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PubMed1999

Cancer patients' expectations of the role of family physicians in communication about complementary therapies.

OBJECTIVE: To explore cancer patients' experiences with and expectations of the role of family physicians in communication about complementary therapies. DESIGN: Focus group interviews. SETTING: British Columbia Cancer Agency and the University of Calgary. PARTICIPANTS: Sample of 14 cancer patients using complementary therapies comprising 3 focus groups (2 in BC and 1 in Alberta). RESULTS: The role of family physicians in discussing complementary therapies varied from being extraneous to patients' decision making to being a partner in making decisions about cancer treatments. Patients expected their physicians to be supportive, caring, kind and to show an interest in them. They also expected their physicians to be accepting and nonjudgmental regarding complementary therapy use and to reinforce a sense of hope. Most patients did not expect their doctors to have extensive knowledge about these therapies. All patients strongly felt the need to seek information themselves. In addition, they felt that believing in the type of therapies they were using was very important. CONCLUSION: Family physicians can play an important role in exploring and discussing complementary therapies with their patients. It is important that they are made aware of their patients' needs in this area.

Aged↗

PubMedDate not supplied

Transitioning to survivorship: a pilot study.

There are no clear transition guidelines for adolescent and young adult cancer patients, their parents, and their primary care providers (PCPs) when completing active therapy and within the first few years after therapy. The purpose of this pilot study was to identify needs and concerns of recently treated adolescent cancer patients and their parents, young adult cancer survivors, and the community PCPs of adolescent patients. Four focus group interviews were conducted with survivors and parents, and 3 in-depth interviews were conducted with PCPs. All interviews were audiotaped and transcribed for content analysis. A range of needs were identified, including lack of adequate written and verbal information about their prior treatment, its potential side effects, and appropriate follow-up care. The best sources for education were identified as the primary oncologist, nurse practitioner, or nurse. At completion of treatment, parents and adult survivors felt a lack of psychosocial support. Suggestions from participants included use of informational videos for survivors, weekend education and support programs, ongoing support groups, use of the Internet, and educational newsletters. The PCPs reported a lack of general pediatric oncology knowledge and specific patient information, time constraints in their patient schedules, and having few survivors in their practices as barriers to optimal survivorship care. Further research is needed to look at the unmet educational and psychological needs of childhood cancer survivors and their parents during the critical time when they transition off treatment.

Adolescent↗

PubMed2001

Rethinking ethnography: reconstructing nursing relationships.

AIMS OF THE STUDY: Critical ethnography is being adopted increasingly by nurses as a legitimate form of research methodology. This paper explores the research practices and dilemmas that emerge from this methodology using a recently completed ethnographic study of nurse-nurse and nurse-doctor interactions in a critical care hospital setting. BACKGROUND: Critical ethnography provides a useful methodology that facilitates mutual dialogue among participants. It may be limited, however, by the central role of researchers and by a tendency to negotiate participants' realities according to a particular 'truth'. These concerns have been strongly critiqued by poststructuralists using concepts such as discourse, subjectivity and power. By incorporating the notion of a poststructural analysis into critical ethnography, researchers are in a position to examine critically the tensions in their own practices, and their struggles with documenting and analysing ethnographic accounts. DESIGN: Six registered nurses comprised the participants of the research group. Through the method of professional journalling, the first author of this paper explored her professional interactions with doctors and other nurses in her role as a nurse in the critical care setting under investigation. Other methods included participant observation, and individual and focus group interviews with nurse participants. ISSUES OF METHODOLOGICAL CONCERN: This paper considers three issues of methodological concern: researcher/participant subjectivity; the movement from empowerment to reflexivity and the construction of one form of ethnographic 'truth'. These issues are discussed in reference to the research relationships with the nurse participants and the process of analysing ethnographic accounts. CONCLUSIONS: In working with critical ethnography using a poststructural analysis, we were able to generate valuable insights about previously hidden areas of relationships among nurse participants in a research group during all stages of the research process. It also provided a means of informing the analysis of ethnographic texts.

Anthropology, Cultural↗

PubMed2006

Caring for diverse populations: do academic family medicine practices have CLAS?

