Buiting, Hilde M; Willems, Dick L; Pasman, H Roeline W; Rurup, Mette L; Onwuteaka-Philipsen, Bregje D
There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant. To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant. We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation. Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions. Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further
Buiting, Hilde M.; Willems, Dick L.; Pasman, H. Roeline W.; Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.
There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated
Booij, Suzanne J; Rödig, Verena; Engberts, Dick P; Tibben, Aad; Roos, Raymund A C
In the literature there are few reports on euthanasia or physician-assisted suicide (PAS) or other matters concerning the end-of-life in patients with Huntington's disease (HD), although clinical experience suggests these issues do arise. To obtain in-depth information about patients' thoughts on and attitudes to euthanasia, PAS and the use of advance directives in HD. To assess the difficulties patients encounter when thinking about end-of-life wishes. Semi-structured in-depth interviews with 14 unselected HD patients from our out-patient clinic based on a topic list. Qualitative analysis of the interviews based on grounded theory. We identified three patterns in our group of respondents: patients with distinct wishes, with general wishes and ideas and patients with no wishes. The most important frame of reference regarding end-of-life wishes in HD patients or known gene carriers is the experience with an affected parent. Family is important when thinking about the end of life and advance directives, even more so than the patient's physician. Knowledge about the (requirements of) law is limited. The majority of interviewees expressed some kind of wish regarding end of life, probably more than they had revealed to their physician, but were sometimes hesitant to discuss it. Knowledge on how to deal with wishes, advance directives and response shift is limited. In general, patients underestimate the requirement for sound professional support when considering euthanasia or PAS and the value of an advance directive. In an attempt to improve knowledge and communication about end-of-life issues, physicians should ask the patient directly about their wishes.
Pasman, H.R.W.; Willems, D.L.; Onwuteaka-Philipsen, B.D.
Objective: Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. Methods: In-depth interviews with nine patients whose EAS request was refused and seven physicians of these
Karlsson, Marit; Milberg, Anna; Strang, Peter
Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
Norwood, Frances; Kimsma, Gerrit; Battin, Margaret P
One enduring criticism of the Dutch euthanasia policy is the 'slippery slope' argument that suggests that allowing physicians to conduct legal euthanasia or assisted suicide would eventually lead to patients being killed against their will. What we currently know about euthanasia and its practices in The Netherlands is predominantly based on retrospective quantitative or interview-based studies, but these studies fail to detail the mechanisms of day-to-day practice. To examine the practices that surround euthanasia, particularly among vulnerable patients, using qualitative observation-based data. A 15-month qualitative, observation-based study of home death and general practice in the greater Amsterdam region of The Netherlands. Study included observation and interviews with a sample of 15 (GPs and 650 of their patients, 192 of whom were living with terminal or life-threatening illness (with and without requests for euthanasia). Euthanasia practice typically involves extensive deliberations, the majority of which do not end in a euthanasia death. Euthanasia discussions or 'euthanasia talk' share at least two consequences: (i) the talk puts the onus on patients to continue discussions towards a euthanasia death and (ii) there is a socio-therapeutic component, which tends to affirm social bonds and social life. While this qualitative evidence cannot disprove existence of abuse, it suggests that euthanasia practices have evolved in such a way that patients are more likely to talk about euthanasia than to die a euthanasia death.
Chapple, A; Ziebland, S; McPherson, A; Herxheimer, A
Objective To explore the experiences of people with a “terminal illness”, focusing on the patients' perspective of euthanasia and assisted suicide. Method A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non‐malignant. Results That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. Conclusion Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. PMID:17145910
Chapple, A; Ziebland, S; McPherson, A; Herxheimer, A
To explore the experiences of people with a "terminal illness", focusing on the patients' perspective of euthanasia and assisted suicide. A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a "terminal" illness, malignant or non-malignant. That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death.
Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc
Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662
Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc
Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Large scale, retrospective study. General practice in Belgium. A retrospective mortality study was performed in 2005-2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met.
Cuervo Pinna, M Á; Rubio, M; Altisent Trota, R; Rocafort Gil, J; Gómez Sancho, M
The decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain). A qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated. No other focus group was required due to saturation. The sessions were tape recorded and transcribed by two experts in qualitative methodology. Atlas.ti software was used for the analysis. We were advised by the "Health Care at the end of life" Group of the Organizacion Médica Colegial of Spain. Terminological confusion was verified in: 1) The mixture of etymological, functional and social concepts, 2) the term Passive Euthanasia, 3) the association between euthanasia and physician assisted suicide, 4) the confusion with the equivalent "wish to hasten death", and 5) the difficulty of differentiating sedation with Euthanasia. There was consensus on some aspects: a) Full voluntariness, b) the condition of terminal illness, and c) the condition of unbearable symptoms. Conceptual variability persists in relation to the concept of Euthanasia, and is particularly noticeable in the persistence of the concept of passive euthanasia. It would be desirable to achieve a common language to assign a precise meaning to these words to help doctors in their professional practice. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.
The problem of euthanasia emerges again and again in today's Europe. The Dutch type of regulation of euthanasia could be introduced into the Hungarian legal system. Today, in Hungary, the ethical guidelines of the chamber of medicine, the criminal law and the administrative health law also forbid active euthanasia. In Hungary, the criminal code reform of 2012 missed to liberalise the regulation of euthanasia. Such liberalisation awaits bottom-up support from the part of the society. In Europe, active euthanasia is legal only in the Netherlands, Belgium, Luxemburg and Switzerland. In Hungary, a passive form of euthanasia is legal, i.e. a dying patient may, under strict procedural circumstances, refuse medical treatment. The patient is not allowed to refuse medical treatment, if she is pregnant and foreseeably capable to give birth to her child.
Brock, D W
The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release...
Meeussen, Koen; Van den Block, Lieve; Bossuyt, Nathalie; Echteld, Michael; Bilsen, Johan; Deliens, Luc
In many countries, physicians are confronted with requests for euthanasia. Notwithstanding that euthanasia is legally permitted in Belgium, it remains the subject of intense debate. To gather in-depth empirical data on how general practitioners (GPs) deal with these requests in Belgium. Mortality follow-back study in 2005-2006 via the nationwide Sentinel Network of General Practitioners. Standardized face-to-face interviews were conducted with GPs for all the reported patients who did not die suddenly or totally unexpectedly at home, as judged by the GP. We conducted 205 interviews. Of these, 27 patients had at some point expressed a wish to receive a drug administered by a physician with the explicit intention to end life, that is, euthanasia. Thirteen of these formulated their requests explicitly and repeatedly, according to their GP. Compared with patients who expressed a wish but not an explicit/repeated request for euthanasia, those patients' requests were more often documented (8 of 13 vs. 2 of 14; P=0.01), and reiterated until their final days of life (6 of 13 vs. 0 of 14; P=0.02). Five patients received euthanasia. For the other 22 patients, GPs gave different reasons for not acceding to the request, often related to criteria stipulated in the Belgian law on euthanasia, and sometimes related to personal reasons. It is not uncommon for patients to ask their GP for euthanasia, although explicit requests remain relatively rare. Requests tend to vary widely in form and content, and far more are expressed than complied with. For many GPs, the Belgian law on euthanasia serves as a guiding principle in this decision-making process, although in a minority of the cases, a GP's personal opinion toward euthanasia seems to be decisive. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Brock, D W
The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release the dying patient from otherwise prolonged suffering and agony. Potentially bad consequences of permitting euthanasia include the undermining of the "moral center" of medicine by allowing physicians to kill, the weakening of society's commitment to provide optimal care for dying patients, and, of greatest concern, the "slippery slope" argument. The evaluation of the arguments leads to support for euthanasia, with its performance not incompatible with a physician's professional commitment.
Lavery, J V; Boyle, J; Dickens, B M; Maclean, H; Singer, P A
Euthanasia and assisted suicide, and policies to address them are the subjects of contentious debate in many countries. However, the question of why people desire euthanasia or assisted suicide has not been coherently answered. We aimed to answer this question in a specific group of patients. We did a qualitative study of 32 people with HIV-1 or AIDS, who were enrolled in the HIV-1 Ontario Observational Database at Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. We elicited participants' experiences of deliberation about euthanasia or assisted suicide, and the meaning of these experiences with in-depth, face-to-face interviews. We analysed our data with grounded theory methods. Participants' desire for euthanasia and assisted suicide were affected by two main factors: disintegration, which resulted from symptoms and loss of function; and loss of community, which we defined as progressive diminishment of opportunities to initiate and maintain close personal relationships. These factors resulted in perceived loss of self. Euthanasia and assisted suicide were seen by participants as means of limiting loss of self. These determinants of desire for euthanasia or assisted suicide in people with HIV-1 or AIDS have implications for the debate on these practices, and development of policies to regulate them.
Kouwenhoven, Pauline S C; Raijmakers, Natasja J H; van Delden, Johannes J M; Rietjens, Judith A C; van Tol, Donald G; van de Vathorst, Suzanne; de Graeff, Nienke; Weyers, Heleen A M; van der Heide, Agnes; van Thiel, Ghislaine J M W
The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive (AED) when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia. In this qualitative study, 16 medical specialists, 19 general practitioners, 16 elderly physicians and 16 members of the general public were interviewed and asked for their opinions about a vignette on euthanasia based on an AED in a patient with advanced dementia. Members of the general public perceived advanced dementia as a debilitating and degrading disease. Physicians emphasized the need for direct communication with the patient when making decisions about euthanasia. Respondent from both groups acknowledged difficulties in the assessment of patients' autonomous wishes and the unbearableness of their suffering. Legally, an AED may replace direct communication with patients about their request for euthanasia. In practice, physicians are reluctant to forego adequate verbal communication with the patient because they wish to verify the voluntariness of patients' request and the unbearableness of suffering. For this reason, the applicability of AEDs in advanced dementia seems limited.
In the introduction the author defines different kinds of euthanasia (active, passive, indirect, assisted suicide etc). Some concepts were discussed: value of human life, humanity and the autonomy of a person. In the next chapter the author presents the standpoints on the forced end of life in different societies, from ancient Greece and medieval opinions to recent results of research in the USA, England, Germany, the Netherlands and Australia. In the third chapter – Legislation related to th...
Matthew R. Hunt BSc (PT, PhD
Full Text Available In this paper one aspect of the transition that must be made by experienced clinicians who become involved in conducting qualitative health research is examined, specifically, the differences between clinical and research interviewing. A clinician who is skillful and comfortable carrying out a clinical interview may not initially apprehend the important differences between these categories and contexts of interviewing. This situation can lead to difficulties and diminished quality of data collection because the purpose, techniques and orientation of a qualitative research interview are distinct from those of the clinical interview. Appreciation of these differences between interview contexts and genres, and strategies for addressing challenges associated with these differences, can help clinician researchers to become successful qualitative interviewers.
.... The topic is still contentious; arguments for and against it seem to stretch infinitely, but at the same time there are many who form opinions on the topic without having a clear image of the concept and forms of euthanasia...
Denier, Yvonne; Gastmans, Chris; De Bal, Nele; Dierckx de Casterlé, Bernadette
To describe the communication during the euthanasia care process for mentally competent, terminally ill patients in general hospitals in Flanders, as seen from the perspective of the nurse. International literature shows that nurses are involved in the care process surrounding euthanasia, regardless of the legal status of euthanasia in the country being studied. In particular, research shows that communication is an important part of good euthanasia care. However, the actual way nurses' communication contributes to the quality of the euthanasia care process remains unclear. A Grounded Theory Design was used. Analysis of 18 in-depth, semi-structured interviews with nurses from nine different hospitals in Flanders (Belgium). The interviews took place during a 20-month period in 2005-2006. The euthanasia care process for mentally competent, terminally ill patients in general hospitals in Flanders is a complex and dynamic process, the connecting thread of which is nurses' communication. During this process, nurses perceive that they communicate often and a lot, with various people, in different contexts, in different ways and with various purposes. This communicative process is intensified by the moral and psychological weight of the theme, and its impact on everyone involved, as well as by the relatively short period of time, during which it all takes place. This article adds to the growing body of literature on nursing care for patients requesting euthanasia. The findings suggest that for nurses, communication is a key instrument for realising good-quality euthanasia care. Being the essence of nursing care for patients requesting euthanasia, nurses' communication requires support and guidance on the level of nursing education, professional guidelines and hospital context. © 2010 Blackwell Publishing Ltd.
Dees, Marianne K; Vernooij-Dassen, Myrra J; Dekkers, Wim J; Elwyn, Glyn; Vissers, Kris C; van Weel, Chris
Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in the Netherlands, there is little known about how decision-making occurs and no guidance to support this difficult aspect of clinical practice. To explore the decision-making process in cases where patients request euthanasia and understand the different themes relevant to optimise this decision-making process. A qualitative thematic analysis of interviews with patients making explicit requests for euthanasia, most-involved relative(s) and treating physician. Thirty-two cases, 31 relatives and 28 treating physicians. Settings were patients' and relatives' homes and physicians' offices. Five main themes emerged: (1) initiation of sharing views and values about euthanasia, (2) building relationships as part of the negotiation, (3) fulfilling legal requirements, (4) detailed work of preparing and performing euthanasia and (5) aftercare and closing. A patient's request for euthanasia entails a complex process that demands emotional work by all participants. It is characterised by an intensive period of sharing information, relationship building and negotiation in order to reach agreement. We hypothesise that making decisions about euthanasia demands a proactive approach towards participants' preferences and values regarding end of life, towards the needs of relatives, towards the burden placed on physicians and a careful attention to shared decision-making. Future research should address the communicational skills professionals require for such complex decision-making.
Ten Cate, Katja; van Tol, Donald G; van de Vathorst, Suzanne
In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the patient nor a duty of the physician. Beside the legal requirements, physicians can weigh their own considerations when they decide on a request for EAS. We aim at a better understanding of the considerations that play a role when physicians decide on a request for EAS. This was a qualitative study. We analysed 33 interviews held with general practitioners (GPs) from various regions in the Netherlands. The considerations found can be divided in three main types. (i) Perceived legal criteria, (ii) individual interpretations of the legal criteria and (iii) considerations unrelated to the legal criteria. Considerations of this 3rd type have not been mentioned so far in the literature and the debate on EAS. Examples are: the family should agree to EAS, the patient's attitude must reflect resignation, or conflicts must be resolved. Our study feeds the ethical discussion on the tension that can arise between a physician's own views on death and dying, and the views and preferences of his patients. When considerations like 'no unresolved conflicts' or 'enough resignation' influence the decision to grant a request for EAS this poses questions from an ethical and professional point of view. We hypothesise that these considerations reflect GPs' views on what 'good dying' entails and we advocate further research on this topic.
Georges, J-J; The, A M; Onwuteaka-Philipsen, B D; van der Wal, G
Caring for terminally ill patients is a meaningful task, however the patient's suffering can be a considerable burden and cause of frustration. The aim of this study is to describe the experiences of general practitioners (GPs) in The Netherlands in dealing with a request for euthanasia from a terminally ill patient. The data, collected through in-depth interviews, were analysed according to the constant comparative method. Having to face a request for euthanasia when attempting to relieve a patient's suffering was described as a very demanding experience that GPs generally would like to avoid. Nearly half of the GPs (14/30) strive to avoid euthanasia or physician assisted suicide because it was against their own personal values or because it was emotional burdening to be confronted with this issue. They explained that by being directed on promoting a peaceful dying process, or the quality of end-of-life of a patient by caring and supporting the patient and the relatives it was mainly possible to shorten patient's suffering without "intentionally hastening a patient's death on his request". The other GPs (16/30) explained that as sometimes the suffering of a patient could not be lessened they were open to consider a patient's request for euthanasia or physician assisted suicide. They underlined the importance of a careful decision-making process, based on finding a balance between the necessity to shorten the patient's suffering through euthanasia and their personal values. Dealing with requests for euthanasia is very challenging for GPs, although they feel committed to alleviate a patient's suffering and to promote a peaceful death.
White, Katherine M; Wise, Susi E; Young, Ross McD; Hyde, Melissa K
A qualitative study explored beliefs about active voluntary euthanasia (AVE) in a sample (N = 18) of medical practitioners and nurses from Australia, where AVE is not currently legal. Four behaviors relating to AVE emerged during the interviews: requesting euthanasia for oneself, legalizing AVE, administering AVE to patients if it were legalized, and discussing AVE with patients if they request it. Using thematic analysis, interviews were analyzed for beliefs related to advantages and disadvantages of performing these AVE behaviors. Medical practitioners and nurses identified a number of similar benefits for performing the AVE-related behaviors, both for themselves personally and as health professionals. Benefits also included a consideration of the positive impact for patients, their families, and the health care system. Disadvantages across behaviors focused on the potential conflict between those parties involved in the decision making process, as well as conflict between one's own personal and professional values.
Jacob, Stacy A.; Furgerson, S. Paige
Students new to doing qualitative research in the ethnographic and oral traditions, often have difficulty creating successful interview protocols. This article offers practical suggestions for students new to qualitative research for both writing interview protocol that elicit useful data and for conducting the interview. This piece was originally…
-anchored interviewing, and second, by an interview guide that explores a research participant's personal experience with mindfulness meditation. An excerpt from an interview is discussed to illustrate the advantages of this interview form, namely its value as a methodological instrument for qualitative research...
Sorsa, Minna Anneli; Kiikkala, Irma; Åstedt-Kurki, Päivi
To provide an overview of bracketing as a skill in unstructured qualitative research interviews. Researchers affect the qualitative research process. Bracketing in descriptive phenomenology entails researchers setting aside their pre-understanding and acting non-judgementally. In interpretative phenomenology, previous knowledge is used intentionally to create new understanding. A literature search of bracketing in phenomenology and qualitative research. This is a methodology paper examining the researchers' impact in creating data in creating data in qualitative research. Self-knowledge, sensitivity and reflexivity of the researcher enable bracketing. Skilled and experienced researchers are needed to use bracketing in unstructured qualitative research interviews. Bracketing adds scientific rigour and validity to any qualitative study.
Malterud, Kirsti; Siersma, Volkert Dirk; Guassora, Ann Dorrit Kristiane
Sample sizes must be ascertained in qualitative studies like in quantitative studies but not by the same means. The prevailing concept for sample size in qualitative studies is “saturation.” Saturation is closely tied to a specific methodology, and the term is inconsistently applied. We propose...... the concept “information power” to guide adequate sample size for qualitative studies. Information power indicates that the more information the sample holds, relevant for the actual study, the lower amount of participants is needed. We suggest that the size of a sample with sufficient information power...... depends on (a) the aim of the study, (b) sample specificity, (c) use of established theory, (d) quality of dialogue, and (e) analysis strategy. We present a model where these elements of information and their relevant dimensions are related to information power. Application of this model in the planning...
