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Relationship between preferences for decisional control and illness information among women with breast cancer: a quantitative and qualitative analysis.

This study examined relationships between cancer patients' preferences for involvement in making treatment decisions and preferences for information about diagnosis, treatment, side effects, and prognosis. Participants were 35 women with stage I and II breast cancer recruited from two medical oncology and radiation oncology clinics. Following administration of card sort measures of preference for involvement in treatment decision making and information needs, a semi-structured interview was conducted to provide patients with an opportunity to elaborate on their role preferences and health care experiences. Results showed that patients who desired an active role in treatment decision making also desired detailed information. This relationship was not as clear for passive patients. Relative to passive patients, active patients desired significantly more detailed explanations of their diagnosis, treatment alternatives, and treatment procedures. Active patients also preferred that their physicians use the words 'cancer' or 'malignancy' when referring to their illness while passive patients preferred that their physicians use a eupheumism. Further research is needed to critically detail the advantages and disadvantages of the active and passive roles and their impact on disease progression and psychological well-being.

Adult↗

New meanings: a qualitative study of change in nursing education.

This paper reports on the experiences of teachers in one college of nursing and midwifery in South East England during a period of profound and complex change. Personal perceptions and reactions are studied in the context of professional organizational influences. A phenomenological approach was used to identify and portray the personal perspectives and meanings of the respondents. Fifty semi-structured interviews with a purposeful sample of the college staff were supplemented with participant observation and documentary analysis. The data were analysed inductively, and emergent categories were confirmed and clarified through respondent validation. Findings relating to organizational, professional and personal perceptions are presented alongside the major themes of belonging, knowing and controlling. The conclusions and implications of this exploratory study are discussed, together with aspects of the researcher's role and areas for future research.

Education, Nursing↗

Student supervision: myth or reality?

This paper is based on the early findings of a qualitative longitudinal study using a grounded theory approach to analysis. A cohort of Project 2000 students and their clinical supervisors were observed in 10 different ward settings and interviewed prior to leaving the setting. A non-participant observation technique was utilized, noting the students' interactions with their deemed supervisors. The students and the supervisors were then interviewed using a semi-structured question format to explore supervision issues. The findings suggest that both students and supervisors in the study believe that supervision is an important learning strategy. However, what is believed in theory would not always appear to hold true in practice. The study identifies a limited knowledge by the supervisors of the skills and models of supervision, indicating the need for greater role preparation and a more clearly defined role specification. Supervision tended to focus upon tasks rather than issues. Furthermore, the role conflicts experienced by the supervisors was perceived as inhibiting facilitation of student learning. It is recommended that, for supervision to be more effective within the present operational constraints, it should utilize a more problem-solving approach, thus encouraging critical reflection on practice.

Adolescent↗

Development and evaluation of patient-centred polygenic risk score reports for glaucoma screening.

BACKGROUND: Polygenic risk scores (PRS), which provide an individual probabilistic estimate of genetic susceptibility to develop a disease, have shown effective risk stratification for glaucoma onset. However, there is limited best practice evidence for reporting PRS and patient-friendly reports for communicating PRS effectively are lacking. Here we developed patient-centred PRS reports for glaucoma screening based on the literature, and evaluated them with participants using a qualitative research approach. METHODS: We first reviewed existing PRS reports and literature on probabilistic risk communication. This informed the development of a draft glaucoma screening PRS report for a hypothetical high risk individual from the general population. We designed three versions of the report to illustrate risk using a pictograph, a pie chart and a bell curve. We then conducted semi-structured interviews to assess preference of visual risk communication aids, understanding of risk, content, format and structure of the reports. Participants were invited from an existing study, which aims to evaluate the clinical validity of glaucoma PRS among individuals > 50 years from the general population. Numeracy and literacy levels were assessed. RESULTS: We interviewed 12 individuals. The cohort was highly educated (42% university education), all were European and 50% were female. Numeracy (mean 2.1 ± 0.9, range 0 to 3), graph literacy (mean 2.8 ± 0.8, range 0 to 4) and genetic literacy (mean 24.2 ± 6.2, range - 20 to + 46) showed a range of levels. We analysed the reports under three main themes: visual preferences, understanding risk and reports formatting. The visual component was deemed important to understanding risk, with the pictograph being the preferred visual risk representation, followed by the pie chart and the bell curve. Participants expressed preference for absolute risk in understanding risk, along with the written content explaining the results. The importance of follow-up recommendations and time to glaucoma onset were deemed important. Participants expressed varied opinions in the level of information and the colours used, which informed revisions of the report. CONCLUSIONS: Our study revealed preferences for reporting PRS information in the context of glaucoma screening, to support the development of clinical PRS reporting. Further research is needed to assess PRS communication in other groups representative of target populations and with other target audiences (e.g. referring clinicians), and its potential psychosocial impact in the wider community.