BACKGROUND AND OBJECTIVES: The Future of Family Medicine Final Report calls for greater emphasis on training physicians to provide culturally proficient and effective quality care to an increasingly diverse population. It remains unclear, however, how prepared academic family medicine practices are to address this need. METHODS: We carried out a qualitative sub-study (as part of a larger research study) using depth and focus group interviews at two urban family medicine centers to understand the challenges and opportunities involved in meeting the Department of Health and Human Services Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. The Lewin Group's Organizational Cultural Competence Assessment Profile was used to analyze the qualitative interview data. RESULTS: The main themes that emerged from interviews with faculty physicians, administrators, staff, and patients were: (1) the need for more linguistically appropriate services, (2) lack of communication among those involved in care delivery, and (3) interest in education about cultural and linguistic competence. CONCLUSIONS: The academic family medicine practices studied are frustrated and challenged to integrate cultural and linguistic competence into patient care. Organizational pressures, multiple competing demands, and resource constraints inhibit preparedness to address the CLAS standards and important new national requirements and guidelines.

Clinical Competence↗

PubMed1998

Abortion, revised: participants in the U.S. clinical trials evaluate mifepristone.

This paper centers on the questions: How do non-surgical abortion methods affect private experiences of abortions? How might they influence public conceptions of abortion? Drawing on interviews with clients who participated in the 1994-95 U.S. clinical trials of mifepristone at one trial site (conducted during the trials), and focus group interviews conducted with health care workers at all 17 trial sites (after the trials were completed), we examine participants' evaluations of this method of abortion. Surgical abortion functioned as the reference point by which research participants assessed medical abortion. They discussed mifepristone abortion in terms of nature and invasion, privacy and bodily integrity, denial and agency. Clients frequently portrayed mifepristone abortion as a better moral choice than surgical abortion--in some cases even depicting it as not-really-an-abortion but rather as a miscarriage. Clients felt that mifepristone offered them a greater measure of control over their abortion experiences. Health care providers offered critical analysis of their clients' perceptions, yet affirmed the potential of medical abortion to offer women greater variety and latitude in procreative decision-making, and perhaps even to depoliticize the issue of abortion in the U.S. by thwarting the efforts of anti-abortionists to target providers and aborting women.

Abortifacient Agents, Steroidal↗

PubMed2004

Teaching empathy to first year medical students: evaluation of an elective literature and medicine course.

BACKGROUND: Empathy is critical to the development of professionalism in medical students, and the humanities-particularly literature-have been touted as an effective tool for increasing student empathy. This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development. METHOD: In 2000-2001, first year students (n=22) volunteered for an eight-session literature and medicine elective and were randomly assigned to either immediate participation in the class or a wait-list group, who participated in the same class 6 months later. Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-the-humanities scale. Students also participated in a qualitative group interview pre- and post-intervention. RESULTS: Empathy and attitudes toward the humanities improved significantly (p<0.01) after participation in the class when both groups of students were combined. The scaled treatment effect size was in the moderate range (> or =0.60 standard deviation units) for both measures that had statistically significant pre-to-post changes. Furthermore, student understanding of the patient's perspective became more detailed and complex after the intervention. Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress. CONCLUSION: A brief literature-based course can contribute to greater student empathy and appreciation for the value of humanities in medical education.

Adult↗

PubMed2003

Dementia diagnosis in developing countries: a cross-cultural validation study.

BACKGROUND: Research into dementia is needed in developing countries. Assessment of variations in disease frequency between regions might enhance our understanding of the disease, but methodological difficulties need to be addressed. We aimed to develop and test a culturally and educationally unbiased diagnostic instrument for dementia. METHODS: In a multicentre study, the 10/66 Dementia Research Group interviewed 2885 people aged 60 years and older in 25 centres, most in Universities, in India, China and southeast Asia, Latin America and the Caribbean, and Africa. 729 had dementia and three groups were free of dementia: 702 had depression, 694 had high education (as defined by each centre), and 760 had low education (as defined by each centre). Local clinicians diagnosed dementia and depression. An interviewer, masked to dementia diagnosis, administered the geriatric mental state, the community screening instrument for dementia, and the modified Consortium to Establish a Registry of Alzheimer's Disease (CERAD) ten-word list-learning task. FINDINGS: Each measure independently predicted a diagnosis of dementia. In an analysis of half the sample, an algorithm derived from all three measures gave better results than any individual measure. Applied to the other half of the sample, this algorithm identified 94% of dementia cases with false-positive rates of 15%, 3%, and 6% in the depression, high education, and low education groups, respectively. INTERPRETATION: Our algorithm is a sound basis for culturally and educationally sensitive dementia diagnosis in clinical and population-based research, supported by translations of its constituent measures into most languages used in the developing world.

Algorithms↗

PubMed1999

The Experience of Waiting for Diagnosis After an Abnormal Mammogram.