Euthanasia has received increasing attention in both academic and public debates as one of the most controversial issues. However, the contribution of psychology-related themes to the topic has had little role on these ongoing debates. The aim of the present study is twofold: (1) to explore the main themes relating to euthanasia as provided by psychology-related research; (2) to analyze the temporal trends of psychology-related research on euthanasia over the last decades. A comprehensive search of academic literature was conducted on PsychINFO database. A qualitative software-based thematic analysis was carried out on 602 journal abstracts published from 1935 to 2014. This study highlighted four different thematic areas which characterized the scientific discourse on euthanasia: (1) moral values, in terms of religious, philosophical, and social implications concerning the individual's decision to die; (2) professional ethics, in terms of health and social workers' legal responsibility in death assistance; (3) end-of-life care, with regard to medical options provided to support individuals nearing death; and (4) patient's right to healthcare, in terms of access to palliative care and better quality of dying. Euthanasia discourse over the last decades seems to be overall characterized by two main dimensions: (1) the increasing trend of social legitimacy and acceptability of euthanasia over time, which moved from ethical to healthcare issues; and (2) the curvilinear temporal trend about the request/provision process in euthanasia, which moved from patient's decision for ending life (mainly characterizing the most past and recent research) to the role of health professionals (with a peak in the 1990s). The results suggest palliative care as a potential future research area which can provide healthcare providers with skills to 'connect' with patients, understand patients' hidden agendas, and grant a good quality of life and dying process.
Janghorban, Roksana; Latifnejad Roudsari, Robab; Taghipour, Ali
The most commonly used method for data collection in qualitative research is interviewing. With technology changes over the last few decades, the online interview has overcome time and financial constraints, geographical dispersion, and physical mobility boundaries, which have adversely affected onsite interviews. Skype as a synchronous online service offers researchers the possibility of conducting individual interviews as well as small focus groups, comparable to onsite types. This commentary presents the characteristics of the Skype interview as an alternative or supplemental choice to investigators who want to change their conventional approach of interviewing.
Full Text Available The most commonly used method for data collection in qualitative research is interviewing. With technology changes over the last few decades, the online interview has overcome time and financial constraints, geographical dispersion, and physical mobility boundaries, which have adversely affected onsite interviews. Skype as a synchronous online service offers researchers the possibility of conducting individual interviews as well as small focus groups, comparable to onsite types. This commentary presents the characteristics of the Skype interview as an alternative or supplemental choice to investigators who want to change their conventional approach of interviewing.
This article asks what applied linguistics can learn from related disciplines with regard to the collection, analysis and representation of qualitative interviews. It assesses the contributions of qualitative sociology, anthropology, discursive psychology and outlines four "discourse dilemmas" which might provide the basis for a more critical and…
Adams, Catherine A.; Thompson, Terrie Lynn
This article argues the importance of including significant technologies-in-use as key qualitative research participants when studying today's digitally enhanced learning environments. We gather a set of eight heuristics to assist qualitative researchers in "interviewing" technologies-in-use (or other relevant objects), drawing on concrete…
Haahr, Anita; Norlyk, Annelise; Hall, Elisabeth
Nurse researchers engaged in qualitative interviews with patients and spouses in healthcare may often experience being in unforseen ethical dilemmas. Researchers are guided by the bioethical principles of justice, beneficence, non-maleficence respect for human rights and respect for autonomy...... through the entire research process. However, these principles are not sufficient to prepare researchers for unanticipated ethical dilemmas related to qualitative researchs interviews. We describe and discuss ethically challenging and difficult moments embedded in two cases from our own phenomenological...... interview studies. We argue that qualitative interviews involve navigation between being guided by bioethics as a researcher, being a therapist/nurse and being a fellow human being or even a friend. The researchers' premises to react to unexpected situations and act in a sound ethical manner must...
Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D.; Muller, Martien T.; van der Wal, Gerrit; van der Heide, Agnes; van der Maas, Paul J.
This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most…
Busted, Laila Mohrsen; Nielsen, Dorthe Susanne; Birkelund, Regner
to decrease the experienced burden that relatives to persons with dementia experience. The qualitative research project consists of three parts; 1) An interview study to investigate the problem area as experienced by 24 relatives. 2) Initiate family intervention, conducted by professional caregivers......, and examine the intervention through individual qualitative interviews with 18 family members who have participated in the family health conversations. 3) An interview study to examine what the intervention meant to the family within the last year by re-interviewing the family members through family...... interviews. The data will be interpreted in a phenomenological-hermeneutic approach, inspired by Kvale and Brinkmann. The study contributes to the body of knowledge in the area of family health therapeutic conversations for families with dementia challenges. The results are important for the future...
Marifran Mattson PhD
Full Text Available This article examines the ways in which integrating a metatheory to guide qualitative interviews supports health theory and the research methodology of interviewing. This study applied Harm Reduction Theory (HRT as a metatheory to the Reconceptualized Health Belief Model (RHBM in targeting motorcyclists to practice safety behaviors. After integrating the metatheory with a health behavior theory to develop research questions and frame the interview guide, we recruited and interviewed 37 at-risk motorcyclists. The process of interviewing participants and the results of the study support the integration of harm reduction metatheory to enhance interview methodology as a way to effectively engage participants by building rapport, encouraging participants to apply theory, and empowering them to be open and honest in their responses. This research process highlights ways in which incorporating a metatheory to guide theory diverges from the more traditional, theory-driven approach to interviewing.
Hershberger, Patricia E; Kavanaugh, Karen
Despite an increasing use of qualitative email interviews by nurse researchers, there is little understanding about the appropriateness and equivalence of email interviews to other qualitative data collection methods, especially on sensitive topics research. The purpose is to describe our procedures for completing asynchronous, email interviews and to evaluate the appropriateness and equivalency of email interviews to phone interviews in two qualitative research studies that examined reproductive decisions. Content analysis guided the methodological appraisal of appropriateness and equivalency of in-depth, asynchronous email interviews to single phone interviews. Appropriateness was determined by: (a) participants' willingness to engage in email or phone interviews, (b) completing data collection in a timely period, and (c) participants' satisfaction with the interview. Equivalency was evaluated by: (a) completeness of the interview data, and (b) insight obtained from the data. Of the combined sample in the two studies (N=71), 31% of participants chose to participate via an email interview over a phone interview. The time needed to complete the email interviews averaged 27 to 28days and the number of investigator probe-participant response interchanges was 4 to 5cycles on average. In contrast, the phone interviews averaged 59 to 61min in duration. Most participants in both the email and phone interviews reported they were satisfied or very satisfied with their ability to express their true feelings throughout the interview. Regarding equivalence, 100% of the email and phone interviews provided insight into decision processes. Although insightful, two of the email and one phone interview had short answers or, at times, underdeveloped responses. Participants' quotes and behaviors cited within four published articles, a novel evaluation of equivalency, revealed that 20% to 37.5% of the citations about decision processes were from email participants, which is
Camila Junqueira Muylaert
Full Text Available Objetives This methodological study explain and emphasize the extent and fertility of the narrative interview in qualitative research. Methods To describe the narrative method within the qualitative research. Results The qualitative research method is characterized by addressing issues related to the singularities of the field and individuals investigated, being the narrative interviews a powerful method for use by researchers who aggregate it. They allow the deepening of research, the combination of life stories with socio-historical contexts, making the understanding of the senses that produce changes in the beliefs and values that motivate and justify the actions of possible informants. Conclusion The use of narrative is an advantageous investigative resource in qualitative research, in which the narrative is a traditional form of communication whose purpose is to serve content from which the subjective experiences can be transmitted.
Winsome Chunnu Brayda PhD
Full Text Available This article discusses the qualitative interviewing techniques that the authors used to conduct their respective dissertation research in Jamaica and South Carolina. (The research in Jamaica examined the implementation of primary education policies. The research in South Carolina delved into the life history of Benner C. Turner, a controversial college president. Most of the literature about interviewing focuses on asking the right questions; in contrast, this article discusses the challenges of interviewing. In this article, selected interviews are used from both studies to examine the difficulties these researchers encountered when conducting “sensitive” interviews, the risks female researchers face in unfamiliar places, and the challenges of working in international settings (which requires interpersonal skills and cultural competency. While the task of research interviewing is complex, the authors provide ideas that can be used to navigate such moments.
Bedoin, D.; Scelles, R.
This study focuses on the qualitative research interview, an essential tool frequently used in the human and social sciences, conducted with children having communication disorders. Two distinct populations are addressed--children with intellectual disability and deaf children without related disabilities--with the aim of identifying the main…
Guillemin, M.; Harris, A.
In the social sciences, there has been an increasing level of interest in the five senses, especially in disciplines such as anthropology, sociology, architecture and human geography. In this case study, we focus on using the senses in qualitative research interviews. We discuss a research method
Camila da Silva Gonçalo
Full Text Available In this study, we aimed to present and discuss the results of a systematic literature review on the use of Distance Interviews (DI in qualitative health research. Searches were conducted in the PubMed and CINAHL databases and 37 references were included. Data were organized according to author, year of publication, journal title, and manuscript objective. The results revealed that the most recurrent theme was the comparison of Distance Interviews with other methods of data collection. Low cost, easier access to respondents, higher participation rates, and recruitment of volunteers were identified as the main benefits offered by DI. Distance Interviews were used for various purposes, from validation of instruments for data collection to diagnosis. We concluded that there is a need to expand on the theme explored in this article, because the incorporation of information and communication technologies in the healthcare field represents a valuable access route in capturing qualitative data.
Verhofstadt, Monica; Thienpont, Lieve; Peters, Gjalt-Jorn Ygram
Background The concept of ‘unbearable suffering’ is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients. Aims To provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia. Method Testimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software. Results Five domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment. Conclusions The development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures. PMID:28970302
Connelly, Lynne M; Peltzer, Jill N
In this methodological article, the authors address the problem of underdeveloped themes in qualitative studies they have reviewed. Various possible reasons for underdeveloped themes are examined, and suggestions offered. Each problem area is explored, and literature support is provided. The suggestions that are offered are supported by the literature as well. The problem with underdeveloped themes in certain articles is related to 3 interconnected issues: (a) lack of clear relationship to the underlying research method, (b) an apparent lack of depth in interviewing techniques, and (c) lack of depth in the analysis. Underdeveloped themes in a qualitative study can lead to a lack of substantive findings that have meaningful implications for practice, research, and the nursing profession, as well as the rejection of articles for publication. Fully developed themes require knowledge about the paradigm of qualitative research, the methodology that is proposed, the effective techniques of interviewing that can produce rich data with examples and experiences, and analysis that goes beyond superficial reporting of what the participants have said. Analytic problem areas include premature closure, anxiety about how to analyze, and confusion about categories and themes. Effective qualitative research takes time and effort and is not as easy as is sometimes presumed. The usefulness of findings depends on researchers improving their research skills and practices. Increasingly researchers are using qualitative research to explore clinically important issues. As consumers of research or members of a research team, clinical nurse specialists need to understand the nature of this research that can provide in-depth insight and meaning.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
In companion animal practice, convenience euthanasia (euthanasia of a physically and psychologically healthy animal) is recognized as one of the most difficult situations. There is little published on veterinary perceptions of the consequences of convenience euthanasia. A qualitative study on the subject based on interviews with 14 veterinarians was undertaken. The animal's interests in the dilemma of convenience euthanasia was taken into consideration, strictly from the point of view of the physical suffering and stress related to the procedure. The veterinarian's goal was to respect the animal's interests by controlling physical pain. Most often, veterinarians made their own interests and those of the owners a priority when considering the consequences of their decision to perform or refuse convenience euthanasia.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
In companion animal practice, convenience euthanasia (euthanasia of a physically and psychologically healthy animal) is recognized as one of the most difficult situations. There is little published on veterinary perceptions of the consequences of convenience euthanasia. A qualitative study on the subject based on interviews with 14 veterinarians was undertaken. The animal’s interests in the dilemma of convenience euthanasia was taken into consideration, strictly from the point of view of the physical suffering and stress related to the procedure. The veterinarian’s goal was to respect the animal’s interests by controlling physical pain. Most often, veterinarians made their own interests and those of the owners a priority when considering the consequences of their decision to perform or refuse convenience euthanasia. PMID:28698691
O'Cathain, Alicia; Goode, Jackie; Drabble, Sarah J; Thomas, Kate J; Rudolph, Anne; Hewison, Jenny
Qualitative research is undertaken with randomized controlled trials of health interventions. Our aim was to explore the perceptions of researchers with experience of this endeavour to understand the added value of qualitative research to the trial in practice. A telephone semi-structured interview study with 18 researchers with experience of undertaking the trial and/or the qualitative research. Interviewees described the added value of qualitative research for the trial, explaining how it solved problems at the pretrial stage, explained findings, and helped to increase the utility of the evidence generated by the trial. From the interviews, we identified three models of relationship of the qualitative research to the trial. In 'the peripheral' model, the trial was an opportunity to undertake qualitative research, with no intention that it would add value to the trial. In 'the add-on' model, the qualitative researcher understood the potential value of the qualitative research but it was viewed as a separate and complementary endeavour by the trial lead investigator and wider team. Interviewees described how this could limit the value of the qualitative research to the trial. Finally 'the integral' model played out in two ways. In 'integral-in-theory' studies, the lead investigator viewed the qualitative research as essential to the trial. However, in practice the qualitative research was under-resourced relative to the trial, potentially limiting its ability to add value to the trial. In 'integral-in-practice' studies, interviewees described how the qualitative research was planned from the beginning of the study, senior qualitative expertise was on the team from beginning to end, and staff and time were dedicated to the qualitative research. In these studies interviewees described the qualitative research adding value to the trial although this value was not necessarily visible beyond the original research team due to the challenges of publishing this research
Background Qualitative research is undertaken with randomized controlled trials of health interventions. Our aim was to explore the perceptions of researchers with experience of this endeavour to understand the added value of qualitative research to the trial in practice. Methods A telephone semi-structured interview study with 18 researchers with experience of undertaking the trial and/or the qualitative research. Results Interviewees described the added value of qualitative research for the trial, explaining how it solved problems at the pretrial stage, explained findings, and helped to increase the utility of the evidence generated by the trial. From the interviews, we identified three models of relationship of the qualitative research to the trial. In ‘the peripheral’ model, the trial was an opportunity to undertake qualitative research, with no intention that it would add value to the trial. In ‘the add-on’ model, the qualitative researcher understood the potential value of the qualitative research but it was viewed as a separate and complementary endeavour by the trial lead investigator and wider team. Interviewees described how this could limit the value of the qualitative research to the trial. Finally ‘the integral’ model played out in two ways. In ‘integral-in-theory’ studies, the lead investigator viewed the qualitative research as essential to the trial. However, in practice the qualitative research was under-resourced relative to the trial, potentially limiting its ability to add value to the trial. In ‘integral-in-practice’ studies, interviewees described how the qualitative research was planned from the beginning of the study, senior qualitative expertise was on the team from beginning to end, and staff and time were dedicated to the qualitative research. In these studies interviewees described the qualitative research adding value to the trial although this value was not necessarily visible beyond the original research team due
Full Text Available With the internationalization of higher education, research settings and researcher backgrounds are becoming increasingly complex, further complicating disciplinary assumptions, traditions and techniques. This article highlights key practical and conceptual issues that arose during planning fieldwork, fieldwork conduct, subsequent analysis and writing up of a qualitative study carried out within a Confucian setting. Drawing on the experience with a detailed research study of a pay for performance scheme (involving 31 in-depth interviews undertaken by a South Korean researcher, this article explores conceptual and practical issues that emerged between Anglophone methods and countries with a Confucian heritage. It is discussed how processes of sampling/recruitment, ethics, fieldwork conduct (including insider relations, power hierarchies, and translation are complicated in such settings. The article seeks to expand our understandings of qualitative research vis-à-vis contemporary Confucian cultures, something which has previously not been well addressed and which is part of the ongoing project of "globalizing qualitative research." URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs150274
Curry-Chiu, Margaret E; Catley, Delwyn; Voelker, Marsha A; Bray, Kimberly Krust
The effectiveness of Motivational Interviewing (MI) to change health behaviors is well documented. Previous studies support use of MI to change oral health behaviors in the areas of early childhood caries and periodontal diseases, but research is limited due to the sparse number of oral health care providers with training in MI. The University of Missouri-Kansas City (UMKC) formally integrated MI training into its dental hygiene curriculum five years ago. Summative program evaluation of UMKC's MI training shows that it effectively equips graduates with MI skills. The aim of this qualitative study was to use semi-structured interviews with nine program alumni to provide insight into the experiences of MI-trained dental hygienists in clinical practice. All interviews were captured with a digital voice recorder, were transcribed, and were resubmitted to the interviewees for checking. Five themes emerged from the data analysis: salience, best practices, barriers, facilitators, and lessons learned. These dental hygienists strongly valued and embraced the spirit of MI. They reported feeling strongly that it should be part of all dental hygiene curricula, and they upheld MI as a best practice. The participants approved of their MI instruction as a whole but felt it was difficult and sometimes not viable in practice. They reported that MI training had improved their communication skills and increased treatment acceptance. Time, difficulty, and managing patient resistance were the most often cited barriers, while a supportive climate and creating a routine were the most often cited facilitators.
... AFFAIRS Agency Information Collection: (PACT Qualitative Evaluation: Patient & Caregiver Interviews); Comment Request AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION: Notice...). SUPPLEMENTARY INFORMATION: Title: PACT Qualitative Evaluation: Patient & Caregiver Interviews. OMB Control...
