Interaction between participants in focus groups with older patients and general practitioners

Mothers, milk and mourning: The meanings of breast milk after loss of an infant

Breast milk is a highly valued substance, immunologically and nutritionally, which also signifies maternal care and love for the infant. This intersection of biological and cultural qualities confers breast milk with complex meanings, which necessarily shape the experience of breastfeeding. Our research, investigating the experience of lactation after the loss of an infant, casts a novel light on these meanings. This article analyses the experience of 17 Australian bereaved mothers and 114 health professionals charged with their care. We find that while all the mothers found post-loss lactation emotionally painful, many also found redemptive meaning in their milk-production, as a bond with the lost child, as confirmation of their maternal competence and as a life giving substance that they could donate to other needy infants. These complex meanings and positive connotations were at odds with hospital cultures that regard post-loss lactation as valueless and best dealt with through medical suppression, despite the more complex insights of individual health-care professions.

Mapping Hospital-Based Lactation Care Provided to Bereaved Mothers: A Basis for Quality Improvement

Objective: The study aimed to identify and map the factors that shape the delivery of hospital-based lactation care for bereaved mothers to inform quality improvement initiatives targeting hospital-based lactation care. Methods: Focus groups and interviews were conducted at three large hospitals in Australia with 113 health professionals including obstetricians, neonatologists, midwives, neonatal nurses, lactation consultants, social workers or pastoral care workers, Human Milk Bank (HMB) staff, and perinatal bereavement nurses. Thematic and interactional data analysis identified the nature, scope, and pattern of bereavement lactation care. Results: A bereaved lactation care pathway was generated from health professionals' reports. Bereaved lactation care, if provided, was limited to brief encounters aimed at facilitating lactation suppression. The type of lactation care offered, and any exploration of the variable biopsychosocial significance of lactation after infant death, was conditional on (i) availability of health professionals with suitable awareness, knowledge, capacity, confidence, and comfort to discuss lactation; (ii) hospital culture and mode of suppression primarily practiced; (iii) mother's breast milk being visible to hospital staff; (iv) mother expressing interest in expanded lactation management options; (v) availability of, and eligibility to, donate to a HMB; and (vi) support beyond the hospital setting being facilitated. Conclusion: Mothers should be presented with the full array of lactation management options available after stillbirth or infant death. Inclusion of evidence-based, biopsychosocial and patient-centered approaches to lactation care is urgently required in health professionals' bereavement training and in the policies of hospitals and HMBs.

Portrayal of medical decision making around medical interventions life-saving encounters on three medical television shows

INTRODUCTION

Previous literature has shown that patients obtain information about the medical system from television shows. Additionally, shared decision making is regularly cited as the ideal way to make decisions during a medical encounter. Little information exists surrounding the characteristics of medical decision-making, such as who makes the decision, on medical television shows. We evaluate the characteristics of medical decisions in lifesaving encounters on medical television shows and evaluate if these characteristics were different on staged and reality television shows.

METHODS

We coded type of medical intervention, patient's ability to participate in decision, presence of patient advocate during decision, final decision maker, decision to use intervention, and controversy surrounding decision on three television shows. Frequencies by show were calculated and differences across the three television shows and between staged (ER) and reality (BostonMed and Hopkins) television shows were assessed with chi-square tests.

RESULTS

The final data set included 37 episodes, 137 patients and 593 interventions. On ER, providers were significantly more likely to make the decision about the medical intervention without informing the patient when a patient was capable of making a decision compared to BostonMed or Hopkins (p<0.001). Across all shows, 99% of all decisions on whether to use a medical intervention resulted in the use of that intervention.

DISCUSSION

Medical interventions are widely portrayed in the medical television shows we analyzed. It is possible that what patients see on television influences their expectations surrounding the decision making process and the use of medical interventions in everyday healthcare encounters.

Introducing dyadic interviews as a method for collecting qualitative data

In dyadic interviews, two participants interact in response to open-ended research questions. There are few precedents for using dyadic interviews as a technique for qualitative research. We introduce this method largely in comparison to focus groups, because both represent forms of interactive interviewing. We do not, however, view dyadic interviews as miniature focus groups, and treat them as generating their own opportunities and issues. To illustrate the nature of dyadic interviewing, we present summaries of three studies using this method. In the first study, we used dyadic interviews and photovoice techniques to examine experiences of people with early-stage dementia. In the second study, we explored the experiences of staff who provided services to elderly housing residents. In the third study, we examined barriers and facilitators to substance abuse treatment among Asian Americans and Pacific Islanders in Hawaii. We conclude with a discussion of directions for future research using dyadic interviews.