Humans↗

Quality of life in long-stay institutions in England: nurse and resident perceptions.

Quality of life (QOL) of older persons living in institutions is a critical consideration in international economic policies and health care decisions. Yet, there is little relevant research to support decisions about culturally acceptable and effective nursing care for this population. This qualitative study explored and compared perceptions of older residents and nurses in three long-stay institutions in south-west England. It addressed issues viewed as important to a good QOL for residents and ways in which nurses promote QOL. A convenience sample of 10 residents aged 65 and older (80% female) and nine nurses (n = five registered general nurses and four enrolled nurses) were interviewed using a semi-structured schedule. Interview data were analysed using an analytic induction method of content analysis. While theme frequency and examples differed, themes common to both residents and nurses were individuality, professionalism, connectedness, and physical functioning. Resident responses tended to be personal, succinct, and sometimes negative. Nurses' responses were more positive, detailed, and reflective of general professional responsibilities. Implications for nursing education, research, and practice are discussed. Improvement in QOL will be addressed differently based on social and cultural settings. However, there may be commonalities that are applicable across cultures.

Adult↗

A Qualitative Analysis of Cancer Survivors' Experience in a Time-Restricted Eating vs Control Clinical Trial to Address Cancer-Related Fatigue.

PURPOSE: To describe cancer survivors' lived experiences in a clinical trial that tested an individualized nutrition counseling with or without time-restricted eating to address cancer-related fatigue. METHODS: The Fatigue REDuction After cancer study was a two-arm, randomized controlled trial. Participants were adult cancer survivors who were 2 months to 2 years post-treatment. All participants received individualized nutrition counseling; those in the time-restricted eating group self-selected a consistent 10-hour eating window for 12 weeks. After the study, semi-structured exit interviews were conducted to gauge participants' experiences in the trial. Interviews were transcribed and two independent coders thematically analyzed the interviews using inductive and deductive coding. NVivo software was used for data organization and analysis. RESULTS: Participants (n = 24; TRE = 11; Control = 13) were 55 ± 13 years old, 75% were female, and they had a variety of cancer types. The majority of participants found that being in the study helped them to set and achieve lifestyle goals and would therefore recommend the study to others. Participants in the time-restricted eating group noted that time-restricted eating helped them set a better routine, providing a positive sense of control. However, some noted difficulty switching to a 14-hour fasting schedule, as it can interfere with their regular routine or employment schedules. Many participants noted they were happy that cancer-related fatigue was gaining more attention, hoping to find solutions for persistent cancer-related fatigue. CONCLUSION: The majority of participants found the study useful and, regardless of their group assignment or the intervention's impact on their fatigue, found the study helped them to gain better control of their dietary habits.

Humans↗

Child and adolescent psychiatry placement in specialist psychiatric training: a regional study.

Before beginning higher professional training in one of the subspecialties, all psychiatry trainees must complete a general professional psychiatric training. At this stage, some but not all will undertake a clinical placement in child and adolescent psychiatry. Fifty-seven trainees who had completed one of the 15 child and adolescent psychiatry placements in a Regional Health Authority, took part in a semi-structured telephone interview. The trainees were asked to compare the child and adolescent psychiatry placement with a general adult psychiatry placement with respect to the training received in a number of areas. These areas were considered to be important to psychiatrists of all future subspecialties and included: assessment, communication, psychological interventions and psychological theories. In addition, subjects were asked about their general professional training as a whole and the role that child and adolescent psychiatry placements should play. The interview included quantitative and qualitative components. The findings suggest that child and adolescent psychiatry placements can make a significant contribution to a number of important areas of general professional development and that there would be considerable support for strengthening the role of such placements in psychiatry training.