Erlandsson, Kerstin; Jinghede Nordvall, Cecilia; Ohman, Anna; Häggström-Nordin, Elisabet
To describe the thoughts, reflections, and experiences of friends-with-benefits relationships among a group of Swedish adolescents. A qualitative study with an explorative and descriptive design. Eight adolescents, aged 16-18, were interviewed. Individual in-depth interviews were undertaken. Data were analyzed using latent content analysis. The informants involved themselves in Friends-with-benefits (FWB) relationships to find physical and psychological intimacy without any expectations or demands. FWB relationships were perceived to have more advantages when the partner was a close friend with whom an informant felt comfortable. There was ambivalence about the legitimacy of romantic feelings in an FWB relationship, although it was quite common. Sexual concurrency was common and often accepted. Sexual risk-taking behavior involving the use of alcohol and a lack of contraception was considered common in FWB relationships. Informants requested more education and support as regards their sexual behavior. FWB relationships were often initiated to find physical and psychological intimacy with no expectations or demands. Advantages such as sexual concurrency and no demands were central. A deeper understanding of how adolescents think and reason about sexuality and relationships can make a difference when working to improve young people's sexual and reproductive health. © 2012 Wiley Periodicals, Inc.
The importance of trust between patients and healthcare personnel is emphasised in nurses' and physicians' ethical codes. Trust is crucial for an effective healthcare personnel-patient relationship and thus for treatment and treatment outcomes. Cultural and linguistic differences may make building a trusting and positive relationship with ethnic minority patients particularly challenging. Although there is a great deal of research on cultural competence, there is a conspicuous lack of focus on the concepts of trust and distrust concerning ethnic minority patients, particularly in relation to the concept of 'othering'. To study which factors help build trust or create distrust in encounters between healthcare professionals and hospitalised ethnic minority patients, as well as study the dynamic complexities inherent within the process of 'othering'. Qualitative design, in-depth interviews and hermeneutic analysis. The interviewees were 10 immigrant patients (six women and four men - eight Asians, two Africans - ages 32-85 years) recruited from a south-eastern Norwegian hospital. Study approval was obtained from the hospital's Privacy Ombudsman for Research and the hospital's leadership. Participation was voluntary and participants signed an informed consent form. Distrust and othering may be caused by differences in belief systems, values, perceptions, expectations, and style of expression and behaviour. Othering is a reciprocal phenomenon in minority ethnic patient-healthcare personnel encounters, and it influences trust building negatively. Besides demonstrating general professional skill and competence, healthcare personnel require cultural competence to create trust. © The Author(s) 2016.
Yanos, Philip T.; Hopper, Kim
In this paper, we discuss a problem in qualitative interviewing labeled by Bourdieu as ‘false, collusive objectification’. As described by Bourdieu, interviews where this occurs appear authentic because they often echo social science concepts and terminology and therefore may please the interviewer; however, they are actually unusable. We evaluate Bourdieu’s claim for the existence of ‘false’ interviews in light of the predominant postmodern position in qualitative research, offer examples from our own research on people diagnosed with mental illness and raise the issue of whether, when and how qualitative researchers should concern themselves with the shortcomings of interviews. We conclude with suggestions derived from Bourdieu’s view on how to address the problem he described. PMID:21132071
Janghorban, Roksana; Latifnejad Roudsari, Robab; Taghipour, Ali
... affected onsite interviews. Skype as a synchronous online service offers researchers the possibility of conducting individual interviews as well as small focus groups, comparable to onsite types...
Croxson, Caroline Hd; Ashdown, Helen F; Hobbs, Fd Richard
GPs report the lowest levels of morale among doctors, job satisfaction is low, and the GP workforce is diminishing. Workload is frequently cited as negatively impacting on commitment to a career in general practice, and many GPs report that their workload is unmanageable. To gather an in-depth understanding of GPs' perceptions and attitudes towards workload. All GPs working within NHS England were eligible. Advertisements were circulated via regional GP e-mail lists and national social media networks in June 2015. Of those GPs who responded, a maximum-variation sample was selected until data saturation was reached. Semi-structured, qualitative interviews were conducted. Data were analysed thematically. In total, 171 GPs responded, and 34 were included in this study. GPs described an increase in workload over recent years, with current working days being long and intense, raising concerns over the wellbeing of GPs and patients. Full-time partnership was generally not considered to be possible, and many participants felt workload was unsustainable, particularly given the diminishing workforce. Four major themes emerged to explain increased workload: increased patient needs and expectations; a changing relationship between primary and secondary care; bureaucracy and resources; and the balance of workload within a practice. Continuity of care was perceived as being eroded by changes in contracts and working patterns to deal with workload. This study highlights the urgent need to address perceived lack of investment and clinical capacity in general practice, and suggests that managing patient expectations around what primary care can deliver, and reducing bureaucracy, have become key issues, at least until capacity issues are resolved. © British Journal of General Practice 2017.
Kelman, Ilan; Luthe, Tobias; Wyss, Romano; Tørnblad, Silje H; Evers, Yvette; Curran, Marina Martin; Williams, Richard J; Berlow, Eric L
This study integrates quantitative social network analysis (SNA) and qualitative interviews for understanding tourism business links in isolated communities through analysing spatial characteristics...
Sercu, M; Pype, P; Christiaens, T; Grypdonck, M; Derese, A; Deveugele, M
In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and-as advised by Belgian Medical Deontology--in the context of a trusted patient--physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Although GPs can understand a patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and-if they grant it-to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.
Meyer, Bente; Levinsen, Karin
Interviews with trainees were conducted after the Action Research period (November-December 2006), when LBs 1-4 were tested on trainees. The aim of the interviews was to understand how teachers learn to teach and to relate to the online environment through the specific context of the Lancelot live...
Goodell, L Suzanne; Stage, Virginia C; Cooke, Natalie K
The increased emphasis on incorporating qualitative methodologies into nutrition education development and evaluation underscores the importance of using rigorous protocols to enhance the trustworthiness of the findings. A 5-phase protocol for training qualitative research assistants (data collectors and coders) was developed as an approach to increase the consistency of the data produced. This training provides exposure to the core principles of qualitative research and then asks the research assistant to apply those principles through practice in a setting structured on critical reflection. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
Phillips, Lindsay A.
This qualitative analysis explores the role of substance abuse in reentry from prison to society. Participants who recidivated (N = 20) in an urban prison system identified substance abuse as their primary reason for recidivism. Treatment implications are discussed.
Alcock, John; Iphofen, Ron
John Alcock and Ron Iphofen examine a method to assist with interview transcription using free, open source computer software and digital recordings, and consider some underlying practical, ethical and philosophical issues.
Full Text Available This paper addresses several issues related to validity in qualitative research and, more specifically, explores the ways in which validity has been discussed and applied in research with qualitative interviews. The central question is to what extent, if at all, traditional positivist validity criteria are applicable, but also relevant, for evaluation of research with qualitative interviewing. The qualitative interview has been chosen as the focal point of this paper because of its peculiarity in terms of the relationship between the interviewer and the interviewee or, in other words, the ways in which during an interview meaning and narrative are constructed through discourse between the participants. The importance of the relationship (with its characteristics between research participants (interviewer and interviewee for the outcome of a qualitative interview cannot be overemphasized and is as such of particular interest for the assessment of its validity. I introduce and summarize the main approaches to the study and establishment of validity and scrutinize their significance for the example of qualitative interviewing and research in particular. This paper shows the importance of considering research context (in this instance interview for any assessment of validity, if validity at all ought to assume the same role in qualitative and quantitative research. As alternatives to the positivist notion of validity concepts such as reflexivity, transparency and credibility throughout the research process are introduced and advocated.
Full Text Available The books by M. Alvesson and J. Salmons deal with some different kinds of methodologies: qualitative (case study, grounded theory, phenomenology, and multiple qualitative methodologies, quantitative (experimental and quasi-experimental, and mixed methods. The trends in and the future of interview research, qualitative and mixed research methods are discussed.
Dieltjens, Sylvain M; Heynderickx, Priscilla C; Dees, Marianne K; Vissers, Kris C
The literature, field research, and daily practice stress the need for adequate communication in palliative care. Although language is of the utmost importance in communication, linguistic analysis of end-of-life discussions is scarce. Our aim is 2-fold: We want to determine what the use of 4 significant Dutch modal verbs expressing volition, obligation, possibility, and permission reveals about the concept of unbearable suffering and about physicians' communicative style. We quantitatively (TextStat) and qualitatively (bottom-up approach) analyzed the use of the modal verbs in 15 interviews, with patients requesting euthanasia or physician-assisted suicide, their physicians, and their closest relatives. An essential element of unbearable suffering is the patient's incapacity to perform certain tasks. Further, the physician's preference for particular modal verbs reveals whether his attitude toward patients is more or less patronizing and more or less appreciative. Linguistic analysis can help medical professionals to better understand their communicative skills, styles, and approach to patients in end-of-life situations. We have shown how linguistic analysis can contribute to a better understanding of physician-patient interaction. Moreover, we have illustrated the usefulness of interdisciplinary research in the medical domain. © 2013 World Institute of Pain.
Bengtsson, Tea Torbenfeldt; Fynbo, Lars
In this article we analyse the significance of silence in qualitative interviews with 36 individuals interviewed about high-risk, illegal activities. We describe how silence expresses a dynamic power relationship between interviewer and interviewee. In the analysis, we focus on two different type...
Garrard, E; Wilkinson, S
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of euthanasia and the (supposed) permissibility of what is often called passive euthanasia. Secondly, the claim that passive euthanasia (so-called) cannot really be euthanasia because it does not cause death. And finally, a consequence based argument which appeals to the (alleged) bad consequences of accepting the category of passive euthanasia.We conclude that although healthcare professionals' nervousness about the concept of passive euthanasia is understandable, there is really no reason to abandon the category provided that it is properly and narrowly understand and provided that "euthanasia reasons" for withdrawing or withholding life-prolonging treatment are carefully distinguished from other reasons.
Full Text Available Interviews are the most pervasive means of collecting data in qualitative research projects. The purpose of this paper is to discuss how the practice of conducting interviews has evolved within consumer and marketing research and to offer insights for those who would like to gather qualitative data via interviews. To do so, we first identify and differentiate two broad perspectives on qualitative marketing and consumer research: the phenomenological approach and the post-structuralist approach. We then develop a step by step guideline on how to conceive, conduct, and analyze interviews under both approaches. As much as the paper provides a useful toolkit to researchers with initial and intermediate degrees of intimacy with qualitative methods, it also contributes to the mapping of important ongoing paradigmatic discussions in the field of qualitative marketing and consumer research.
Jylhänkangas, Leila; Smets, Tinne; Cohen, Joachim; Utriainen, Terhi; Deliens, Luc
In many western societies health professionals play a powerful role in people's experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death-related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world-view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals - the freethinker with an atheist world-view - accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.
Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees
Tong, Allison; Sainsbury, Peter; Craig, Jonathan
... (indepth interviews and focus groups). Methods We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals...
Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.
Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees
Magnusson, R S
The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE) while ignoring the covert practice of PAS/AE by doctors and other health professionals. Against the background of survey studies suggesting that anything from 4% to 10% of doctors have intentionally assisted a patient to die, and interview evidence of the unregulated, idiosyncratic nature of underground PAS/AE, this paper assesses three alternatives to the current policy of prohibition. It argues that although legalisation may never succeed in making euthanasia perfectly safe, legalising PAS/AE may nevertheless be safer, and therefore a preferable policy alternative, to prohibition. At a minimum, debate about harm minimisation and the regulation of euthanasia needs to take account of PAS/AE wherever it is practised, both above and below ground.
Gill, P; Stewart, K; Treasure, E; Chadwick, B
This paper explores the most common methods of data collection used in qualitative research: interviews and focus groups. The paper examines each method in detail, focusing on how they work in practice, when their use is appropriate and what they can offer dentistry. Examples of empirical studies that have used interviews or focus groups are also provided.
DeLyser, Dydia; Potter, Amy E.
This article describes experiential-learning approaches to conveying the work and rewards involved in qualitative research. Seminar students interviewed one another, transcribed or took notes on those interviews, shared those materials to create a set of empirical materials for coding, developed coding schemes, and coded the materials using those…
E. Garrard; S. Wilkinson
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001...
Garrard, E; Wilkinson, S
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of...
Denier, Yvonne; Dierckx de Casterlé, Bernadette; De Bal, Nele; Gastmans, Chris
The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country--after the Netherlands--to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. "Intense" is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one's power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed.
Borgsteede, Sander D; Deliens, Luc; Graafland-Riedstra, Corrie; Francke, Anneke L; van der Wal, Gerrit; Willems, Dick L
Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about this. Qualitative, semi-structured interviews were held with 20 GPs and 30 of their patients in primary care in the Netherlands, where euthanasia is legalised. The patients had a life expectancy of less than 6 months, and cancer, heart failure or chronic obstructive pulmonary disease as underlying disease. Many patients did not communicate about euthanasia with their GP. Neither the patient nor the GP were clear in formulating their expectations concerning future decision making. The initial patient-GP communication consisted of an exchange of opinions about situations in which euthanasia would be desirable. GPs had different opinions about who should initiate communication, and found it difficult to judge the right moment to talk. It is essential to pay attention to education in communication about dying and euthanasia and to train the GPs to gain insight in the patient's end-of-life preferences, and to direct care at the best possible quality of life.
Mealer, Meredith; Jones Rn, Jacqueline
To explore the methodological and ethical issues of conducting qualitative telephone interviews about personal or professional trauma with critical care nurses. The most common method for conducting interviews is face-to-face. However, there is evidence to support telephone interviewing on a variety of sensitive topics including post-traumatic stress disorder (PTSD). Qualitative telephone interviews can limit emotional distress because of the comfort experienced through virtual communication. Critical care nurses are at increased risk of developing PTSD due to the cumulative exposure to work-related stress in the intensive care unit. We explored the methodological and ethical issues of conducting qualitative telephone interviews, drawing on our experiences communicating with a group of critical care nurses. Qualitative research interviews with 27 critical care nurses. Fourteen of the nurses met the diagnostic criteria for PTSD; 13 did not and had scores consistent with high levels of resilience. This is a methodology paper on the authors' experiences of interviewing critical care nurses on sensitive topics via the telephone. The authors found that establishing rapport and connections with the participants and the therapeutic use of non-verbal communication were essential, and fostered trust and compassion. The ethical issues of this mode of communication include protecting the privacy and confidentiality associated with the disclosure of sensitive information, and minimising the risk of psychological harm to the researcher and participants. Qualitative telephone interviews are a valuable method of collecting information on sensitive topics. This paper explores a method of interviewing in the workplace. It will help inform interventions to promote healthy adaptation following trauma exposure in the intensive care unit.
Kathryn K. DeRoche
Full Text Available Use of qualitative interviews with individuals currently receiving mental health services has increased over the last decade in the United States due to the calls for system change that emphasizes individuals' perceptions of their own progress. However, interviews with youth receiving mental health services are rarely encountered. In this article, an overview of methodological considerations when conducting an interview inquiry with youth currently receiving mental health services will be discussed, incorporating suggestions from the published literature and our experiences with previous interview studies. Our theoretical definition of youth receiving mental health services along with six major areas of concern: appropriate interview questions, youth development of cognitive ability, ethical issues, power relationships, cultural competency, and methods of interview inquiry are discussed. Finally, other researchers are encouraged to investigate techniques for gathering rich data through interview research with youth experiencing mental health issues. URN: urn:nbn:de:0114-fqs0803178
Tomlinson, Emily; Spector, Aimee; Nurock, Shirley; Stott, Joshua
Despite media and academic interest on assisted dying in dementia, little is known of the views of those directly affected. This study explored the views of former carers on assisted dying in dementia. This was a qualitative study using thematic analysis. A total of 16 former carers of people with dementia were recruited through national dementia charities and participated in semi-structured interviews. While many supported the individual's right to die, the complexity of assisted dying in dementia was emphasized. Existential, physical, psychological and psychosocial aspects of suffering were identified as potential reasons to desire an assisted death. Most believed it would help to talk with a trained health professional if contemplating an assisted death. Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required. © The Author(s) 2015.
Douglas, Charles; Kerridge, Ian; Ankeny, Rachel
There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed.
Full Text Available Abstract Background Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview. Methods A descriptive qualitative study. The data were collected in the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study. Results The interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible. Conclusion The open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview.
The article explores how the Internet and email offer space for participants to think and make sense of their experiences in the qualitative research encounter. It draws on a research study that used email interviewing to generate online narratives to understand academic lives and identities through research encounters in virtual space. The…
Wood, Marjorie L.
Focus group interviews, described as a qualitative research method with good potential in family medicine, are traced from their origins in market research to their growing role in sociology and medicine. Features of this method are described, including design, conduct, and analysis. Both proven and potential areas for primary care research using focus groups are outlined.
This paper explores the possibility of expanding the focus group interview into the field of English as a Second Language (ESL), where this research methodology is yet to be thoroughly explored. Specifically, it aims to challenge popular criticisms about the reliability and validity of the focus group as a qualitative research methodology. It does…
Lagro-Janssen, A.L.M.; Schijf, C.P.T.
The aim of the study is a report of Dutch women's views on abnormal cervical smear test results and the consequences thereof. Twenty-seven women with recent PAP III in their history were interviewed in the context of this qualitative study. GPs often do not inform patients beforehand about the ways
Dietrich, Hanno; Ehrlenspiel, Felix
Cognitive models postulate that respondents to a questionnaire follow a four-stage process when answering a question: comprehension, memory retrieval, decision, and response. Cognitive interviewing is a qualitative tool to gain insight into this process by means of letting respondents think aloud or asking them specific questions (Willis, 2005).…
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
Companion animal welfare in our society has become increasingly important, yet many healthy animals are euthanized in veterinary facilities. How is it possible to explain the simultaneous presence of these opposing views of obligation toward animals? The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians in order to understand their thought processes. A qualitative study was undertaken to analyze the results of interviews of 14 veterinarians. The study showed that veterinarians interviewed assessed convenience euthanasia based mainly on their subjective evaluation of the owner-animal bond. As most owner-animal bonds stem from an anthropocentric point of view, decisions on convenience euthanasia were taken mostly by considering the veterinarian's and the client/owner's interests.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
Companion animal welfare in our society has become increasingly important, yet many healthy animals are euthanized in veterinary facilities. How is it possible to explain the simultaneous presence of these opposing views of obligation toward animals? The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians in order to understand their thought processes. A qualitative study was undertaken to analyze the results of interviews of 14 veterinarians. The study showed that veterinarians interviewed assessed convenience euthanasia based mainly on their subjective evaluation of the owner-animal bond. As most owner-animal bonds stem from an anthropocentric point of view, decisions on convenience euthanasia were taken mostly by considering the veterinarian’s and the client/owner’s interests. PMID:28246412
Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. PMID:26284572
Ranney, Megan L; Meisel, Zachary F; Choo, Esther K; Garro, Aris C; Sasson, Comilla; Morrow Guthrie, Kate
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative health research and examples of its common use in emergency care research, describing study designs and data collection methods most relevant to our field (observation, individual interviews, and focus groups). Here in Part II of this series, we outline the specific steps necessary to conduct a valid and reliable qualitative research project, with a focus on interview-based studies. These elements include building the research team, preparing data collection guides, defining and obtaining an adequate sample, collecting and organizing qualitative data, and coding and analyzing the data. We also discuss potential ethical considerations unique to qualitative research as it relates to emergency care research. © 2015 by the Society for Academic Emergency Medicine.