Australian general practitioner perceptions of the detection and screening of at-risk drinking, and the role of the AUDIT-C: a qualitative study

BACKGROUND

At-risk drinking is common in Australia. Validated screening tools such as the AUDIT-C have been promoted to general practitioners (GPs), but appear rarely used and detection of at-risk drinking in primary care remains low. We sought to describe Australian GP perceptions of the detection and screening of at-risk drinking; to understand their low uptake of alcohol screening questionnaires, and in particular, their attitude to the adoption of the AUDIT-C.

METHODS

Semi-structured focus group interviews of four groups of GPs and GP trainees were conducted in metropolitan Sydney between August and October 2011. Audio recordings were transcribed and analysed using grounded theory methodology.

RESULTS

We identified four main themes: there was consensus that detecting at-risk drinking is important but difficult to do, social and cultural attitudes to alcohol consumption affect willingness to ask questions about its use, the dynamics of patient-doctor interactions are important, and alcohol screening questionnaires lack practical utility. Analysis suggests that the conceptual barriers to detecting at-risk drinking were: community stigma and stereotypes of "problem drinking", GP perceptions of unreliable patient alcohol use histories, and the perceived threat to the patient-doctor relationship.

CONCLUSION

This small exploratory study found that the practice of, and barriers to, detecting at-risk drinking appear to be inextricably linked to the sociocultural beliefs surrounding alcohol use. Screening questionnaires such as the AUDIT-C are not designed to address these issues. In the current context, it is unlikely that approaches that focus on the use of these tools will be effective at improving detection of at-risk drinking by GPs.

Interviewing separately or as couples? Considerations of authenticity of method

Heideggerian researchers recognize that people and their worlds are coconstructed; people make sense of their world from within it, not detached from it. The presence of one's partner in a joint interview will therefore influence the experience of participants, and will also influence the descriptions they provide. In this article, we present a reflexive discussion of two studies in which we used Heideggerian hermeneutic phenomenology to explore people's experiences of sexuality and intimacy within the context of their illness. We present the Heideggerian concepts of Dasein, authenticity and truth, and draw on extracts from our interview transcripts to exemplify the different effects of joint and one-to-one interviews. We also discuss ethical considerations regarding these different interview approaches. Heidegger's philosophy does not preferentially support either method, but helps us to be clearer about the merits and limitations of each approach. Combining both approaches provides richer understanding of phenomena.

Taking humor seriously: talking about drinking in Native American focus groups

Focus groups provide a source of data that highlight community ideas on a topic of interest. How interview data will be utilized varies by project. With this in mind, we identify ways that focus group data from a particular population (Native American) articulate a health issue of individual tribal concern (alcohol consumption). Taking our analytic framework from linguistics, one of the four fields of inquiry in anthropology, we examine format ties and the performance of humor as stylistic features of tribal focus groups and illustrate how linguistic devices can be used in analyzing aspects of adolescent and adult drinking. Focus group data require systematic review and analysis to identify useful findings that can lead to inquiry points to initiate collaborative work with local experts before the data can be developed and configured into effective program initiatives.

The challenges of conducting focus-group research among Asian older adults

The paper demonstrates the particular value of focus groups as a data collection method in studies of older people with particular reference to those living in large cities in Asia. The strengths and limitations of focus groups as a modality of qualitative research are discussed and a case study is presented. Some of the method's strengths derive from the synergy of the interactions among elders with a shared history and lived experiences. Focus-group exchanges have the potential for inter-personal learning and reminiscence benefits. One difficulty with the method, however, is that many Asian people are inhibited about sharing personal problems in a group context. Drawing from a number of empirical studies based in Singapore, the challenges of conducting focus groups with older participants are detailed and appropriate ways of addressing them considered. The article elaborates on the author's use of software such as NVivo to expedite the analysis of large volumes of transcribed data, and on the retrieval of relevant quotes. Software is useful in extracting themes from codes, as well as allowing the researcher to appreciate the links between codes. Ethical issues such as confidentiality, cultural sensitivities such as language and respect for religion and tradition, and lessons learnt from conducting research using the group setting are discussed. Culturally relevant responses to these challenges are offered which could be useful for future researchers conducting focus groups in Asia.