In order to better understand the experience of women following abnormal screening mammogram and before definitive diagnosis, we undertook a series of focus group interviews in six geographic areas in the province of British Columbia, Canada. While all 33 participants had experienced abnormal mammograms within the previous year, each group included women with a range of ages and diagnostic outcomes. Verbatim transcripts of all focus groups were subjected to qualitative secondary analysis using interpretive descriptive methods. Through a process of grounded inductive analysis, conceptual themes within the data were identified and tested. The findings of this study provide an experiential account of common patterns within the structure and process of waiting for diagnosis. The accounts depict the way the women experienced time, their individual and common responses to waiting, and the impact of health system factors, including provider communication. These findings confirm that, regardless of its outcome, waiting for definitive diagnosis after an abnormal screening mammogram is an intense and often agonizing experience for the women involved and for their families. Furthermore, our results highlight the relevance of such issues as information systems, support, coordination of services, and health care communication, and underscore the important role that service delivery factors can play in making such experiences bearable.

Journal Article↗

PubMed2001

A comprehensive, stage-sensitive model of grief in dementia caregiving.

PURPOSE: Grief is an overlooked but important element of the caregiver experience. This study defines a model of caregiver grief to aid in clinical intervention and to support further research. DESIGN AND METHODS: This study addressed the grief responses of 87 spouse and adult-child caregivers of patients with progressive dementia representing mild, moderate, severe, and postdeath. Questionnaire data and qualitative findings from 16 semistructured focus group interviews provide the basis for a descriptive model of anticipatory grief in dementia caregiving. RESULTS: Significant differences emerged between spouse and adult-child caregiver groups as a whole and as a function of Clinical Dementia Rating impairment level. Caregiver grief was found to fluctuate between intellectual, affective, and existential poles depending upon current care demands and expectations. IMPLICATIONS: These findings suggest that anticipatory grief in dementia caregiving is "real" grief, equivalent in intensity and breadth to death-related grief.

Alzheimer Disease↗

PubMedDate not supplied

Physicians, patients, and the electronic health record: an ethnographic analysis.

PURPOSE: Little is known about the effects of the electronic health record (EHR) on physician-patient encounters. The objectives of this study were to identify the factors that influence the manner by which physicians use the EHR with patients. METHODS: This ethnographic study included 4 qualitative components: 80 hours of participant observation in 4 primary care offices in the Pacific Northwest; individual interviews with 52 patients, 12 office staff members, 23 physicians, and 1 nurse-practitioner; videotaped reviews of 29 clinical encounters; and 5 focus-group interviews with physicians and computer advocates. The main outcome measures were factors that influence how physicians use the EHR. Researchers qualitatively derived these factors through serial reviews of data. RESULTS: This study identified 14 factors that influence how EHRs are used and perceived in medical practice today. These factors were categorized into 4 thematic domains: (1) spatial--effect of the physical presence and location of EHRs on interactions between physicians and patients; (2) relational--perceptions of physicians and patients about the EHR and how those perceptions affected its use; (3) educational--issues of developing physicians' proficiency with and improving patients' understandings about EHR use; and (4) structural--institutional and technological forces that influence how physicians perceived their use of EHR. CONCLUSIONS: This study found that the introduction of EHRs into practice influences multiple cognitive and social dimensions of the clinical encounter. It brings into focus important questions that through further inquiry can determine how to make best use of the EHR to enhance therapeutic relationships.

Adult↗

PubMedDate not supplied

Experiences against HIV/AIDS/STDS of Somalis in exile in Gothenburg, Sweden.

Since 1989, the City of Göteborg Immigrant Services Administration has been making efforts to inform about HIV/AIDS. The purpose has been to ensure that even immigrant residents of the City of Göteborg (Gothenburg) have access to relevant information about HIV/AIDS. The administration's efforts have been a part of the collected efforts of Gothenburg to prevent the spreading of HIV. This paper attempts to discover and describe experiences against HIV/AIDS/STDs of Somalis in Exile in Gothenburg, Sweden. A qualitative sociological in-depth interviews with 13 individuals (6 women and 7 men) and with semi-structured and themetized emerging design was carried on. A follow up focus group interviews with 10 individuals (2 women and 8 men) was also performed. The paper reveals that the general understanding of subjects on the issues under discussion is almost the same though details may vary from one research participant to the other. They have described this through narratives. STDs and specially HIV/AIDS was perceived as something dishonourable by the subjects. The HIV/AIDS is perceived as a sin which Allah sends to punish those who have fornication or sex without marriage (Zinna). Of course, this tendency of shying off the problem leads to ignorance of how to behave, which in turn decreases the risk of perceptions and as a result may also increase the risk of being infected. As concerns protection as a preventive measure, attitudes vary. The traditionalists have argued that condom increased the possibility of promiscuity or fonication, while young and more modern people saw condom as something good. We may conclude that Somalis who have arrived in Western world and in Sweden as adults did never have a modern sexual education for themselves due to socio-cultural reasons and this has important implication for giving proper information to their children about sex organs, human sexual development and preventive measures against HIV/AIDS/STDs. These immigrant parents should be offered culturally sensitive communication and educational programmes aimed at raising their awareness about teenagers sexuality and the preventive measures against HIV/AIDS/STDs.