Klopfer, Frederick J.; Price, William F.
Information on euthanasia attitudes was obtained from fixed-schedule interviews gathered from 331 respondents. It was found that a favorable attitude toward euthanasia coincided with (1) belief in an afterlife; (2) a less favorable attitude toward euthanasia if relatives make the decision; and (3) younger respondents. (Author)
Miller, David Gibbes; Kim, Scott Y H
ObjectivesTo assess how Dutch regional euthanasia review committees (RTE) apply the euthanasia and physician-assisted suicide (EAS) due care criteria in cases where the criteria are judged not to have been met ('due care not met' (DCNM)) and to evaluate how the criteria function to set limits in Dutch EAS practice. A qualitative review using directed content analysis of DCNM cases in the Netherlands from 2012 to 2016 published on the RTE website (https://www.euthanasiecommissie.nl/) as of 31 January 2017. Of 33 DCNM cases identified (occurring 2012-2016), 32 cases (97%) were published online and included in the analysis. 22 cases (69%) violated only procedural criteria, relating to improper medication administration or inadequate physician consultation. 10 cases (31%) failed to meet substantive criteria, with the most common violation involving the no reasonable alternative (to EAS) criterion (seven cases). Most substantive cases involved controversial elements, such as EAS for psychiatric disorders or 'tired of life', in incapacitated patients or by physicians from advocacy organisations. Even in substantive criteria cases, the RTE's focus was procedural. The cases were more about unorthodox, unprofessional or overconfident physician behaviours and not whether patients should have received EAS. However, in some cases, physicians knowingly pushed the limits of EAS law. Physicians from euthanasia advocacy organisations were over-represented in substantive criteria cases. Trained EAS consultants tended to agree with or facilitate EAS in DCNM cases. Physicians and families had difficulty applying ambiguous advance directives of incapacitated patients. As a retrospective review of physician self-reported data, the Dutch RTEs do not focus on whether patients should have received EAS, but instead primarily gauge whether doctors conducted EAS in a thorough, professional manner. To what extent this constitutes enforcement of strict safeguards, especially when cases contain
Oberink, Riëtta; Boom, Saskia M.; van Dijk, Nynke; Visser, Mechteld R. M.
Background: The Motivational Interviewing target Scheme (MITS) is an instrument to assess competency in Motivational Interviewing (MI) and can be used to assess MI in long and brief consultations. In this qualitative study we examined two sources of the Unified Model of Validity, the current
Luciana de Cassia Nunes Nascimento
Full Text Available ABSTRACT Objective: report the experience of applying the theoretical data saturation technique in qualitative research with schoolchildren. Method: critical reading of primary sources and compilation of raw data, followed by thematic grouping through colorimetric codification and allocation of themes/types of statements in charts to find theoretical saturation for each grouping. Results: colorimetric codification occurred according to previously established themes: bodily hydration; physical activities and play; handling of sickle-cell disease; feeding and clothing. On the eleventh interview, it was possible to reach the theoretical saturation of themes, with four additional interviews being performed. Conclusion: this experience report enabled the description of the five sequential steps for identification of theoretical data saturation in qualitative research conducted with schoolchildren.
Kon, Alexander A
Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate.
Kvale, Steinar; Brinkmann, Svend
Interviewet spiller en afgørende rolle i en stor del kvalitativ forskning. Men det er samtidig en kompleks disciplin, der rummer mange faldgruber og kræver fintfølende analytiske kompetencer. I denne bog giver Steinar Kvale og Svend Brinkmann en introduktion til de teoretiske og praktiske aspekte...... disciplin gennem en præsentation af dets syv stadier, hvor forfatterne klæder læseren fagligt på til at planlægge og foretage interviews....
Full Text Available This article problematizes conventional qualitative educational research through a process of reading observation and interview in rhizomatic research. Such an approach to doing research brings together Multiple Literacies Theory and rhizoanalysis, innovative practices with transdisciplinary implications. This article contributes to on-going research regarding the emergence of multiple literacies and rhizoanalysis as a way to experiment in disrupting conventional research concepts, in this case, observations and interviews. Rhizoanalysis is proposed because of its non-hierarchical and non-linear perspective to conducting qualitative research. In a similar manner, Multiple Literacies Theory seeks to release school-based literacy from its privileged position and unfold literacy as multiple and non-hierarchical. This theoretical and practical stance to educational research is deployed in an assemblage that includes a study of multiple writing systems with 5- to 8 –year- old multilingual children. Reading observation and interviews through the lens of rhizoanalysis and Multiple Literacies Theory becomes an exploration in reconceptualization of qualitative research.
Howlett, Owen; McKinstry, Carol; Lannin, Natasha A
Allied health professionals frequently use surveys to collect data for clinical practice and service improvement projects. Careful development and piloting of purpose-designed surveys is important to ensure intended measuring (that respondents correctly interpret survey items when responding). Cognitive interviewing is a specific technique that can improve the design of self-administered surveys. The aim of this study was to describe the use of the cognitive interviewing process to improve survey design, which involved a purpose-designed, online survey evaluating staff use of functional electrical stimulation. A qualitative study involving one round of cognitive interviewing with three occupational therapists and three physiotherapists. The cognitive interviewing process identified 11 issues with the draft survey, which could potentially influence the validity and quality of responses. The raised issues included difficulties with: processing the question to be able to respond, determining a response to the question, retrieving relevant information from memory and comprehending the written question. Twelve survey amendments were made following the cognitive interviewing process, comprising four additions, seven revisions and one correction. The cognitive interviewing process applied during the development of a purpose-designed survey enabled the identification of potential problems and informed revisions to the survey prior to its use. © 2017 Occupational Therapy Australia.
Tausch, Anja P; Menold, Natalja
Although focus groups are commonly used in health research to explore the perspectives of patients or health care professionals, few studies consider methodological aspects in this specific context. For this reason, we interviewed nine researchers who had conducted focus groups in the context of a project devoted to the development of an electronic personal health record. We performed qualitative content analysis on the interview data relating to recruitment, communication between the focus group participants, and appraisal of the focus group method. The interview data revealed aspects of the focus group method that are particularly relevant for health research and that should be considered in that context. They include, for example, the preferability of face-to-face recruitment, the necessity to allow participants in patient groups sufficient time to introduce themselves, and the use of methods such as participant-generated cards and prioritization.
Seale, Clive; Charteris-Black, Jonathan; MacFarlane, Aidan; McPherson, Ann
We report a comparative keyword analysis of interviews and Internet postings involving people with breast and prostate cancer and discussion of sexual health. Interviewees produce retrospective accounts, their content guided by interviewers' questions, which might elicit rich biographical and contextual details. Internet exchanges concern participants' current experiences and contain detailed accounts of disease processes, medical procedures, bodily processes, and, in the case of sexual health, sexual practices. They are used by participants to exchange information and support in a relatively anonymous context. Because of the ease with which large amounts of such archived Internet materials can be accessed and analyzed, this source has considerable potential for direct observation of illness experiences, although some disadvantages also exist. This reverses an earlier situation where observational research was more laborious than qualitative interviews. Observational material for research purposes is, through the Internet, now easy to obtain and produces naturalistic data.
Dees, M.K.; Vernooij-Dassen, M.J.F.J.; Dekkers, W.J.M.; Elwyn, G.; Vissers, K.C.P.; Weel, C. van
Background: Euthanasia has been legally performed in the Netherlands since 2002. Respect for patient's autonomy is the underpinning ethical principal. However, patients have no right to euthanasia, and physicians have no obligation to provide it. Although over 3000 cases are conducted per year in
Tong, Allison; Sainsbury, Peter; Craig, Jonathan
Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
Klopfer, Fredrick J.; Price, William F.
The study presented was conducted to examine potential relationships between attitudes regarding the dying process, including acceptance of euthanasia, and other attitudinal or demographic attributes. The data of the survey was comprised of responses given by 331 respondents to a door-to-door interview. Results are discussed in terms of preferred…
C. R. Gherardi
Full Text Available Los avances de la medicina en el área tecnológica respecto de la aplicación de métodos de soporte vital en el paciente crítico y las modificaciones culturales que se han operado en la sociedad contemporánea con relación al derecho de los pacientes a decidir sobre el final de sus vidas, hacen imprescindible disponer de una definición de eutanasia que atienda la vigencia de este nuevo escenario. La exclusión de las llamadas formas pasivas y en general de la omisión como procedimiento o conducta posible para la provocación de la muerte y la necesidad de la voluntariedad explícita del paciente delimitarían muy concretamente el concepto de eutanasia. Del mismo modo, una referencia concreta sobre el modo de provocar la muerte debería integrar obligatoriamente su definición. Así, la eutanasia significaría básicamente provocar la muerte de un paciente portador de una enfermedad mortal, a su requerimiento y en su propio beneficio, por medio de la administración de un tóxico o veneno en dosis mortal. Esta definición muy restrictiva separaría la eutanasia de los casos de rechazo de tratamiento, aunque se produjera la muerte como resultado del mismo, y también de las situaciones en que la abstención o el retiro de un soporte vital en el paciente crítico permite la llegada de la muerte.Technological progress in medicine regarding the application of life-sustaining treatment in the critical patient and the cultural changes that have taken place in contemporary society with respect to the patients' right to decide over the end of their lives, demand the existence of a definition of euthanasia that will acknowledge this new scenario. The concept of euthanasia would be very specifically limited by the exclusion of so-called passive forms of euthanasia and of omission as a possible procedure to cause death and the need for the explicit request of the patient involved. Likewise, the definition of euthanasia should include a specific
de Boer, Marike E; Dröes, Rose-Marie; Jonker, Cees; Eefsting, Jan A; Hertogh, Cees M P M
To gain insight into how advance directives for euthanasia affect resident care in Dutch nursing homes. Survey of elderly care physicians and additional qualitative interviews with a selection of elderly care physicians and relatives of people with dementia who had an advance directive for euthanasia. Dutch nursing home practice. Four hundred thirty-four elderly care physicians completed the general part of the questionnaire; 110 physicians provided case histories. Interviews were conducted with 11 physicians and eight relatives. The questionnaire contained general questions about the incidence of advance directives for euthanasia in people with dementia. A second part involved questions about the most recent case of a person with dementia and an advance directive for euthanasia who had died. The interviews with elderly care physicians and relatives focused on further exploration of the decision-making process regarding adherence to the advance directive for euthanasia. Despite law-based possibilities, advance directives for euthanasia of people with dementia were rarely adhered to, although they seem to have a supportive role in setting limitations on life-sustaining treatments. Elderly care physicians and relatives were found to be reluctant to adhere to advance directives for euthanasia. Not being able to engage in meaningful communication played a crucial role in this reluctance. Advance directives for euthanasia are never adhered to in the Netherlands in the case of people with advanced dementia, and their role in advance care planning and end-of-life care of people with advanced dementia is limited. Communication with the patient is essential for elderly care physicians to consider adherence to an advance directive for euthanasia of a person with dementia. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
Full Text Available On the basis of several examples from our longitudinal study "Transitions to Employment," dealing with the shaping of biography of young adults and typical transition-patterns from education to employment, we discuss the use of a text databank in the evaluation of problem-centered interviews. First, we explain the structure of the project's "databank of biographical interviews with young adults" which is founded on a thematic and temporarily differentiating system of categories recording job- and family-related actions and orientations. We present different ways of using the databank in qualitative evaluation. The manner how certain cases and categories of the databank are selected and included in the analysis depends on the objective and the problem's complexity. Our examples show that the use of a databank is an important possibility to support the evaluation of qualitative interviews, facilitating a thematic directed access and thus allowing the handling of data which are particularly extensive. URN: urn:nbn:de:0114-fqs0003183
Monique Sedgwick RN, PhD
Full Text Available Qualitative data collection, especially conducting in-person interviews, presents challenges for researchers whose participants are geographically dispersed. Often alternative means of interviewing using communication technology are necessary. This was true for this focused ethnographic research exploring the experiences of participants who were connected to a particular cultural group by virtue of their similar experience but who were not located in the same geographical area. The purpose of this paper is to present the experience of using videoconferencing technology to collect experiential data from undergraduate nursing students and preceptors who were dispersed over a 640,000 square kilometer area in western and northern Canada during a rural hospital-based preceptorship. Recommendations for using videoconferencing as a medium for conducting in-depth qualitative interviews include using a high-bandwidth connection such as SuperNet or Web conferencing, and evaluating whether the type of information sought is likely to be shared in other than in-person face-to-face situations.
César A. Cisneros Puebla
Full Text Available We present our rationale for this special interview issue. The interview as experienced in everyday life is contrasted with the interview as a critical research tool in qualitative research. In using the qualitative interview ourselves we learn about the professional and intellectual development of those who helped to create the foundations of qualitative research. We learn about qualitative research as a specific field of instruction, as method and theory, as writing, and practice. A discussion of the various types of interviews included in this issue is followed by a discussion of how technological advances will provide us with considerably more interview options in the future. URN: urn:nbn:de:0114-fqs0403370
Jokiniemi, Krista; Haatainen, Kaisa; Pietilä, Anna-Maija
The aim of this study is to describe the factors hindering and facilitating the implementation of the advanced practice registered nurses role at Finnish university hospitals, and to examine the implications for its future development. A descriptive qualitative approach, using thematic individual interviews, was conducted in 2011 with a sample of 11 advanced practice registered nurses. The data were analysed using qualitative content analysis. The advanced practice registered nurses role barriers had an impact on the role development needs. In turn, the facilitating factors helped encounter the challenges of the role, therefore having an impact on both the current role achievement, as well as contributing to the future role development. The factors hindering and facilitating the advanced practice registered nurses role need to be acknowledged to support the role implementation and planning of the future of the role. © 2014 Wiley Publishing Asia Pty Ltd.
Lee, Eun Jin
The purpose of this study was to describe the process and evaluate the effect of positive group psychotherapy and motivational interviewing as an intervention for smoking cessation. A qualitative descriptive study was conducted at a university in South Korea. Positive group psychotherapy and motivational interviewing were attended by 36 smokers for 1 hour once a week, for 6 hours. A recorded exit interview was conducted after the intervention. The resulting transcripts were analyzed with content analysis and thematic analysis. Among the 36 study participants, the importance of stopping smoking was rated higher in the successful cessation (defined as those who ceased smoking for at least 3 months; hereafter, success group) group (8.6 ± 0.4, n = 10) than in the failed cessation (defined as those who did not cease smoking for at least 3 months; hereafter, failure group) group (7.75 ± 0.3, n = 26; p compliments about efforts for smoking cessation." The importance of and confidence in smoking cessation were predictors for successful cessation for 3-6 months. Motivational interviewing increased motivations, whereas positive group psychotherapy increased positive thoughts and confidence.
Kelman, Ilan; Luthe, Tobias; Wyss, Romano; Tørnblad, Silje H; Evers, Yvette; Curran, Marina Martin; Williams, Richard J; Berlow, Eric L
This study integrates quantitative social network analysis (SNA) and qualitative interviews for understanding tourism business links in isolated communities through analysing spatial characteristics. Two case studies are used, the Surselva-Gotthard region in the Swiss Alps and Longyearbyen in the Arctic archipelago of Svalbard, to test the spatial characteristics of physical proximity, isolation, and smallness for understanding tourism business links. In the larger Surselva-Gotthard region, we found a strong relationship between geographic separation of the three communities on compartmentalization of the collaboration network. A small set of businesses played a central role in steering collaborative decisions for this community, while a group of structurally 'peripheral' actors were less influential. By contrast, the business community in Svalbard showed compartmentalization that was independent of geographic distance between actors. Within towns of similar size and governance scale, Svalbard is more compartmentalized, and those compartments are not driven by geographic separation of the collaboration clusters. This compartmentalization in Svalbard was reflected in a lower density of formal business collaboration ties compared to the communities of the Alps. We infer that the difference is due to Svalbard having higher cultural diversity and population turnover than the Alps communities. We propose that integrating quantitative network analysis from simple surveys with qualitative interviews targeted from the network results is an efficient general approach to identify regionally specific constraints and opportunities for effective governance.
Behmann, Mareike; Lückmann, Sara Lena; Schneider, Nils
Improving palliative care is a public health priority. However, little is known about the views of public health experts regarding the state of palliative care in Germany and the challenges facing it. The main aim of this pilot study was to gather information on the views of internationally experienced public health experts with regard to selected palliative care issues, with the focus on Germany, and to compare their views with those of specialist palliative care experts. Qualitative guided interviews were performed with ten experts (five from palliative care, five from public health). The interviews were analysed using qualitative content analysis. Older people and non-cancer patients were identified as target groups with a particular priority for palliative care. By contrast to the public health experts, the palliative care experts emphasized the need for rehabilitative measures for palliative patients and the possibilities of providing these. Significant barriers to the further establishment of palliative care were seen, amongst other things, in the powerful lobby groups and the federalism of the German health system. The findings suggest that from the experts' point of view (1) palliative care should focus on the needs of older people particularly in view of the demographic changes; (2) more attention should be paid to rehabilitative measures in palliative care; (3) rivalries among different stakeholders regarding their responsibilities and the allocation of financial resources have to be overcome in Germany.
Full Text Available Abstract Background Improving palliative care is a public health priority. However, little is known about the views of public health experts regarding the state of palliative care in Germany and the challenges facing it. The main aim of this pilot study was to gather information on the views of internationally experienced public health experts with regard to selected palliative care issues, with the focus on Germany, and to compare their views with those of specialist palliative care experts. Qualitative guided interviews were performed with ten experts (five from palliative care, five from public health. The interviews were analysed using qualitative content analysis. Findings Older people and non-cancer patients were identified as target groups with a particular priority for palliative care. By contrast to the public health experts, the palliative care experts emphasized the need for rehabilitative measures for palliative patients and the possibilities of providing these. Significant barriers to the further establishment of palliative care were seen, amongst other things, in the powerful lobby groups and the federalism of the German health system. Conclusion The findings suggest that from the experts' point of view (1 palliative care should focus on the needs of older people particularly in view of the demographic changes; (2 more attention should be paid to rehabilitative measures in palliative care; (3 rivalries among different stakeholders regarding their responsibilities and the allocation of financial resources have to be overcome in Germany.