Adolescent Psychiatry↗

Underrepresented populations in genomic research: a qualitative study of researchers' perspectives.

BACKGROUND: The lack of diversity in genomic data limits researchers' ability to investigate the relationships between genetic profiles, disease manifestations, and responses to new therapies. As a result, innovations in treatment could have potentially harmful effects on a significant portion of the population due to incomplete or inaccurate genomic data. In addition, the lack of harmonization in the use of population descriptors in genomic studies raises both ethical and scientific concerns regarding which descriptors should be used to study and recruit underrepresented populations. Therefore, understanding the factors contributing to the lack of diversity in genomic research is an urgent scientific, clinical, and public health priority. This study aims to explore the social and contextual factors influencing the participation of underrepresented populations in genomic research, from the perspective of researchers in the field. METHODS: A total of 13 semi-structured interviews were conducted with researchers experienced in genomic research in Canada and fluent in either French or English. The interview transcripts were analyzed using thematic analysis. RESULTS: Researchers identified several factors contributing to the low participation of underrepresented populations in genomic research, with one key factor being the geographic distribution of research institutions and the disconnect between research efforts and the communities being studied. To address this issue, participants stressed the importance of moving away from colonial practices, such as conducting research on a community without consulting its members in the design phase. Furthermore, it was suggested that existing diversity, equity, and inclusion policies alone were insufficient to effectively address the challenge. Lastly, the study also highlighted a potential link between how study populations are categorized and the willingness of underrepresented groups to participate in genomic research. CONCLUSION: Although researchers are generally aware of the literature on the causes, consequences, and potential solutions for increasing participation, confusion remains regarding the use of population descriptors. Our findings highlight the need for improved education, greater consensus, and expanded dialogue within the genomic research community to promote the harmonization of population descriptors.

Humans↗

Oral health and health related behaviours among three-year-old children born to first and second generation Pakistani mothers in Bradford, UK.

Many young Muslim children whose families originated from the Indian sub-continent have poorer levels of oral health than their indigenous White peers, but it is unclear whether and to what extent subsequent generations may be similarly disadvantaged. This study aimed to compare dental health and associated behavioural attributes among United Kingdom-born three-year-old children of first and second generation Pakistani Muslim mothers resident in areas of social deprivation in Bradford, West Yorkshire. Multi-lingual interviews completed a home-based, semi-structured questionnaire, and a dental examination was conducted at a subsequent visit on 226 children, 117 with Pakistan-born mothers and 109 born in the UK. When the two generation groups were compared, no differences were observed in infant feeding practices, oral hygiene routines or dental attendance patterns, in mothers' attendance at ante-natal classes, or their knowledge of caries prevention. However, a higher proportion of UK-born mothers were able to speak English and reported that they had attended a dentist themselves, had received advice there, and were better informed of categories exempt from dental charges. A 24-hour retrospective qualitative dietary recall indicated that children of UK-born mothers consumed, on average, more frequent intakes of foods classified in the 'bread and cereal' group and of sweet drinks at meal times. While there were no significant differences in the proportion who were cavity free, children of UK-born mothers had higher mean caries experience (dmft=2.30) compared with those of Pakistan-born mothers (dmft=1.38). It was concluded that the total burden of dental caries experience among a subsequent generation of Pakistani children was higher than that of the previous generation. Poor dental health is likely to remain a challenge in this community for the foreseeable future.

Adult↗

Cognitive factors influencing women to seek care during pregnancy.