Acquired Immunodeficiency Syndrome↗

PubMed2005

Eliminating gender-based violence: learning from the widowhood practices elimination initiative of a women organisation in Ozubulu, Anambra State of Nigeria.

Gender-based violence has received increased international focus since after the International Conference on Population and Devlopment in Cairo 1994 and the Fourth World Conference on Women in Beijing in 1995. This paper reports the activities and outcome of a Christian women group initiative to eliminate dehumanising widowhood practices, a prevalent type of gender-based violence among the Igbos in Eastern Nigeria. Through in-depth interviews, group discussions, participant observations and membership records, information was elicited on the processes and outcome of the women group initiative. Evaluation was done using the community action cycle framework model for community mobilisation. The women group was able to identify and eliminate major dehumanising widowhood practices. Though women were the victims of violence, they were surprisingly also the perpetrators and astute enforcers of the practice, as well as those who vehemently opposed any form of change. Superstitious beliefs and associated fears were major reasons for opposition to change. Women can play key and effective roles in eliminating gender-based violence and in initiating and implementing programmes that guarantee their reproductive and human rights. They should, therefore, be strengthened and encouraged to champion issues that affect their well-being.

Bereavement↗

PubMed2002

Successful strategies for serving diverse populations.

Unique insights of key delivery staff and successful delivery strategies used to overcome cultural barriers were obtained through intensive interviews with fifty staff members. Participants in the study were identified as knowledgeable staff members by project coordinators. An open-ended qualitative methodology was used to interview staff members about barriers they faced in delivering services to new populations and strategies that were used to address these barriers. Fifty interviews were completed. Of those, forty-two interviewees were frontline staff members and eight were "hands-on" administrators. Fifteen of these staff members worked in programs that were targeted to urban dwelling Latino families and ten served urban African-Americans. Of the twenty-five staff members who worked in programs targeted to rural populations, eight worked to provide respite to African-American families while four served rural Latinos. The remaining thirteen interviewees served rural families of all ethnic groups. Interviews were tape recorded for accuracy and later transcribed. Emergent themes include: successful vs. unsuccessful service efforts, diversity of caregivers within ethnic groups, staff members' perceptions of their clients, staffing patterns, cultural views of Alzheimer's disease, service use in general, and government assistance. Concrete examples from staff members' experiences are used to illustrate these themes.

Black or African American↗

PubMed2006

Clinicians' responses to abnormal vital signs in an emergency department.

The importance of observing patient vital signs in emergency department (ED) practice has been stressed in the literature. Failure of clinicians to respond to abnormal vital signs (AVS) has been described as a potential reason for delayed management in ED practice, with a likelihood of increased morbidity. This study aimed to explore and describe clinicians' responses to AVS in a busy ED. A qualitative descriptive approach was used with three focus groups being conducted with 18 volunteer registered nurses (RNs) and medical officers (MOs) who worked in the ED of an area health service in Western Sydney. Transcribed focus group interviews were analysed using a process of constant comparison and contrast and a description of clinicians' responses to AVS written. An analysis of text from focus groups revealed three main categories of clinicians' responses to AVS: identification, reporting and implementing action. Clinicians in this study recognised, reported and acted on AVS. However, delays in responding to AVS occurred due to a variety of reasons. The main reasons identified were issues with documentation and the ability to seek advice of appropriate staff, ineffective communication, fear of reprimand, inexperience of working in EDs, workload, distractions and interruptions. In conclusion, environmental and human factors contribute to inappropriate delays regarding AVS in the ED. These factors can be acted on by initiating appropriate education programmes and establishing improved communication networks. Better use of the existing medical emergency team (MET) in the ED can act to alleviate situations associated with delays in managing AVS.

Adolescent↗

PubMed1998

Maintaining Vegetarian Diets Personal Factors, Social Networks and Environmental Resources.