Full Text Available This study integrates quantitative social network analysis (SNA and qualitative interviews for understanding tourism business links in isolated communities through analysing spatial characteristics. Two case studies are used, the Surselva-Gotthard region in the Swiss Alps and Longyearbyen in the Arctic archipelago of Svalbard, to test the spatial characteristics of physical proximity, isolation, and smallness for understanding tourism business links. In the larger Surselva-Gotthard region, we found a strong relationship between geographic separation of the three communities on compartmentalization of the collaboration network. A small set of businesses played a central role in steering collaborative decisions for this community, while a group of structurally 'peripheral' actors were less influential. By contrast, the business community in Svalbard showed compartmentalization that was independent of geographic distance between actors. Within towns of similar size and governance scale, Svalbard is more compartmentalized, and those compartments are not driven by geographic separation of the collaboration clusters. This compartmentalization in Svalbard was reflected in a lower density of formal business collaboration ties compared to the communities of the Alps. We infer that the difference is due to Svalbard having higher cultural diversity and population turnover than the Alps communities. We propose that integrating quantitative network analysis from simple surveys with qualitative interviews targeted from the network results is an efficient general approach to identify regionally specific constraints and opportunities for effective governance.
Tijdink, J.K.; Schipper, K.; Bouter, L.M.; Maclaine Pont, P; de Jonge, J.; Smulders, Y.M.
Objective: To investigate the biomedical scientist's perception of the prevailing publication culture. Design: Qualitative focus group interview study. Setting: Four university medical centres in the Netherlands. Participants: Three randomly selected groups of biomedical scientists (PhD,
H.D. Pruijt (Hans)
textabstractInterviewStreamliner is a free, open source, minimalist alternative to complex computer-assisted qualitative data analysis packages. It builds on the flexibility of relational database management technology.
van Tol, Donald G; Rietjens, Judith A C; van der Heide, Agnes
A pivotal due care criterion for lawful euthanasia in the Netherlands is that doctors must be convinced that a patient requesting for euthanasia, suffers unbearably. Our study aims to find out how doctors judge if a patient suffers unbearably. How do doctors bridge the gap from 3rd person assessment to 1st person experience? We performed a qualitative interview study among 15 physicians, mainly general practitioners, who participated earlier in a related quantitative survey on the way doctors apply the suffering criterion. Results show that doctors follow different 'cognitive routes' when assessing a patients suffering in the context of a euthanasia request. Sometimes doctors do this imagining how she herself would experience the situation of the patient ('imagine self'). Doctors may also try to adopt the perspective of the patient and imagine what the situation is like for this particular patient ('imagine other'). Besides this we found that the (outcome of the) assessment is influenced by a doctor's private norms, values and emotions considering (the performance of) euthanasia. We conclude by arguing why doctors should be aware of both the 'cognitive route' followed as well as the influence of their own personal norms on the assessment of suffering in the context of euthanasia requests. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem. This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.
Cope, A L; Wood, F; Francis, N A; Chestnutt, I G
Dentists are responsible for 9-10% of all antibiotics dispensed in primary care in the UK, many of which may be provided contrary to clinical guidelines. Since antibiotic consumption has been identified as a major cause of antibiotic resistance, dental prescribing may be a significant contributor to this important public health problem.Objective This study aims to explore general dental practitioners' (GDPs) perceptions and attitudes towards antibiotic use and resistance. Qualitative interview study with 19 purposively sampled GDPs working in Wales. A set of open-ended questions were developed and amended during semi-structured telephone interviews. Interviews were recorded, transcribed verbatim and codes were developed using thematic analysis. Perceptions of antibiotic use and resistance varied widely between practitioners, particularly with respect to the prevalence and impact of resistant strains on the management of dentoalveolar infection, and the impact of dental prescribing on the emergence of resistance. GDPs reported that their antibiotic prescribing decisions were driven by both clinical pressures and wider public health considerations. Interventions to enhance the quality of antibiotic prescribing in primary care dentistry should address issues associated with inappropriate prescribing as well as providing education about the causes, prevalence and impact of antibiotic resistance.
Conclusions: The findings of this unique historical-prospective qualitative analysis of interviews performed before the onset of psychosis, confirmed previous findings of premorbid abnormality of future non-affective psychosis patients. Using qualitative analysis enabled obtaining a more in-depth understanding of the real-life experience of the premorbid period among patients with non-affective psychotic disorders.
Macé, Sandrine; Oppert, Jean-Michel
Background The prevalence of noncommunicable diseases, including those such as type 2 diabetes, obesity, dyslipidemia, and hypertension, so-called cardiometabolic diseases, is high and is increasing worldwide. Strong evidence supports the role of physical activity in management of these diseases. There is general consensus that mHealth technology, including electronic activity monitors, can potentially increase physical activity in patients, but their use in clinical settings remains limited. Practitioners’ requirements when prescribing electronic activity monitors have been poorly described. Objective The aims of this qualitative study were (1) to explore how specialist physicians prescribe electronic activity monitors to patients presenting with cardiometabolic conditions, and (2) to better understand their motivation for and barriers to prescribing such monitors. Methods We conducted qualitative semistructured interviews in March to May 2016 with 11 senior physicians from a public university hospital in France with expertise in management of cardiometabolic diseases (type 1 and type 2 diabetes, obesity, hypertension, and dyslipidemia). Interviews lasted 45 to 60 minutes and were audiotaped, transcribed verbatim, and analyzed using directed content analysis. We report our findings following the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Most physicians we interviewed had never prescribed electronic activity monitors, whereas they frequently prescribed blood glucose or blood pressure self-monitoring devices. Reasons for nonprescription included lack of interest in the data collected, lack of evidence for data accuracy, concern about work overload possibly resulting from automatic data transfer, and risk of patients becoming addicted to data. Physicians expected future marketing of easy-to-use monitors that will accurately measure physical activity duration and intensity and provide understandable motivating feedback
Buurman, M.B.R.; Lagro-Janssen, A.L.M.
Scand J Caring Sci; 2013; 27; 406-413 Women's perception of postpartum pelvic floor dysfunction and their help-seeking behaviour: a qualitative interview study Aims: To explore women's perception of postpartum pelvic floor dysfunction and their help-seeking behaviour. Methods: We interviewed 26
In February 2014 the Belgian parliament voted to extend the existing euthanasia law to cover children under the age of 18. The law sanctions euthanasia for children with terminal or incurable conditions who are near death, suffering 'constant and unbearable pain', and whose parents and health professionals agree with the decision. The child also has to be interviewed by a psychologist or psychiatrist to ascertain and certify their 'capacity of discernment'.
Frich, J.C.; Malterud, K.; Fugelli, P.
OBJECTIVE: To explore how patients at risk of coronary heart disease (CHD) portray candidates for CHD. DESIGN: Qualitative interview study. SETTING: Norway. SUBJECTS: A total of 20 men and 20 women diagnosed with heterozygous familial hypercholesterolemia (FH) recruited through a lipid clinic. MAIN...... OUTCOME MEASURES: Participants' beliefs concerning persons who are considered candidates for CHD. RESULTS: Some participants believed that CHD could happen to anyone, while the majority conveyed detailed notions of persons they considered to be likely victims of CHD. Participants often portrayed...... the coronary candidate as someone who was different from themselves. Among those who mentioned gender, all presented the candidate as a man. Some women said that they had to reconcile themselves to being at risk of CHD, since they at first had conceived CHD as a man's disease. While some participants...
Leask, Julie; Jackson, Cath; Trevena, Lyndal; McCaffery, Kirsten; Brotherton, Julia
This study sought to evaluate the early implementation of Australia's national HPV vaccination program for adult women aged 18-26 years. We conducted qualitative in-depth interviews with 24 program managers and primary care providers in key roles of implementation across the country. While participants had generally positive beliefs about the vaccine, some questioned the cost-effectiveness for women aged 18-26 years. A short timeframe for implementing a unique and complex program raised particular challenges including ensuring providers and consumers received timely access to information. Media attention helped and hindered implementation. Existing primary care systems and close coordination between players helped overcome these issues. Although challenging, delivery of HPV vaccination to adult women is achievable and the Australian experience provides useful information for countries commencing HPV vaccination programs in this population.
Nashid, Tanzina; Olsson, Pia
Menstrual regulation (MR) programmes were introduced in Bangladesh in 1974 to reduce morbidity and mortality due to unsafe abortions. About 468,000 MR procedures are performed annually, and its potential is not fully used. To develop MR programmes, the voices of women could add important aspects to its acceptability. This qualitative interview study aimed to explore and describe the perceptions about MR in a sample of women from Dhaka, Bangladesh. The most prominent perception was that, despite the moral dilemma inherent in terminating pregnancies, MR was highly valued as a solution in problematic life situations. However, unprofessional attitudes and misconduct among MR providers were revealed, and there was also a lack of knowledge and openness in families. To improve the quality of MR services, professional ethics needs to be highlighted in training and supervision of providers. To improve the acceptability of MR, education on the benefits of MR has to be made available to the whole population.
Sposato, Niklas S; Bjerså, Kristofer
Assessment in manual therapy includes quantitative and qualitative procedures, and intervertebral motion palpation (IMP) is one of the core assessment methods in osteopathic practice. The aim of this study was to explore osteopathic practitioners' experiences of clinical decision-making and IMP as a diagnostic tool for planning and evaluation of osteopathic interventions. The study was conducted with semi-structured interviews that included eight informants. Content analysis was used as the analytical procedure. In total, three categories emerged from the analysis: strategic decision-making, diagnostic usability of IMP, and treatment applicability of IMP. The study indicated that IMP was considered relevant and was given particular importance in cases where IMP findings confirmed clinical information attained from other stages in the diagnostic process as a whole. However, IMP findings were experienced as less important if they were not correlated to other findings. Copyright © 2016 Elsevier Ltd. All rights reserved.
Olsson, Pia; Wijewardena, Kumudu
In Sri Lanka pregnancy termination is very restricted by law and social norms. Premarital sex, and pregnancies are not generally accepted and unmarried pregnant women are vulnerable in their decision-making on pregnancy termination. The objective of this study was to describe the circumstances of becoming pregnant and factors considered in the decision-making for seeking pregnancy termination in a sample of unmarried women in Colombo, Sri Lanka. Individual qualitative interviews were conducted with 19 unmarried women seeking pregnancy terminations at a reproductive health centre in Colombo, Sri Lanka. The interviews were later analysed using qualitative content analysis. Becoming pregnant in a love relationship was predominant in this sample. Awareness of contraceptives varied and initial reaction to the pregnancy involved strong contradictory emotions. Multiple interrelated factors were considered in the decision-making for termination. Family pressure was the most prominent factor followed by the partner's qualities and attitude towards the pregnancy, economic factors and own feelings, values and future fertility. The women described that their own emotional, religious and economic reasons for continuing the pregnancy were often outweighed by their responsibility to the family, male partner and unborn child. These unmarried women's sexual and reproductive rights were limited and for many the pregnancy termination was socially unsafe. They found themselves at the interface of two value systems. Modern values allow for relationships with men prior to marriage; whereas, traditional values did not. The limited possibilities to prevent pregnancies and little hope for support if continuing the pregnancy; made women seek pregnancy termination despite own doubts. Copyright © 2010 Elsevier B.V. All rights reserved.
Jordal, Malin; Wijewardena, Kumudu; Olsson, Pia
In Sri Lanka, motherhood within marriage is highly valued. Sex out of wedlock is socially unacceptable and can create serious public health problems such as illegal abortions, suicide and infanticide, and single motherhood as a result of premarital sex is considered shameful. The way unmarried women facing single motherhood reflect on and make use of their agency in their social environments characterised by limited social and financial support has consequences for the health and well-being of both themselves and their children. The aim of this study was to explore and describe how unmarried women facing single motherhood in Sri Lanka handle their situation. This qualitative study comprised semi-structured interviews with 28 unmarried pregnant women or single mothers. The data were analysed by qualitative content analysis and the results related to the conceptual framework of social navigation. The women facing single motherhood expressed awareness of having trespassed norms of sexuality through self-blame, victimhood and obedience, and by considering or attempting suicide. They demonstrated willingness to take responsibility for becoming pregnant before marriage by giving the child up for adoption, bringing up the child themselves, claiming a father for their child, refraining from marriage in the future, permanently leave their home environment, and taking up employment. Throughout the interviews, the women expressed fear of shame, and striving for familial and societal acceptance and financial survival. A social environment highly condemning of unmarried motherhood hindered these women from making strategic choices on how to handle their situation. However, to achieve acceptance and survival, the women tactically navigated norms of femininity, strong family dependence, a limited work market, and different sources of support. Limited access to resources restricted the women's sexual and reproductive health and rights, including their ability to make acceptable
71 8. Summary- Euthanasia and criminal law Euthanasia is often regarded as a controversial topic that is being discussed all around the world. The legislative rules differ among the countries to various extent. The scope of this work is to offer a summary of legal regulations in euthanasia, particulary in the area of criminal law and a several examples of these regulations in Europe, USA and Australia. In the first chapter, the term of euthanasia is defined which is necessary for the purpose ...
Salloch, Sabine; Otte, Ina; Reinacher-Schick, Anke; Vollmann, Jochen
Physicians' clinical expertise forms an exclusive body of competences, which helps them to find the appropriate diagnostics and treatment for each individual patient. Empirical evidence, however, suggests that there is an inverse relationship between the number of years in practice and the quality of care provided by a physician. Knowledge and adherence to professional standards (such as clinical guidelines) are often used as indicators in previous research. Semistructured interviews and the Q method were used for an explorative study on oncologists' views on the interplay between their own clinical expertise, intuition, and the external evidence incorporated in clinical guidelines. The interviews were audio recorded, transcribed ad verbatim, and analysed using qualitative content analysis. Data analysis shows the complex character of clinical expertise with respect to experience, professional development, and intuition. An irreplaceable role is attributed to personal and bodily experience during the providing of care for a patient. Professional experience becomes important, particularly in those situations that lie out of the focus of "guideline medicine." Intuition is regarded as having a strong emotional component and helps for deciding which therapeutic option the patient can deal with. Using measurable knowledge and adherence to standards as indicators does not account for the complexity of clinical expertise. Other factors, such as the importance of bodily experience and physicians' intuitive knowledge, must be considered, also with respect to the occurrence of treatment biases. © 2017 John Wiley & Sons, Ltd.
Schantz Laursen, Birgitte
Prostate cancer affects a growing number of men. Although erectile dysfunction is a well-known side effect, its impact on sex life and sexuality is under-researched. The aim of this study was therefore to elucidate the effect of surgical treatment for prostate cancer on men's sexuality. Data for the descriptive qualitative study were collected in interviews. The author applied a phenomenological-hermeneutic frame of understanding. Four themes appeared in the analysis of the interviews: lack of control, sense of self, intimate relations and redefining sexuality. Men experience erectile dysfunction as a negative influence on their sexuality with respect to their sex life, sense of self and intimate relations. The dysfunction is thus shown not only to affect sexual life but also to have repercussions for a range of aspects in male intimate life. A broader perspective should be applied in supporting the men's efforts towards improving their quality of life, for example through sexual counselling services performed by nurses. © 2016 Nordic College of Caring Science.
Kilander, Helena; Salomonsson, Birgitta; Thor, Johan; Brynhildsen, Jan; Alehagen, Siw
A substantial proportion of women who undergo an abortion continue afterwards without switching to more effective contraceptive use. Many subsequently have repeat unintended pregnancies. This study, therefore, aimed to identify and describe health professionalś experiences of providing contraceptive counselling to women seeking an abortion. We interviewed 21 health professionals (HPs), involved in contraceptive counselling of women seeking abortion at three differently sized hospitals in Sweden. The interviews were recorded and transcribed verbatim and analysed using conventional qualitative content analysis. Three clusters were identified: 'Complex counselling', 'Elements of counselling' and 'Finding a method'. HPs often experienced consultations including contraceptive counselling at the time of an abortion as complex, covering both pregnancy termination and contraceptive counselling. Women with vulnerabilities placed even greater demands on the HPs providing counselling. The HPs varied in their approaches when providing contraceptive counselling but also in their knowledge about certain contraception methods. HPs described challenges in finding out if women had found an effective method and in the practicalities of arranging intrauterine device (IUD) insertion post-abortion, when a woman asked for this method. HPs found it challenging to provide contraceptive counselling at the time of an abortion and to arrange access to IUDs post-abortion. There is a need to improve their counselling, their skills and their knowledge to prevent repeat unintended pregnancies.
Hoddinott, Pat; Craig, Leone C A; Britten, Jane; McInnes, Rhona M
To investigate the infant feeding experiences of women and their significant others from pregnancy until 6 months after birth to establish what would make a difference. Qualitative serial interview study. Two health boards in Scotland. 72 of 541 invited pregnant women volunteered. 220 interviews approximately every 4 weeks with 36 women, 26 partners, eight maternal mothers, one sister and two health professionals took place. The overarching theme was a clash between overt or covert infant feeding idealism and the reality experienced. This is manifest as pivotal points where families perceive that the only solution that will restore family well-being is to stop breast feeding or introduce solids. Immediate family well-being is the overriding goal rather than theoretical longer term health benefits. Feeding education is perceived as unrealistic, overly technical and rules based which can undermine women's confidence. Unanimously families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at 3-4 months when solids are being considered. Family-orientated interactive discussions are valued above breastfeeding-centred checklist style encounters. Adopting idealistic global policy goals like exclusive breast feeding until 6 months as individual goals for women is unhelpful. More achievable incremental goals are recommended. Using a proactive family-centred narrative approach to feeding care might enable pivotal points to be anticipated and resolved. More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality.