To assess the relationship of cognitive factors to a pregnant woman's decision to seek prenatal care, a semi-structured interview instrument was administered to 30 women soon after they were seen for care. A content analysis of interview transcripts was performed to identify variables affecting the decision to seek care. Variables were coded numerically, and those correlated with number of weeks gestation at first visit for pregnancy care were entered into a stepwise linear multiple regression model. Three variables accounted for 74% of the variance in the week of gestation at which pregnancy care began. Women who desired the pregnancy, wished confirmation of the pregnancy, and experienced pregnancy-related symptoms tended to seek care earlier. Results were discussed in terms of the usefulness of this integration of quantitative and qualitative methods for the study of factors related to seeking pregnancy care and the need to consider cognitive factors when designing programs to improve the delivery of prenatal care.

Adolescent↗

'Breathtaking': the consequences of chronic respiratory disorder.

Chronic obstructive airways disease (COAD) is a major, though neglected, medical and social problem in the United Kingdom today. Dyspnoea is one of the most distressing and disabling symptoms of COAD, which is itself the largest single cause of absence from work in the United Kingdom. This paper reports on 92 patients suffering from COAD, who were interviewed in order to assess impairment, disability and handicap, and a smaller subsample of 24 of these patients who were followed-up using open-ended, semi-structured, tape-recorded interviews in order to cover in more detail some of the issues raised in the first quantitative stage of the study. Low correlations were found between lung function and disability (-0.38 p less than 0.001), accounting for only 14% of the variance, and high correlations between measures of dyspnoea and disability (-0.90 p less than 0.001). Major areas of disability and handicap included: household management, ambulation, sleep and rest, recreation and pastimes, and work. Financial problems and difficulties, housing problems and problems of social isolation were also frequently reported. The paper then attempts to explore the relationship between impairment, disability and handicap, drawing on both the quantitative and qualitative data collected in order to illustrate the variable nature of this relationship. The paper concludes by suggesting both the need for a more integrated approach to the care and rehabilitation of COAD patients and their families, and for a complementary social perspective and approach to COAD and its treatment.

Activities of Daily Living↗

A Qualitative Study of the Roles and Responsibilities of Academic and Journalistic Publishing in Social and Behavioral Genomics.

The conduct and translation of scientific research is shaped by academic and journalistic publishing. Academic journals issue editorial guidelines and policies that inform how researchers shape and present their studies. Journalists select and report on academic studies for public audiences. Despite the potential importance of journal editors and journalists in the scientific process, little has been done to examine how these groups think about their roles and responsibilities-especially when it comes to ethically sensitive scientific domains like social and behavioral genomics (SBG): the study of whether and how genetic differences between individuals correlate with differences in behaviors such as aggression and outcomes such as educational attainment. To begin filling this gap, we conducted semi-structured interviews with editors working at academic journals that publish SBG research (n = 10) and journalists who have reported on SBG studies (n = 13). Journal editors largely saw themselves as mediators between authors and peer reviewers who help to shepherd along research. Journalists frequently described themselves as translators of science for wide audiences; at times they also saw themselves as interrogators of science. While both groups considered SBG especially ethically sensitive and prone to risks such as misinterpretation, many expressed that systematic ethical review processes and guidelines for SBG are lacking. Further, many deferred the ethical responsibility to minimize risks associated with SBG to others. Our findings highlight the need for more explicit frameworks in academic and journalistic publishing to support the ethically responsible conduct and communication of SBG.

ELSI↗

Teaching caring to nursing students.

This article reports on phenomenological research designed to discover how caring was taught in a nursing education program. The basic questions were: 1) What is the meaning of caring to the faculty and students; 2) How do the faculty communicate this meaning to the students; and 3) How does this meaning shape the experience of the students? Data were collected from a small associate degree nursing program using: a) semi-structured interviews with all faculty and a selected group of students, b) classroom observations, and c) review of documents. Data were analyzed for and found to have content explaining the meaning of caring, how caring was being taught, and what students were learning about caring as the essence of nursing. Implications derived speak to the need for faculty and administrators to have caring as a way of being if they wish to communicate caring as the essence of nursing to students.

Altruism↗

Psychiatric outcome of termination of pregnancy for foetal abnormality.

