[Barriers to communication between clinicians and immigrants]

Clinicians lack cultural competencies and communication skills relevant to clinical decision-making in cases of language and cultural barriers. Life course perspectives and basic understanding of life in exile are not integrated in diagnostics, treatment or follow-up resulting in low patient compliance, mistrust, complications, diagnostic errors and delays. Stereotyping and generalizations put patients in a position where they are forced to protect themselves by withholding important information. When in doubt clinicians should ask, listen and avoid guessing.

Role of biographical experience and bodily sensations in patients' adaptation to hypertension

OBJECTIVE

To explore patients' adaptation to hypertension and to describe its impact on their sense of body, biographical experience, approach to life and daily activities.

METHODS

A qualitative interview study with nine men and eight women (age: 35-50 years) with hypertension from four general practices in Denmark. The informants differed in type and duration of treatment.

RESULTS

Adaptation to hypertension was influenced by the patients' biographical experiences and involved changes in body perception. The process affected patients' daily activities and they actively tested their physical abilities. Patients gradually adopted behaviour and attitudes to reduce their risk of cardiovascular disease.

CONCLUSION

A diagnosis of hypertension constitutes a biographical disruption and has an impact on daily life. Patients' adaptation to hypertension combines biographical and bodily experiences.

PRACTICE IMPLICATIONS

Attention to patients' biographies and images of hypertension is an important element of hypertensive treatment.

Patients' attitudes to medical and psychosocial aspects of care in fertility clinics: findings from the Copenhagen Multi-centre Psychosocial Infertility (COMPI) Research Programme

BACKGROUND

The aims were (i) to identify gender differences in motivations to seek assisted reproduction and gender differences in expectations about medical and psychosocial services and (ii) to examine factors that predict the perceived importance of, and intention to use, psychosocial services among infertile people.

METHODS

We conducted an epidemiological study based on questionnaires among all new couples attending five fertility clinics with a response rate of 80.0% and a total of 2250 patients.

RESULTS

The vast majority of both men and women considered a high level of medical information and patient-centred care as important. Fewer respondents (women 10.0-20.8%, men 4.1-8.9%) felt that professional psychosocial services were important and/or had the intention to use these services. The main predictor of perceived importance of patient-centred care and professional psychosocial services for both men and women was high infertility-related stress in the marital, personal and social domain.

CONCLUSIONS

A supportive attitude from medical staff and the provision of both medical and psychosocial information and support should be integral aspects of medical care in fertility clinics. Although only a minority of the participants perceived professional psychosocial services as important, they should be available for patients whose infertility causes them much strain, especially for patients whose marital relationship suffered much because of infertility.

[The secrecy aspect of donor insemination]

A literature review among couples treated with donor insemination (DI) showed that almost all participants had planned not to inform the child that this treatment had taken place. Many of the couples had told other people about the treatment, and thus opened up the possibility of a traumatic disclosure. Though secrecy about DI treatment could be taxing for the couple, this strain did not negatively influence the assessment of the relationship, parenthood, or the parent-child relation. Psychosocial development of DI-children was not different from other children's development. It was not possible to show a deleterious effect of keeping the treatment a secret. There is a lack of qualitative studies about the consequences of secrecy for the relationship between DI-parents, for parenthood and for the child. Only one study included adult DI-children.