Mesman, R; Faber, M J; Westert, G P; Berden, H J J M
To contribute to a better understanding of volume-outcome relationships in surgery by exploring Dutch surgeons' views on the underlying mechanism. A qualitative study based on face-to-face semi structured interviews and an inductive content analysis approach. Interviews were conducted in eight hospitals in the Netherlands (2 university, 4 teaching and 2 general). Twenty surgeons (gastrointestinal, vascular and trauma). Dutch surgeons' views on volume-outcome relationships in surgery and the underlying mechanism. The majority of surgeons believed volume is related to outcomes after surgery. Interviewees highlighted the importance of both focus and skills when describing the underlying mechanism. Focus was visible on three levels: hospital, surgeon and team. Focus on a hospital level referred to investing in specific infrastructure and dedicated personnel. Surgeons described both the benefits and downsides of surgeons' increased focus to a certain surgical subspeciality. And their experiences on the importance of working with fixed, procedure-specific teams. The positive influence of caseload on technical and nontechnical skills was acknowledged, as well as the benefits of combining skills by operating together. Although a basic skill set should be maintained, this does not necessarily require high volume. Focus and skills are important explanatory factors in volume-outcome relationships according to Dutch surgeons. This suggests that both high- and low-volume providers should enable specialized, fixed teams for complex surgeries and focus on maintenance of both their technical and nontechnical skills. By uncovering the underlying mechanism, imperfect quality indicators such as volume can be supplemented or replaced.
Benedicte Lind Barfoed
Full Text Available Objective. General practitioners’ (GPs’ perception of risk is a cornerstone of preventive care. The aims of this interview study were to explore GPs’ professional and personal attitudes and experiences regarding treatment with lipid-lowering drugs and their views on patient compliance. Methods. The material was drawn from semistructured qualitative interviews. We sampled GPs purposively from ten selected practices, ensuring diversity of demographic, professional, and personal characteristics. The GPs were encouraged to describe examples from their own practices and reflect on them and were informed that the focus was their personal attitudes and experiences. Systematic text condensation was applied for analysis in order to uncover the concepts and themes. Results. The analysis revealed the following 3 main themes: (1 use of cardiovascular guidelines and risk assessment tools, (2 strategies for managing patient compliance, and (3 GPs’ own risk management. There were substantial differences in the attitudes concerning all three themes. Conclusions. The substantial differences in the GPs’ personal and professional risk perceptions may be a key to understanding why GPs do not always follow cardiovascular guidelines. The impact on daily clinical practice, personal consultation style, and patient behaviour with regard to prevention is worth studying further.
Borràs Josep M
Full Text Available Abstract Background The Spanish National Health System recognised multidisciplinary care as a health priority in 2006, when a national strategy for promoting quality in cancer care was first published. This institutional effort is being implemented on a co-operative basis within the context of Spain's decentralised health care system, so a high degree of variability is to be expected. This study was aimed to explore the views of professionals working with multidisciplinary cancer teams and identify which barriers to effective team work should be considered to ensure implementation of health policy. Methods Qualitative interview study with semi-structured, one-to-one interviews. Data were examined inductively, using content analysis to generate categories and an explanatory framework. 39 professionals performing their tasks, wholly or in part, in different multidisciplinary cancer teams were interviewed. The breakdown of participants' medical specialisations was as follows: medical oncologists (n = 10; radiation oncologists (n = 8; surgeons (n = 7; pathologists or radiologists (n = 6; oncology nurses (n = 5; and others (n = 3. Results Teams could be classified into three models of professional co-operation in multidisciplinary cancer care, namely, advisory committee, formal co-adaptation and integrated care process. The following barriers to implementation were posed: existence of different gateways for the same patient profile; variability in development and use of clinical protocols and guidelines; role of the hospital executive board; outcomes assessment; and the recording and documenting of clinical decisions in a multidisciplinary team setting. All these play a key role in the development of cancer teams and their ability to improve quality of care. Conclusion Cancer team development results from an specific adaptation to the hospital environment. Nevertheless, health policy plays an important role in promoting an organisational approach
Full Text Available Obesity in Sweden has doubled to 14% over the last 20 years. New strategies for treatment and prevention are needed. Excessive gestational weight gain has been found to contribute substantially to obesity, and there is a consistent association between postpartum weight retention and obesity later in life. We aimed to explore what factors women perceive as reasons for having substantial postpartum weight retention, to identify areas for new and improved interventions.Qualitative interview study (semi-structured using an emergent design. Fifteen women, with a postpartum weight retention ≥ 10 kg, were interviewed by a trained cognitive therapist. Eight women had pre-pregnancy BMI below 30 kg/m2. Interviews were transcribed verbatim and data analysed using inductive manifest content analysis. Salient text passages were extracted, shortened, coded and clustered into categories.Participants reported no knowledge of current gestational weight gain recommendations or of risks for adverse pregnancy outcomes with excessive weight gain or postpartum weight retention. Excessive eating emerged as a common strategy to provide relief of psychological, emotional and physical discomfort, such as depression and morning sickness. Women perceived medical staff as being unconcerned about weight, and postpartum weight loss support was scarce or absent. Some women reported eating more due to a belief that breastfeeding would automatically lead to weight loss.There is a need to raise awareness about risks with unhealthy gestational weight development and postpartum weight retention in women of childbearing age. The common strategy to cope with psychological, emotional or physical discomfort by eating is an important factor to target with intervention. The postpartum year is a neglected period where additional follow-up on weight and weight loss support is strongly indicated.
Ghekiere, Ariane; Van Cauwenberg, Jelle; de Geus, Bas; Clarys, Peter; Cardon, Greet; Salmon, Jo; De Bourdeaudhuij, Ilse; Deforche, Benedicte
Environmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood. Purposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi-) urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library) within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach. The discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (in)directly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities. Road safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.
Full Text Available BACKGROUND: Environmental factors are found to influence transport-related physical activity, but have rarely been studied in relation with cycling for transport to various destinations in 10-12 yr old children. The current qualitative study used 'bike-along interviews' with children and parents to allow discussion of detailed environmental factors that may influence children's cycling for transport, while cycling in the participant's neighborhood. METHODS: Purposeful convenience sampling was used to recruit 35 children and one of their parents residing in (semi- urban areas. Bike-along interviews were conducted to and from a randomly chosen destination (e.g. library within a 15 minutes' cycle trip in the participant's neighborhood. Participants wore a GoPro camera to objectively assess environmental elements, which were subsequently discussed with participants. Content analysis and arising themes were derived using a grounded theory approach. RESULTS: The discussed environmental factors were categorized under traffic, urban design, cycling facilities, road design, facilities at destination, aesthetics, topography, weather, social control, stranger danger and familiar environment. Across these categories many environmental factors were (indirectly linked to road safety. This was illustrated by detailed discussions of the children's visibility, familiarity with specific traffic situations, and degree of separation, width and legibility of cycle facilities. CONCLUSION: Road safety is of major concern in this 10-12 yr old study population. Bike-along interviews were able to identify new, detailed and context-specific physical environmental factors which could inform policy makers to promote children's cycling for transport. However, future studies should investigate whether hypothetical changes to such micro environmental features influence perceptions of safety and if this in turn could lead to changes in children's cycling for transport.
Merriweather, Judith; Smith, Pam; Walsh, Timothy
To compare and contrast current nutritional rehabilitation practices against recommendations from National Institute for Health and Excellence guideline Rehabilitation after critical illness (NICE) (2009, http://www.nice.org.uk/cg83). Recovery from critical illness has gained increasing prominence over the last decade but there is remarkably little research relating to nutritional rehabilitation. The study is a qualitative study based on patient interviews and observations of ward practice. Seventeen patients were recruited into the study at discharge from the intensive care unit (ICU) of a large teaching hospital in central Scotland in 2011. Semi-structured interviews were conducted on transfer to the ward and weekly thereafter. Fourteen of these patients were followed up at three months post-ICU discharge, and a semi-structured interview was carried out. Observations of ward practice were carried out twice weekly for the duration of the ward stay. Current nutritional practice for post-intensive care patients did not reflect the recommendations from the NICE guideline. A number of organisational issues were identified as influencing nutritional care. These issues were categorised as ward culture, service-centred delivery of care and disjointed discharge planning. Their influence on nutritional care was compounded by the complex problems associated with critical illness. The NICE guideline provides few nutrition-specific recommendations for rehabilitation; however, current practice does not reflect the nutritional recommendations that are detailed in the rehabilitation care pathway. Nutritional care of post-ICU patients is problematic and strategies to overcome these issues need to be addressed in order to improve nutritional intake. © 2013 John Wiley & Sons Ltd.
Butterworth, Jo; Sansom, Anna; Sims, Laura; Healey, Mark; Kingsland, Ellie; Campbell, John
UK general practice is experiencing a workload crisis. Pharmacists are the third largest healthcare profession in the UK; however, their skills are a currently underutilised and potentially highly valuable resource for primary health care. This study forms part of the evaluation of an innovative training programme for pharmacists who are interested in extended roles in primary care, advocated by a UK collaborative '10-point GP workforce action plan'. To explore pharmacists' perceptions of primary care roles including the potential for greater integration of their profession into general practice. A qualitative interview study in UK primary care carried out between October 2015 and July 2016. Pharmacists were purposively sampled by level of experience, geographical location, and type of workplace. Two confidential semi-structured telephone interviews were conducted - one before and one after the training programme. A constant comparative, inductive approach to thematic analysis was used. Sixteen participants were interviewed. The themes related to: initial expectations of the general practice role, varying by participants' experience of primary care; the influence of the training course with respect to managing uncertainty, critical appraisal skills, and confidence for the role; and predictions for the future of this role. There is enthusiasm and willingness among pharmacists for new, extended roles in primary care, which could effectively relieve GP workload pressures. A definition of the role, with examples of the knowledge, skills, and attributes required, should be made available to pharmacists, primary care teams, and the public. Training should include clinical skills teaching, set in context through exposure to general practice, and delivered motivationally by primary care practitioners. © British Journal of General Practice 2017.
McInnes, Rhona J; Hoddinott, Pat; Britten, Jane; Darwent, Kirsty; Craig, Leone C A
Exclusive breastfeeding until six months followed by the introduction of solids and continued breastfeeding is recommended by the World Health Organisation. The dominant approach to achieving this has been to educate and support women to start and continue breastfeeding rather than understanding behaviour change processes from a broader perspective. Serial qualitative interviews examined the influences of significant others on women's feeding behaviour. Thirty-six women and 37 nominated significant others participated in 220 interviews, conducted approximately four weekly from late pregnancy to six months after birth. Responses to summative structured questions at the end of each interview asking about significant influences on feeding decisions were compared and contrasted with formative semi-structured data within and between cases. Analysis focused on pivotal points where behaviour changed from exclusive breastfeeding to introducing formula, stopping breastfeeding or introducing solids. This enabled us to identify processes that decelerate or accelerate behaviour change and understand resolution processes afterwards. The dominant goal motivating behaviour change was family wellbeing, rather than exclusive breastfeeding. Rather than one type of significant other emerging as the key influence, there was a complex interplay between the self-baby dyad, significant others, situations and personal or vicarious feeding history. Following behaviour change women turned to those most likely to confirm or resolve their decisions and maintain their confidence as mothers. Applying ecological models of behaviour would enable health service organisation, practice, policy and research to focus on enhancing family efficacy and wellbeing, improving family-centred communication and increasing opportunities for health professionals to be a constructive influence around pivotal points when feeding behaviour changes. A paradigm shift is recommended away from the dominant approach of
Walshe, Catherine; Roberts, Diane; Appleton, Lynda; Calman, Lynn; Large, Paul; Lloyd-Williams, Mari; Grande, Gunn
To understand successful strategies used by people to cope well when living with advanced cancer; to explore how professionals can support effective coping strategies; to understand how to support development of effective coping strategies for patients and family carers. Qualitative serial (4-12 week intervals) interview study with people with advanced cancer and their informal carers followed by focus groups. The iterative design had a novel focus on positive coping strategies. Interview analysis focused on patients and carers as individuals and pairs, exploring multiple dimensions of their coping experiences. Focus group analysis explored strategies for intervention development. 26 people with advanced (stage 3-4) breast, prostate, lung or colorectal cancer, or in receipt of palliative care, and 24 paired nominated informal/family carers. Participants recruited through outpatient clinics at two tertiary cancer centres in Merseyside and Manchester, UK, between June 2012 and July 2013. 45 patient and 41 carer interviews were conducted plus 4 focus groups (16 participants). People with advanced cancer and their informal/family carers develop coping strategies which enable effective management of psychological wellbeing. People draw from pre-diagnosis coping strategies, but these develop through responding to the experience of living with advanced cancer. Strategies include being realistic, indulgence, support, and learning from others, which enabled participants to regain a sense of wellbeing after emotional challenge. Learning from peers emerged as particularly important in promoting psychological wellbeing through the development of effective 'everyday', non-clinical coping strategies. Our findings challenge current models of providing psychological support for those with advanced cancer which focus on professional intervention. It is important to recognise, enable and support peoples' own resources and coping strategies. Peer support may have potential, and could
Kimbell, Barbara; Boyd, Kirsty; Kendall, Marilyn; Iredale, John; Murray, Scott A
To understand the experiences and support needs of people with advanced liver disease and those of their lay and professional carers to inform improvements in the supportive and palliative care of this rapidly growing but currently neglected patient group. Multiperspective, serial interviews. We conducted up to three qualitative in-depth interviews with each patient and lay carer over 12 months and single interviews with case-linked healthcare professionals. Data were analysed using grounded theory techniques. Patients with advanced liver disease of diverse aetiologies recruited from an inpatient hepatology ward, and their lay carers and case-linked healthcare professionals nominated by the patients. Primary and secondary care in South-East Scotland. 37 participants (15 patients, 11 lay and 11 professional carers) completed 51 individual and 13 joint patient-carer interviews. Nine patients died during the study. Uncertainty dominated experiences throughout the course of the illness, across patients' considerable physical, psychological, social and existential needs and affected patients, lay carers and professionals. This related to the nature of the condition, the unpredictability of physical deterioration and prognosis, poor communication and information-sharing, and complexities of care. The pervasive uncertainty also shaped patients' and lay carers' strategies for coping and impeded care planning. While patients' acute medical care was usually well coordinated, their ongoing care lacked structure and focus. Living, dying and caring in advanced liver disease is dominated by pervasive, enduring and universally shared uncertainty. In the face of high levels of multidimensional patient distress, professionals must acknowledge this uncertainty in constructive ways that value its contribution to the person's coping approach. Pervasive uncertainty makes anticipatory care planning in advanced liver disease challenging, but planning 'just in case' is vital to ensure
Brigham, J C; Pfeifer, J E
It has been argued that euthanasia is one of the most pressing social concerns of our times. A review of current scientific and legal materials, however, indicates that this issue is a complex and contentious one that crosses numerous perspectives and theoretical orientations. In order to provide background for the other articles in this collection, we present a brief history of attitudes toward euthanasia. In addition, various terms that are associated with the concept of euthanasia are defined. Finally, this paper provides a framework for the articles that follow by suggesting that three central issues must be addressed in order to resolve the controversies surrounding euthanasia. These are (1) the establishment of standardized criteria of euthanasia eligibility, (2) the investigation of public attitudes regarding acceptable means for engaging in euthanasia, and (3) the evaluation of the roles of professionals who are directly involved in euthanasia decisions. We hope that the following articles will provide insight into these issues.
Full Text Available Despite evidence suggesting that skills training is an important mechanism of change in dialectical behaviour therapy, little research exploring facilitators and barriers to this process has been conducted. The study aimed to explore clients' experiences of barriers to dialectical behaviour therapy skills training and how they felt they overcame these barriers, and to compare experiences between treatment completers and dropouts. In-depth qualitative interviews were conducted with 40 clients with borderline personality disorder who had attended a dialectical behaviour therapy programme. A thematic analysis of participants' reported experiences found that key barriers to learning the skills were anxiety during the skills groups and difficulty understanding the material. Key barriers to using the skills were overwhelming emotions which left participants feeling unable or unwilling to use them. Key ways in which participants reported overcoming barriers to skills training were by sustaining their commitment to attending therapy and practising the skills, personalising the way they used them, and practising them so often that they became an integral part of their behavioural repertoire. Participants also highlighted a number of key ways in which they were supported with their skills training by other skills group members, the group therapists, their individual therapist, friends and family. Treatment dropouts were more likely than completers to describe anxiety during the skills groups as a barrier to learning, and were less likely to report overcoming barriers to skills training via the key processes outlined above. The findings of this qualitative study require replication, but could be used to generate hypotheses for testing in further research on barriers to skills training, how these relate to dropout, and how they can be overcome. The paper outlines several such suggestions for further research.
Young, Timothy P; Brown, Madison M; Reibling, Ellen T; Ghassemzadeh, Sassan; Gordon, Dawn M; Phan, Tammy H; Thomas, Tamara L; Brown, Lance
In 2001, less than 20% of emergency medicine residents had more than $150,000 of educational debt. Our emergency medicine residents anecdotally reported much larger debt loads. Surveys have reported that debt affects career and life choices. Qualitative approaches are well suited to explore how and why such complex phenomena occur. We aim to gain a better understanding of how our emergency medicine residents experience debt. We conducted individual semistructured interviews with emergency medicine residents. We collected self-reported data related to educational debt and asked open-ended questions about debt influence on career choices, personal life, future plans, and financial decisions. We undertook a structured thematic analysis using a qualitative approach based in the grounded theory method. Median educational debt was $212,000. Six themes emerged from our analysis: (1) debt influenced career and life decisions by altering priorities; (2) residents experienced debt as a persistent source of background stress and felt powerless to change it; (3) residents made use of various techniques to negotiate debt in order to focus on day-to-day work; (4) personal debt philosophy, based on individual values and obtained from family, shaped how debt affected each individual; (5) debt had a normative effect and was acculturated in residency; and (6) residents reported a wide range of financial knowledge, but recognized its importance to career success. Our emergency medicine residents' debt experience is complex and involves multiple dimensions. Given our current understanding, simple solutions are unlikely to be effective in adequately addressing this issue. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
Kangasniemi, Mari; Blomberg, Katja; Korhonen, Anne
to describe mothers' perceptions of their health choices, related duties and responsibilities. descriptive exploratory study with qualitative research method. interviews conducted after the clients' regular health visits to one publicly provided maternity clinic in a southern city in Finland. 13 mothers aged between 21 and 40-years-old, who were pregnant or had given birth in the past four weeks. Six of participants were pregnant or had delivered for first time and it was the second to fourth pregnancy for the remainder. one-to-one semi-structured interviews using the inductive content analysis method. women reported increased responsibility for their health choices for themselves and their baby during pregnancy. However, their duties and responsibilities were seldom discussed at maternity clinics. The duty to reconsider their health choices was described as a predictor of commitment to their pregnancy and motherhood, but they recognised that it required sufficient knowledge to realise this. In addition, the mothers said their health choices changed from private to one of public interest during this period. health choices are connected to maternal duties and responsibilities, but they can sometimes lack clarity during this new phase of life. In future, more research should be conducted to study maternal duties and responsibilities in different contexts. findings highlight the skills of nurses and midwives at maternity clinics to discuss and support mothers' moral pondering during pregnancy. Although health choices in general are well recognised as a part of maternal counselling, these findings suggest a moral perspective should be incorporated into the advice that is provided. Copyright © 2015 Elsevier Ltd. All rights reserved.