Termination of pregnancy for foetal abnormality has become frequent with the increasing sophistication of techniques of antenatal diagnosis. The aim of this study was to obtain quantitative and qualitative information about psychiatric morbidity in women after termination of pregnancy for foetal abnormality. Two samples of women were compared. The first consisted of 71 women who had had a termination of pregnancy for foetal abnormality (FA group). The second consisted of 26 women who had experienced so-called missed abortion (MA group). Both groups had lost a pregnancy in the mid-trimester of pregnancy, but the MA group had no element of choice. Standardized psychiatric and social measures were used to assess both groups on three occasions after the termination. In both groups, 4 weeks after the termination psychiatric morbidity was high (four to five times higher than in the general population of women), and social adjustment was impaired. Six months and 12 months after the abortion, levels of psychiatric morbidity were near normal. Semi-structured interviewing was used to obtain information about the experience of grief after mid-trimester termination. For many women, symptoms of grief persisted throughout the year. These symptoms included typical features of grief as well as grief symptoms specific to pregnancy loss. The findings have implications for the counselling of women after termination for foetal abnormality or after missed abortion.

Abortion, Eugenic↗

Development and pilot testing of a prostate cancer polygenic risk report.

BACKGROUND: Polygenic risk scores (PRS) are increasingly being incorporated into clinical care, yet optimal strategies for communicating PRS results to patients and clinicians remain undefined. Effective report design is critical to ensure comprehension and appropriate use, particularly for complex conditions such as prostate cancer where screening decisions are nuanced. We developed and pilot tested patient-facing materials to communicate integrated polygenic and monogenic risk for prostate cancer in the context of a randomized clinical trial. METHODS: We designed a summary report and accompanying Frequently Asked Questions (FAQ) page to communicate prostate cancer genetic risk within the Prostate Cancer, Genetic Risk, and Equitable Screening Study (ProGRESS). Materials were developed through an iterative, multidisciplinary process informed by existing literature on genomic risk communication. We conducted semi-structured interviews with a national sample of eight men eligible for prostate cancer screening to evaluate comprehension, interpretation of visual elements, perceived usefulness, and preferences for improvement. Interviews were transcribed and analyzed using reflexive thematic analysis. RESULTS: Participants generally found the summary report and FAQ page understandable and visually engaging. Graphical displays of absolute risk, particularly pictograph arrays, facilitated comprehension and helped contextualize risk. Visual cues such as color and bold formatting effectively directed attention to key information, with red coloring perceived as particularly salient for high-risk results. In contrast, more complex visualizations, including bell curves and incidence curves, were frequently misunderstood or not interpreted as intended. Participants expressed a desire for clearer guidance regarding next steps and additional accessible information, suggesting supplementary resources such as hyperlinks or QR codes. Concerns about readability included small font size and high text density. CONCLUSIONS: In this qualitative pilot study, patient-facing materials for communicating prostate cancer PRS were generally well received, with specific design features such as simple visualizations and clear formatting enhancing understanding. Findings highlight the importance of intuitive risk displays and actionable guidance in PRS reporting. These results provide practical insights to inform the design of genomic risk reports as PRS-based prostate cancer screening approaches move toward clinical implementation. TRIAL REGISTRATION: ClinicalTrials.gov NCT05926102; date of registry: July 3, 2023.

Aged↗

Toward personalized interventions for preventing depression in primary care: Qualitative and quantitative findings from the e-predictD pilot study.