This study was designed to investigate factors influencing the maintenance of a vegetarian diet. An interpretivist approach and qualitative research methods were used in the study design. Nineteen vegetarians from a metropolitan area in Western New York State were purposefully recruited using snowball sampling to participate in in-depth interviews. Respondents varied in age, gender and type and duration of vegetarian diet, although the sample was predominantly middle-aged, middle-class and female and had ties to community groups. Interview transcripts were analyzed using the constant comparative method of qualitative data analysis. The maintenance of vegetarian diets was supported by personal factors, social networks and environmental resources. Personal factors included: internal beliefs, skills and habits and physical feedback. Social networks included: organized vegetarian groups as well as animal rights, environmental, or health groups supporting vegetarianism and vegetarian friends. Environmental resources, such as the availability of new vegetarian foods in supermarkets and restaurants, facilitated maintenance of vegetarian diets. Respondents perceived that society viewed vegetarianism as increasingly "mainstream," although diet-centred family conflicts were still common. These findings can assist dietitians in developing strategies for working with vegetarian clients by providing better understanding of personal, social and environmental supports for vegetarians' dietary behaviours.

Journal Article↗

PubMed2004

Measuring psychological well-being: insights from Thai elders.

PURPOSE: Psychological well-being, an important indicator of successful aging, may be conceptualized quite differently across cultures. Using a mixed-methods approach, we developed a measure of psychological well-being based on the indigenous expertise of Thai elders. DESIGN AND METHODS: Data were collected from older people in Thailand in four stages with staggered qualitative and quantitative methods: individual and focus group interviews (n = 67); a preliminary survey (n = 477); cognitive interviews (n = 30); and a second survey (n = 460). We analyzed the resulting psychological well-being items to identify their underlying factor structure and psychometric properties. RESULTS: Confirmatory factor analysis suggested that psychological well-being has two components: intrapersonal and interpersonal. The subscales for this measure have adequate reliability and validity. IMPLICATIONS: This research provides evidence for cultural variability in the nature of psychological well-being and highlights the importance of developing measures that are culturally relevant.

Aged↗

PubMed2002

The professional development portfolio process: setting goals for credentialing.

Professional Development Portfolio (PDP), the new credentialing system for dietetics professionals, places the responsibility for learning, professional development, and career direction on the individual practitioner. This study used questionnaires and focus group interviews to determine whether dietitians engage in reflection, self-assessment, and goal setting, the critical components of PDP recertification. Volunteers (n = 132) participated in 16 focus groups held during 8 state dietetic association meetings. Content analysis was conducted. Some subjects reflected using an informal non-structured process (42 text units), almost half (41%) performed annual self-assessments, and 25% set goals. Job availability, new practice areas, family obligations, and employer needs were key factors in goal formulation. Opportunities for self-direction, independent decision-making, and application of technical expertise were also considered in career choices and goal setting. Although few participants were currently performing PDP critical components, we conclude dietetic practitioners can gain the necessary skills for professional development with the newly available PDP Guide to support the portfolio process. We recommend that dietitians (a) allow sufficient time for the reflection process, including the use of additional tools; (b) develop personal mission statements to drive the goal-setting process; and (c) use effectiveness criteria to critique their goals.

Career Mobility↗

PubMed2006

Learners' decisions for attending Pediatric Grand Rounds: a qualitative and quantitative study.

BACKGROUND: Although grand rounds plays a major educational role at academic medical centers, there has been little investigation into the factors influencing the learners' decision to attend. Greater awareness of attendees' expectations may allow grand rounds planners to better accommodate the learners' perspective, potentially making continuing education activities more attractive and inviting. METHODS: We used both qualitative (part A) and quantitative (part B) techniques to investigate the motivators and barriers to grand rounds attendance. Part A investigated contextual factors influencing attendance as expressed through attendee interviews. Transcripts of the interviews were analyzed using grounded theory techniques. We created a concept map linking key factors and their relationships. In part B we quantified the motivators and barriers identified during the initial interviews through a survey of the grand rounds audience. RESULTS: Sixteen persons voluntarily took part in the qualitative study (part A) by participating in one of seven group interview sessions. Of the 14 themes that emerged from these sessions, the most frequent factors motivating attendance involved competent practice and the need to know. All sessions discussed intellectual stimulation, social interaction, time constraints and convenience, licensure, content and format, and absence of cost for attending sessions. The 59 respondents to the survey (part B) identified clinically-useful topics (85%), continuing education credit (46%), cutting-edge research (27%), networking (22%), and refreshments (8%) as motivators and non-relevant topics (44%) and too busy to attend (56%) as barriers. CONCLUSION: Greater understanding of the consumers' perspective can allow planners to tailor the style, content, and logistics to make grand rounds more attractive and inviting.

Adult↗