Craig, Leone C A; Britten, Jane; McInnes, Rhona M
Objective To investigate the infant feeding experiences of women and their significant others from pregnancy until 6 months after birth to establish what would make a difference. Design Qualitative serial interview study. Setting Two health boards in Scotland. Participants 72 of 541 invited pregnant women volunteered. 220 interviews approximately every 4 weeks with 36 women, 26 partners, eight maternal mothers, one sister and two health professionals took place. Results The overarching theme was a clash between overt or covert infant feeding idealism and the reality experienced. This is manifest as pivotal points where families perceive that the only solution that will restore family well-being is to stop breast feeding or introduce solids. Immediate family well-being is the overriding goal rather than theoretical longer term health benefits. Feeding education is perceived as unrealistic, overly technical and rules based which can undermine women's confidence. Unanimously families would prefer the balance to shift away from antenatal theory towards more help immediately after birth and at 3–4 months when solids are being considered. Family-orientated interactive discussions are valued above breastfeeding-centred checklist style encounters. Conclusions Adopting idealistic global policy goals like exclusive breast feeding until 6 months as individual goals for women is unhelpful. More achievable incremental goals are recommended. Using a proactive family-centred narrative approach to feeding care might enable pivotal points to be anticipated and resolved. More attention to the diverse values, meanings and emotions around infant feeding within families could help to reconcile health ideals with reality. PMID:22422915
Horne, Jane; Lincoln, Nadina Berrice; Preston, Jenny; Logan, Pip
To explore the meaning of confidence to stroke patients after stroke in order to inform the development of a measurement tool. Qualitative interview study using interpretative phenomenological analysis (IPA). Ten stroke survivors were purposively selected from those participating in a multi-centre randomised trial of outdoor mobility rehabilitation. Interviews about confidence were conducted in participants' homes, audio recorded and transcribed verbatim. Six themes emerged from the analysis. These were loss of identity, fear, social confidence, role confidence, mastering skill and attitudes and beliefs. Loss of identity was particularly evident in the early stages of stroke recovery. Fear was a barrier to regaining confidence and was associated with avoidance behaviours. Lack of social confidence was a common problem which appeared difficult to resolve. Life roles motivated participants to re-engage in daily life activities. Personal attitudes and beliefs, combined with the attitudes of significant others, contributed to personal feelings of competence. This study provides a coherent definition of the meaning of confidence through the experiences of stroke survivors. Being successful in gradually re-engaging in activities, including social activities and life roles helped to establish a positive self-belief. The influence of others, such as family and friends reinforce self-beliefs. Confidence and self-efficacy appear to be a similar construct. However, participants in this study also identified a relationship between confidence and self-esteem. The findings indicate that all six themes need to be included in a confidence measure to encompass the meaning of confidence as described by participants with stroke. © The Author(s) 2014.
Kouwenhoven, Pauline S C; Raijmakers, Natasja J H; van Delden, Johannes J M; Rietjens, Judith A C; Schermer, Maartje H N; van Thiel, Ghislaine J M W; Trappenburg, Margo J; van de Vathorst, Suzanne; van der Vegt, Bea J; Vezzoni, Cristiano; Weyers, Heleen; van Tol, Donald G; van der Heide, Agnes
The practice of euthanasia and physician-assisted suicide (PAS) in the Netherlands has been regulated since 2002 by the Euthanasia Act. In the ongoing debate about the interpretation of this Act, comparative information about the opinions of the different stakeholders is needed. To evaluate the opinions of Dutch physicians, nurses and the general public on the legal requirements for euthanasia and PAS. A cross-sectional survey among Dutch physicians and nurses in primary and secondary care and members of the Dutch general public, followed by qualitative interviews among selected respondents. The participants were: 793 physicians, 1243 nurses and 1960 members of the general public who completed the questionnaire; 83 were interviewed. Most respondents agreed with the requirement of a patient request (64-88%) and the absence of a requirement concerning life expectancy (48-71%). PAS was thought acceptable by 24-39% of respondents for patients requesting it because of mental suffering due to loss of control, chronic depression or early dementia. In the case of severe dementia, one third of physicians, 58% of nurses and 77% of the general public agreed with performing euthanasia based on an advance directive. Interviewees illustrated these findings and supported the Act. Health care professionals and the general public mostly support the legal requirements for euthanasia and PAS. The law permits euthanasia or PAS for mental suffering but this possibility is not widely endorsed. The general public is more liberal towards euthanasia for advanced dementia than health care professionals. We conclude that there is ample support for the law after eight years of legal euthanasia.
Abdo, W F Farid
Recently, organ donation after euthanasia has been a topic of discussion in the Dutch media and scientific literature. Unfortunately, both the articles in question and the media interviews contained several unsubstantiated statements. This article describes the background of organ donation after euthanasia and refutes some of the recent statements. It discusses why it is expected that organ donation after euthanasia will result in a far fewer additional organ donors that originally stated. In conclusion, euthanasia is a topic that should be handled with great care.
Häggström, Marie; Bergsman, Ann-Christin; Månsson, Ulrika; Holmström, Malin Rising
Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians. To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs. Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied. The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm. Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety. Copyright © 2016 Elsevier Ltd. All rights reserved.
Norman, E J
This qualitative study investigated the qualities of veterinary student performance that inform a supervisor's impression of their competency. Semi-structured interviews were conducted with a purposive sample of 15 supervisors from different veterinary subdisciplines, to elicit descriptions of excellent, weak and marginal students. Thematic analysis of transcriptions revealed 12 themes, of which engagement was frequently discussed and of stated importance, and trustworthiness was a differentiator of weak and marginal students from excellent students. Other themes were knowledge, application of knowledge, technical and animal handling skills, communication, social interaction, personal functioning, caring for animals, impact, prospects and the difficulty in judging competency. Patterns of association of themes were found, however themes were also used independently in unique combinations for most students described. The findings show the range of abilities, behaviours, attitudes and personal characteristics of students that are considered by supervisors and how these are weighted and balanced. The key contribution of engagement and trustworthiness to the overall impression aligns with research indicating their importance for success in clinical practice, as both contributors to competency and indicators of it. The findings may inform future design and investigation of workplace-based learning and in-training evaluation, as well as conceptions of veterinary competency. British Veterinary Association.
Full Text Available The enlargement of the European Union in 2004 gave rise to moral panics concerning the likelihood of mass migration from the new eastern European member states to established member states in the west. A great deal of social and political science research has examined the ongoing impact of the enlargement, but there remains a gap in the literature regarding the ways in which members of ‘receiving’ populations reacted to these changes. The present paper reports findings from a qualitative interview study of 14-16 year-olds conducted in northern England. It focuses on how migrants from one particular country – Poland – were constructed by participants. Drawing on previous analyses of immigration and racist discourse, the study points to some ways in which Polish migrants and migration were constructed, and how complaints against ‘the Polish’ were formulated. The analysis focusses on four key issues: employment and the economy; language and culture; threat and intimidation; and physical stereotyping. It is suggested that constructions of ‘the Polish’ draw on the tropes of both ‘old’ and ‘new’ racism, and that attention to the use of deixical ingroup referents (‘us’, ‘we’, ‘our’ in contrast to the explicit labelling of the outgroup (‘the Polish’ can be understood in terms of the requirement to present complaints concerning migrant groups via appeals to assumed universal standards of behaviour and civility.
Igarashi, Toshiko; Wakita, Mariko; Miyazaki, Kikuko; Nakayama, Takeo
midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. semi-structured qualitative interview study and constant comparative analysis. 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. Osaka, Kyoto, Nara, and Shiga, Japan. midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research. Copyright © 2014 Elsevier Ltd. All rights reserved.
Skogheim, Gry; Hanssen, Tove A
In some economically developed countries, women's choice of birth care and birth place is encouraged. The aim of this study was to explore and describe the experiences of midwives who started working in alongside/free-standing midwifery units (AMU/FMU) and their experiences with labour care in this setting. A qualitative explorative design using a phenomenographic approach was used. Semi-structured interviews were conducted with ten strategically sampled midwives working in midwifery units. The analysis revealed the following five categories of experiences noted by the midwives: mixed emotions and de-learning obstetric unit habits, revitalising midwifery philosophy, alertness and preparedness, presence and patience, and coping with time. Starting to work in an AMU/FMU can be a distressing period for a midwife. First, it may require de-learning the medical approach to birth, and, second, it may entail a revitalisation (and re-learning) of birth care that promotes physiological birth. Midwifery, particularly in FMUs, requires an especially careful assessment of the labouring process, the ability to be foresighted, and capability in emergencies. The autonomy of midwives may be constrained also in AMUs/FMUs. However, working in these settings is also viewed as experiencing "the art of midwifery" and enables revitalisation of the midwifery philosophy. Copyright © 2015 Elsevier B.V. All rights reserved.
Kangasniemi, Mari; Hirjaba, Marina; Kohonen, Katja; Vellone, Ercole; Moilanen, Tanja; Pietilä, Anna-Maija
To describe cardiac patients' perceptions of their responsibilities in adherence to care. The responsibilities of cardiac patients' adherence to care is a topical issue because of the increasing prevalence of noncommunicable diseases in Western countries, including cardiovascular disease (CVD). Responsibilities for cardiac patients' care have been studied, but little is described about patients' perspectives in this study. A qualitative, hermeneutic inquiry. We used face-to-face individual semistructured interviews with 21 cardiac patients (76% male) aged 58-86 in an urban area of Finland in winter 2013. The data were analysed hermeneutically with inductive content analysis. Based on our results, patients with cardiac disease understood that autonomy provided a basis for their responsibility in adherence to care. It included being able to make independent decisions, in collaboration with health professionals, or even to entrust that responsibility to healthcare professionals. Responsibilities were understood to be an expression of adherence, perceived to benefit the patient and included the duty to adopt a healthy lifestyle and care for their own medical condition. The main factors that influenced patients' responsibilities around adherence to care were their individual resources and motivation, relationships with healthcare professionals and the resources of the healthcare system. Autonomy is an inherent part of cardiac patients' adherence to care, but there has been little focus on their responsibilities in the literature. More attention needs to be paid to the healthcare providers' abilities to support patients' duties and responsibilities in clinical practice and to future research. © 2016 John Wiley & Sons Ltd.
Salloch, Sabine; Breitsameter, Christof
Hospices consider themselves places that practise a holistic form of terminal care, encompassing physical and psychological symptoms, and also the social and spiritual support for a dying patient. So far, the underlying ethical principles have been treated predominantly in terms of a normative theoretical discussion. The interview study discussed in this paper is a qualitative investigation into general and hospice-related conceptions of morality among full-time and voluntary workers in German inpatient hospices. It examines moral conflicts and efforts leading to their solution. The main ideas identified include moral neutrality towards the patients and their requests, the capability of acceptance, the idea of self-restraint with respect to the dying patient and the principle of respect for the natural course of dying. Essential triggers for moral conflicts were the inadequate education of patients, problems of acceptance in view of incurable disease, and disagreements between members of patients' families. The interviewees expressed their scepticism towards formal institutions of ethical counselling. The study has shown a type of virtue ethics that forms an integral part of the overall concept of hospice care, which cannot be treated separately from a holistic idea of care at the end of life.
Tarrant, Mark; Khan, Sammyh S; Farrow, Claire V; Shah, Pooja; Daly, Mark; Kos, Katarina
People with obesity experience a range of physical and psychological ill-health outcomes. This study examined patients' experiences of a group-based programme for the management of morbid obesity delivered within the UK National Health Service. The focus of the study was on the emerging dynamic of the group and patients' perceptions of its impact on health outcomes. A qualitative interview study was conducted and involved patients recruited from a Tier 3 bariatric service in South West England. Verbatim transcripts were analysed using thematic analysis. Twenty patients (12 females) with a BMI ≥ 35 kg/m2 participated in a semi-structured one-to-one interview. Participants had been registered with the bariatric service for at least 6 months. None of the participants had had bariatric surgery. Most participants felt that they had benefited from participating in the group programme and talked about the group as a resource for lifestyle change. Participants' narratives centred on the emergence of a sense of self based upon their participation in the group: establishing psychological connections to other patients, or shared social identity, was regarded as a key mechanism through which the programme's educational material was accessed, and underpinned the experience of social support within the group. Through interaction with other patients, involving the sharing of personal experiences and challenges, participants came to experience their weight 'problem' through a collective lens that they felt empowered them to initiate and sustain individual lifestyle change. Bariatric care groups have the potential to support lifestyle change and weight loss and may help address the psychological needs of patients. Nurturing a sense of shared social identity amongst patients with morbid obesity should be a core aim of the care pathway and may provide the foundation for successful translation of dietetic content in group programmes. Statement of contribution What is already
Russell, Connie Adelle
Scope and method of study. The purpose of this study was to evaluate the effect of gender, major, and prior knowledge of and attitude toward biology on participation in introductory biology laboratories. Subjects for this study were 3,527 students enrolled in college-level introductory biology courses. During the study, three introductory courses were replaced with one mixed-majors course. The new course adopted a different pedagological approach from the previous courses in that an inquiry-based approach was used in lectures and laboratories. All subjects completed a survey that measured content knowledge using the NABT/NSTA High School Biology Examination Version 1990 and attitude using Russell and Hollander's Biology Attitude Scale. I used and discuss the merits of using ethological methods and data collection software, EthoScribeTM (Tima Scientific) to collect behavioral data from 145 students. I also evaluated participation using qualitative interviews of 30 students. I analyzed content knowledge and attitude data using ANOVA and Pearson correlation, and behavioral data using Contingency Table Analysis. I analyzed interviews following methods outlined by Rubin and Rubin. Findings. Course style and gender were the most useful variables in distinguishing differences among groups of students with regard to attitude, content knowledge, and participation in laboratories. Attitude toward biology and achievement measured by the surveys were found to be positively correlated; however, gender, major, class standing, course style and interactions between these variables also had effects on these variables. I found a positive association among attitude, achievement and participation in hands-on activities in laboratories. Differences in participation also were associated group type. In a traditional introductory biology course, females in single-gender groups, gender-equal, or groups in which females were the majority spent more time performing hands-on science
R. S. Magnusson
The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE...
The research presented in this paper focuses on the cognitive diagnostic strategies that prospective elementary mathematics teachers (PTs) use in their reflections of one-on-one diagnostic interviews with children in grade one. Thereby, it responds to the detected lack of knowledge regarding qualitative facets of diagnostic proceeding in interview…
ten Have, H A
Over the past 30 years, euthanasia has been under continuous debate in The Netherlands. This contribution aims to provide a moral assessment of this debate. It is argued that euthanasia should be understood within a historical context, as a protest against medical power and as a way to bring about good death. Within the euthanasia debate, two paradoxes are identified which make the issue inherently complex and hard to regulate. The first paradox results from the dialectical relation between individual autonomy and relief of suffering as the major justifications of euthanasia. Although euthanasia represents an ultimate effort to give the individual patient control over his dying, the result of the debate is an increase of medical power. The second paradox is that although euthanasia emerged from a commitment to good death, it is resulting in a reduced range of options to bring about good death.
Fox, Siobhan; Cashell, Alison; Kernohan, W George; Lynch, Marie; McGlade, Ciara; O'Brien, Tony; O'Sullivan, Sean S; Foley, Mary J; Timmons, Suzanne
Palliative care is recommended for non-malignant illnesses, including Parkinson's disease. However, past research with healthcare workers highlights unmet palliative needs in this population and referral rates to Specialist Palliative Care are low. Some healthcare workers perceive a 'fear' in their patients about introducing palliative care. However, less is known about the views of people with Parkinson's disease and their carers about palliative care. (1) To explore the palliative care and related issues most affecting people with Parkinson's disease and their families and (2) to examine perceptions about/understanding of palliative care. This was a qualitative study; semi-structured interviews were conducted, transcribed and analysed using thematic analysis. A total of 31 people participated, both people with Parkinson's disease ( n = 19) and carers ( n = 12), across three Movement Disorder Clinics in the Republic of Ireland. People with Parkinson's disease and their carers were unfamiliar with the term palliative care. When informed of the role of palliative care, most felt that they would benefit from this input. People with Parkinson's disease and carers experienced a high illness burden and wanted extra support. Crises requiring Specialist Palliative Care involvement may occur at diagnosis and later, with advancing illness. Participants wanted more information about palliative care and especially further supports to address their psychosocial needs. A holistic palliative care approach could address the complex physical and psychosocial symptoms experienced by people with Parkinson's disease and their carers, and people with Parkinson's disease and their carers are open to palliative care. Further research needs to explore how palliative care can be introduced into the routine care for people with Parkinson's disease.
Bristowe, Katherine; Hodson, Matthew; Wee, Bee; Almack, Kathryn; Johnson, Katherine; Daveson, Barbara A; Koffman, Jonathan; McEnhill, Linda; Harding, Richard
Lesbian, gay, bisexual and/or trans (LGBT) people have higher risk of certain life-limiting illnesses and unmet needs in advanced illness and bereavement. ACCESSCare is the first national study to examine in depth the experiences of LGBT people facing advanced illness. To explore health-care experiences of LGBT people facing advanced illness to elicit views regarding sharing identity (sexual orientation/gender history), accessing services, discrimination/exclusion and best-practice examples. Semi-structured in-depth qualitative interviews analysed using thematic analysis. In total, 40 LGBT people from across the United Kingdom facing advanced illness: cancer ( n = 21), non-cancer ( n = 16) and both a cancer and a non-cancer conditions ( n = 3). In total, five main themes emerged: (1) person-centred care needs that may require additional/different consideration for LGBT people (including different social support structures and additional legal concerns), (2) service level or interactional (created in the consultation) barriers/stressors (including heteronormative assumptions and homophobic/transphobic behaviours), (3) invisible barriers/stressors (including the historical context of pathology/criminalisation, fears and experiences of discrimination) and (4) service level or interactional facilitators (including acknowledging and including partners in critical discussions). These all shape (5) individuals' preferences for disclosing identity. Prior experiences of discrimination or violence, in response to disclosure, were carried into future care interactions and heightened with the frailty of advanced illness. Despite recent legislative change, experiences of discrimination and exclusion in health care persist for LGBT people. Ten recommendations, for health-care professionals and services/institutions, are made from the data. These are simple, low cost and offer potential gains in access to, and outcomes of, care for LGBT people.