BACKGROUND: The predictD intervention, delivered by family physicians (FPs), has demonstrated effectiveness and cost-efficiency in preventing depression and anxiety. The e-predictD study aims to design, develop, and evaluate a novel personalized intervention for depression prevention by integrating information and communication technologies (ICTs), risk prediction algorithms, and decision support systems (DSS) for both patients and FPs. OBJECTIVE: To evaluate the satisfaction, usability, and acceptability, of a beta version of the e-predictD intervention in primary care settings. METHODS: The e-predictD intervention follows a biopsychosocial approach, including an initial patient-FP interview, specific FP training, and an app. A β-version was tested in a pilot study without a control group over three months. The app integrates a validated depression risk prediction algorithm, decision algorithms, and a monitoring system supporting the DSS. The DSS generates a personalized prevention plan (PPP) from eight intervention modules: physical exercise, social relationships, problem-solving, communication skills, decision-making, assertiveness, sleep improvement, and cognitive restructuring. Patients and FPs discussed the PPP in a 15-minute baseline interview, selecting modules for implementation over three months. Semi-structured interviews gathered feedback. Assessments included depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12), and major depression risk (predictD algorithm). RESULTS: Six FPs from six Spanish cities enrolled 56 non-depressed patients at moderate-to-high risk of depression; 47 (84%) completed follow-up. The app was used for a median of six days (interquartile range: 1-30). Both FPs and patients expressed satisfaction, leading to incorporated improvements. After three months, significant reductions in major depression risk and anxiety symptoms were observed, alongside improved mental quality of life. However, no significant changes were found in depressive symptoms or physical quality of life. CONCLUSION: This pilot study supports the feasibility and acceptability of the e-predictD β-version, despite lower-than-expected app usability. Health improvements were observed, warranting confirmation in a randomized controlled trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT03990792.

Adult↗

Nurses' definitions of and attitudes towards euthanasia.

A major impetus for this study was recent literature that assumed that nurses' definitions of euthanasia and consequent opinions on decision making are unproblematic. The purpose of this study was to identify nurses' definitions of and attitudes towards euthanasia. Ten semi-structured interviews were conducted with nurses working in a variety of clinical practice settings. The majority of nurses could distinguish between active and passive euthanasia, but it was only in terms of active euthanasia that the debate was seen as significant. It was considered that the term passive euthanasia, particularly in relation to withdrawal of treatment, has served to confuse the real debate centring around active euthanasia. Only two participants were in favour of active euthanasia, but emphasized the need for 'a community of shared responsibility' in decision making. The major finding of the study was the commitment of all participants to caring for and ensuring the comfort of the dying patient. The concepts of ordinary and extraordinary forms of treatment and heroic measures were seen as worthy of debate in the context of dying with dignity rather than of euthanasia. There was an associated aversion to inappropriate heroic measures, which were perceived as prolonging death and interfering with 'dying with dignity'. The development of a personal and moral/ethical stance (in relation to euthanasia) was shown to be an evolving process embedded in a caring philosophy and emphasizing the contextual nature of providing appropriate care.

Adult↗

Caregiver experiences after the death of a person with dementia with Lewy bodies: A mixed-methods analysis.

BackgroundDementia with Lewy bodies (DLB) is a common degenerative dementia, but no studies investigate bereaved caregiver experiences.ObjectiveTo investigate the experiences of caregivers three months after the death of persons with DLB using a mixed-methods approach.MethodsDyads of individuals with moderate-advanced DLB and their primary informal caregivers were followed prospectively every 6 months until the person with DLB died. Caregivers completed a study visit with questionnaires and a semi-structured interview ∼3 months later. Spearman correlation coefficients and Wilcoxon rank-sum tests evaluated the relationships of post-death measures with pre-death patient and caregiver variables. Thematic analysis was used to analyze the interviews.ResultsSeventy-three caregivers completed visits (mean 3.5 months post-death). Most of the caregivers were women (82.2%) and spouses (76.7%) or adult children (17.8%). Over 40% had scores indicating risk for clinical depression. Post-death caregiver experiences (depression, quality of life, grief, resilience) correlated with pre-death caregiver experiences. Post-death experiences did not associate with patient characteristics, disease-related symptoms, or healthcare services used in the last 6 months of life. Trajectories for caregiver measures from pre- to post-death visits varied widely. Interview themes included grief and sadness, anger, guilt and regret, relief, appreciation/gratitude, and adjusting to a new normal.ConclusionsThe finding that pre-death caregiving experiences have the strongest association with post-death experiences emphasizes the critical importance of accessible and evidence-based caregiver support before and after the death of a person with DLB. Research is needed to develop interventions for current and bereaved caregivers of individuals with DLB.Trial registration informationNCT04829656 (submitted 2021-03-22).

Caregivers↗