patients' perspectives of illness can illuminate numerous issues that are important for medical education, some of which are unlikely to arise in the clinical encounter. Qualitative studies can also cover a much broader range of experiences - of both common and rare disease - than clinicians will see in practice. The DIPEx website is based on qualitative analysis of collections of interviews, illustrated with hundreds of video and audio clips, and is an innovative resource for medical education.

Laughter: The Best Medicine?

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH) founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery, which provides hope to the patient and support to caregivers and encourages the healing process. The center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The diagnosis of cancer is incredibly stressful, and treatments are arduous. Humor may help to ease the pain, show the human side of the health care team, and help everyone cope. Whether the patient uses humor to lighten the mood of a difficult consultation with their physician, or health care workers use it to help cheer each other through the day, humor and laughter can be valuable tools. Humor can soften the isolation experienced by both patients and staff. When used sensitively, respecting the gravity of the situation, humor can build the connection among the caregiver, patient, and family. However, insensitive joking is offensive and distressing, and experience suggests a variable acceptance of humor by patients with life-threatening illnesses, making humor a high-risk strategy, and it can be a pejorative maker of an adversive power differential. The medical literature contains little on humor, and very little research has been conducted on this common aspect of human communication. Through an examination of physician and nurse experiences, the role of humor in medicine is reviewed.