Atiqul Haque, M; Janson, S; Moniruzzaman, S; Rahman, A K M F; Mashreky, S R; Eriksson, U-B
Child maltreatment (CM) is a public health problem and is recognized as a huge barrier for child development. Most of the research and definitions on CM are from the perspective of high-income western countries. Because no major studies have been conducted on CM in Bangladesh, the aim of the current study was to explore the experiences of and perceptions on CM in school-age children in rural and urban Bangladesh in order to understand maltreatment in a local context and from a child perspective. Semistructured individual interviews with 24 children (13 boys and 11 girls), between the ages of 9 and 13 years of which 11 were schoolgoing and 13 non-schoolgoing, were conducted during July 2013 and analysed according to qualitative content analysis. CM was a common and painful experience with serious physical and emotional consequences but highly accepted by the society. Vulnerable groups were especially young children, girls, and poor children. The children's voices were not heard due to their low status and low position in their families, schools, and working places. The main theme that emerged in the analysis was children's subordination, which permeated the five categories: (a) perception of children's situation in society, (b) understanding children's development and needs, (c) CM associated to school achievement, (d) negative impact of CM, and (e) emotional responses. Different kinds of abuse are obviously common in Bangladesh, and the schools do not follow the law from 2011 prohibiting corporal punishment at school. The society has to take further steps to live up to the UN Convention on the Rights of the Child, which was ratified already in 1990, to protect the Bangladeshi children from CM. © 2017 John Wiley & Sons Ltd.
Orrell, Alison; McKee, Kevin; Dahlberg, Lena; Gilhooly, Mary; Parker, Stuart
To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. 3 acute and 13 primary care National Health Service Trusts in England. 16 continence service leads in England actively treating and managing older people with UI. In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.
Kiljunen, Outi; Kankkunen, Päivi; Partanen, Pirjo; Välimäki, Tarja
Structural and cultural changes in the care of older people have influenced nursing practice, creating a need to identify current competency requirements for nurses working in care homes. Family members have an important role in ensuring the well-being of older people living in care homes, and family members' can provide valuable information about competence requirements. To explore the expectations of the care home residents' family members regarding the competence of nurses in care homes for older people. A qualitative descriptive design was used. Semi-structured interviews were conducted with 18 care home residents' family members between March and September 2016. Participants were recruited with help from regional associations and member associations of The Central Association of Carers in Finland and from regional associations of The Alzheimer's Society of Finland. The snowball technique was also used. The data were analysed using inductive content analysis. Ethics committee approval was obtained from the university committee on research ethics, and written informed consent was obtained from participants. The care home residents' family members expected that nurses would be able to interact with and treat people respectfully. Reflective collaboration between the nurse and a family member was also emphasised. Family members expected nurses to provide high-quality basic care and nursing and support residents' well-being individually and holistically. Family members' expectations reflect the need for ethical and interactional competence in the care home. In addition, evidence-based practice competencies are required to provide high-quality care. Nurses' ability to provide person-centred, individual and holistic care is vital to ensure care home residents' well-being. © 2017 Nordic College of Caring Science.
Mariska G Oosterveld-Vlug
Full Text Available BACKGROUND: Most nursing home residents spend the remainder of their life, until death, within a nursing home. As preserving dignity is an important aim of the care given here, insight into the way residents experience their dignity throughout their entire admission period is valuable. AIM: To investigate if and how nursing home residents' personal dignity changes over the course of time, and what contributes to this. DESIGN: A longitudinal qualitative study. METHODS: Multiple in-depth interviews, with an interval of six months, were carried out with 22 purposively sampled nursing home residents of the general medical wards of four nursing homes in The Netherlands. Transcripts were analyzed following the principles of thematic analysis. RESULTS: From admission onwards, some residents experienced an improved sense of dignity, while others experienced a downward trend, a fluctuating one or no change at all. Two mechanisms were especially important for a nursing home resident to maintain or regain personal dignity: the feeling that one is in control of his life and the feeling that one is regarded as a worthwhile person. The acquirement of both feelings could be supported by 1 finding a way to cope with one's situation; 2 getting acquainted with the new living structures in the nursing home and therefore feeling more at ease; 3 physical improvement (with or without an electric wheelchair; 4 being socially involved with nursing home staff, other residents and relatives; and 5 being amongst disabled others and therefore less prone to exposures of disrespect from the outer world. CONCLUSION: Although the direction in which a resident's personal dignity develops is also dependent on one's character and coping capacities, nursing home staff can contribute to dignity by creating optimal conditions to help a nursing home resident recover feelings of control and of being regarded as a worthwhile person.
Mbekenga, Columba K; Lugina, Helen I; Christensson, Kyllike; Olsson, Pia
to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting. individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania. these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers' and infants' nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information. these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers' concerns for family health and needs for support. these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers' active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum. Copyright © 2009 Elsevier Ltd. All rights reserved.
Matilainen, Kati; Ahonen, Sanna-Mari; Kankkunen, Päivi; Kangasniemi, Mari
Considering the ethics of each profession is important as inter-professional collaboration increases. Professional ethics creates a basis for radiographers' work, as it includes values and principles, together with rights and duties that guide and support professionals. However, little is known about radiographers' rights when it comes to professional ethics. The aim of this study was to describe radiographers' perceptions and experiences of their professional rights. The ultimate aim was to increase the understanding of professional ethics in this context and support radiographers' ethical pondering in diagnostic radiography. A qualitative method was used. Semistructured group interviews with 15 radiographers were conducted in spring 2013 at two publicly provided diagnostic imaging departments in Finland. Data were analysed by inductive content analysis. All the participants were women, and they had worked as radiographers for an average of 18 years. Based on our analysis, radiographers' professional rights consisted of rights related to their expertise in radiography and the rights related to working conditions that ensured their wellbeing. Expertise-based rights included rights to plan, conduct and assess radiological care with patient advocacy. Radiographers have the right to contribute to a culture of safe radiation in their organisation and to use their professional knowledge to achieve their main target, which is the safe imaging of patients. Radiographers also have right to work in conditions that support their well-being, including the legal rights stated in their employment contract, as well as their rights concerning resources at work. Radiographers' professional rights are an elementary and multidimensional part of their clinical practice. In future, more theoretical and empirical research is needed to deepen the understanding of their rights in the clinical practice and support radiographers on issues related to this aspect of their work. © 2016
Chaloner, C; Sanders, K
The legal status of euthanasia is frequently deliberated. It remains unlawful in Britain and advocates for a change in the law are vigorously opposed by those who argue that it should remain unchanged. An objective account, in which current law and arguments for and against change are exposed, is essential to inform the euthanasia debate. In this article the legal issues concerning euthanasia are examined and arguments raised by proposed changes in the law are considered.
Minerva, Francesca; Sandberg, Anders
In this article we discuss the moral and legal aspects of causing the death of a terminal patient in the hope of extending their life in the future. We call this theoretical procedure cryothanasia. We argue that administering cryothanasia is ethically different from administering euthanasia. Consequently, objections to euthanasia should not apply to cryothanasia, and cryothanasia could also be considered a legal option where euthanasia is illegal. © 2017 John Wiley & Sons Ltd.
Brobeck, Elisabeth; Odencrants, Sigrid; Bergh, Håkan; Hildingh, Cathrine
.... Motivational interviewing is a framework that can help to facilitate this movement. The aim of this study was to describe how patients in primary health care settings experience lifestyle discussions based on motivational interviewing...
Verpoort, Charlotte; Gastmans, Chris; Dierckx de Casterlé, Bernadette
In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.
Pu, S D
Euthanasia in China is gaining increasing acceptance among physicians, intellectuals, and even the people. This paper surveys current attitudes towards euthanasia and suggests why it should be legalized.
Cartwright, C M; Williams, G M; Parker, M H; Steinberg, M A
This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.
Ranney, Megan L.; Meisel, Zachary; Choo, Esther K.; Garro, Aris; Sasson, Comilla; Morrow, Kathleen
Qualitative methods are increasingly being used in emergency care research. Rigorous qualitative methods can play a critical role in advancing the emergency care research agenda by allowing investigators to generate hypotheses, gain an in-depth understanding of health problems or specific populations, create expert consensus, and develop new intervention and dissemination strategies. In Part I of this two-article series, we provided an introduction to general principles of applied qualitative...
Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J
In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.
Galvin, J; Suominen, E; Morgan, C; O'Connell, E-J; Smith, A P
What is known on the subject? Stress can impact students on mental health nurse training. This can have implications at the individual level (e.g. their own mental health) and at the level of the organization (e.g. sickness absence and attrition). What this paper adds to existing knowledge? We interviewed 12 mental health nursing students regarding the stress they experienced during training. Participants described how the academic demands can at times be unbearable during clinical placements. There were also issues with 'being a student' on some placements, with participants describing negative attitudes towards them from staff. The younger participants reported feeling overwhelmed on their initial placements and described some of the main challenges of mental health work for them. Raising concerns about the quality of care on wards was also described as particularly challenging for the students. What are the implications for practice? This paper can be useful to help training providers support mental health nursing students. Recommendations include reducing academic demands during clinical placements and extending and promoting existing support services beyond normal 9 am-5 pm working hours, even if these services are limited. Younger students could be better supported by being allocated to the more well-resourced placements in the early stages of their training. Raising awareness among staff of the tasks students can and cannot perform can help improve staff/student relations. Finally, students should be educated about the issues around raising concerns on placements to help the government's drive for a more open and transparent National Health Service (NHS). Previous studies investigating stress in nursing students focus on general nursing students or adopt quantitative measures. A qualitative study focusing specifically on mental health nursing students is required. One-to-one interviews were carried out with mental health nursing students (n = 12). Data were
Several sections of the Criminal Code of Canada which are relevant to the issue of euthanasia are discussed. In addition, the value placed on the sanctity of life by the law, the failure to recognize motive in cases of euthanasia, and disparate legal and medical definitions of death are also considered. (Author)
Questions and answers on the Belgian model of integral end-of-life care: experiment? Prototype? : "Eu-euthanasia": the close historical, and evidently synergistic, relationship between palliative care and euthanasia in Belgium: an interview with a doctor involved in the early development of both and two of his successors.
Bernheim, Jan L; Distelmans, Wim; Mullie, Arsène; Ashby, Michael A
This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors.
The epistemic interview is a conversational practice, which aims to generate knowledge by subjecting respondents' beliefs to dialectical tests of reasons. Developed by Svend Brinkmann, this model draws inspiration from Socratic dialogues where the interviewer asks confronting questions to press respondents to articulate the normative bases of…
Carrasco M, Víctor Hugo; Crispi, Francisca
Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chiles history in euthanasia and the populations opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure.
Lohiniva, Anna L.; Mokhtar, Alaa; Azer, Ashraf; Elmoghazy, Esaam; Kamal, Eman; Benkirane, Manal; Dueger, Erica
Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative da...
Full Text Available Professor Elizabeth Adams St. Pierre’s work focuses on critical and poststructural theories of language and the subject and what she has called post qualitative inquiry or post inquiry. She asks what might come after conventional humanist qualitative research methodology. She’s especially interested in the new empiricisms/new materialisms as well as new research practices enabled by the ontological turn. During St. Pierre's visit to the Finnish Educational Research Association (FERA Conference in Oulu in November 2014, we had the opportunity to talk with her about post qualitative research around some questions we had sent her beforehand. We then transcribed, edited, and translated the interview, and published it in the Finnish journal Kasvatus (Education in spring 2015. In this interview St. Pierre talks in the US context, where qualitative methodology is turning—or being pushed to turn—back to positivism with normalized and formalized practices, St. Pierre encourages researchers to constantly question the prevailing truths and the traditions they have learnt too well.
Coenen, Michaela; Stamm, Tanja A; Stucki, Gerold; Cieza, Alarcos
To compare two different approaches to performing focus groups and individual interviews, an open approach, and an approach based on the International Classification of Functioning, Disability and Health (ICF). Patients with rheumatoid arthritis attended focus groups (n = 49) and individual interviews (n = 21). Time, number of concepts, ICF categories identified, and sample size for reaching saturation of data were compared. Descriptive statistics, Chi-square tests, and independent t tests were performed. With an overall time of 183 h, focus groups were more time consuming than individual interviews (t = 9.782; P focus groups and 102 categories in the interviews were identified compared to the 231 and 110 respective categories identified in the ICF-based approach. Saturation of data was reached after performing five focus groups and nine individual interviews in the open approach and five focus groups and 12 individual interviews in the ICF-based approach. The method chosen should depend on the objective of the study, issues related to the health condition, and the study's participants. We recommend performing focus groups if the objective of the study is to comprehensively explore the patient perspective.
DeCou, Christopher R; Skewes, Monica C; López, Ellen D S; Skanis, Marie L
Suicide represents a significant health disparity for communities in rural Alaska, and has implications for mental health among people who have lost loved ones from suicide. A qualitative interview study was conducted to examine the ways in which suicide has affected the lives of college students who have migrated from rural villages to an urban university (N = 25). The present research represents a secondary aim of the study-specifically, we examined the affective responses of Alaska Native college students from rural villages after completing in-depth semistructured interviews about their experiences related to suicide. Debriefing questions posed at the conclusion of the interviews revealed that the majority of participants (n 16) stated they felt "better" after completing the interview, and no participants reported feeling "worse." No participant required the use of the safety plan developed in case of severe emotional distress. All participants indicated they would be interested in participating in future research. Analysis of questions pertaining to the interview experience revealed the salience of foundation (the participant's prior experience discussing issues like suicide), process (the interview questions and questioning style), and outcomes (the challenges and benefits of participation described by the respondent). Findings provided important insights concerning the experience of discussing past trauma, perceived importance of research addressing coping with suicide, and the influence of past experiences in the process of talking about suicide.
Full Text Available Abstract Background The Motivational Interviewing target Scheme (MITS is an instrument to assess competency in Motivational Interviewing (MI and can be used to assess MI in long and brief consultations. In this qualitative study we examined two sources of the Unified Model of Validity, the current standard of assessment validation, in the context of General Practice. We collected evidence concerning response process validity and content validity of the MITS in general practice. Furthermore, we investigated its feasibility. Methods Assessing consultations of General Practitioners and GP-trainees (GPs, the assessors systematically noted down their considerations concerning the scoring process and the content of the MITS in a semi-structured questionnaire. Sampling of the GPs was based on maximum variation and data saturation was used as a stopping criterion. An inductive approach was used to analyse the data. In response to scoring problems the score options were adjusted and all consultations were assessed using the original and the adjusted score options. Results Twenty seven assessments were needed to reach data saturation. In most consultations, the health behaviour was not the reason for encounter but was discussed on top of discussing physical problems. The topic that was most discussed in the consultations was smoking cigarettes. The adjusted score options increased the response process validity; they were more in agreement with theoretical constructs and the observed quality of MI in the consultations. Concerning content validity, we found that the MITS represents the broad spectrum and the current understanding of MI. Furthermore, the MITS proved to be feasible to assess MI in brief consultations in general practice. Conclusions Based on the collected evidence the MITS seems a promising instrument to measure MI interviewing in brief consultations. The evidence gathered in this study lays the foundation for research into other aspects of
Stoyles, Byron J; Costreie, Sorin
Our goal in this article is to explicate the way, and the extent to which, euthanasia can be voluntary from both the perspective of the patient and the perspective of the health care providers involved in the patient's care. More significantly, we aim to challenge the way in which those engaged in ongoing philosophical debates regarding the morality of euthanasia draw distinctions between voluntary, involuntary, and nonvoluntary euthanasia on the grounds that drawing the distinctions in the traditional manner (1) fails to reflect what is important from the patient's perspective and (2) fails to reflect the significance of health care providers' interests, including their autonomy and integrity.
Baeke, Goedele; Wils, Jean-Pierre; Broeckaert, Bert
In Belgium, dominant ideological traditions--Christianity and non-religious humanism--have the floor in debates on euthanasia and hardly any attention is paid to the practices and attitudes of ethnic and religious minorities, for instance, Jews. This article aims to meet this lacuna. Qualitative empirical research was performed in the Orthodox Jewish community of Antwerp (Belgium) with a purposive sample of elderly Jewish (non-)Hasidic and secularised Orthodox women. In-depth interviews were conducted to elicit their attitudes towards (non-)voluntary euthanasia and assisted suicide. The research reveals diverse views among women in the community on intentionally terminating a patient's life. Absolute rejection of every act which deliberately terminates life is found among the overwhelming majority of (religiously observant) Orthodox (Hasidic and non-Hasidic) women, as they have an unconditional faith and trust in God's sovereign power over the domain of life and death. On the other hand, the views of secularised Orthodox women--mostly irreligious women, who do not consider themselves Orthodox, thus not following Jewish law, yet say they belong to the Orthodox Jewish community--show an acceptance of voluntary euthanasia and assisted suicide but non-voluntary euthanasia is approached more negatively. As they perceive illness and death as merely profane facts, they stress a patient's absolute right towards self-determination, in particular with regard to one's end of life. Among non-Hasidic Orthodox respondents, more openness is found for cultivating a personal opinion which deviates from Jewish law and for the right of self-determination with regard to questions concerning life and death. In this study, these participants occupy an intermediate position. Our study reveals an interplay between ethical attitudes on euthanasia and religious convictions. The image one has of a transcendental reality, or of God, has a stronger effect on one's (dis)approval of euthanasia
Rietjens, Judith A C; van Delden, Johannes J M; van der Heide, Agnes; Vrakking, Astrid M; Onwuteaka-Philipsen, Bregje D; van der Maas, Paul J; van der Wal, Gerrit
An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices. Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases. Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.
Davis, Trevor; Gorgens, Kim; Shriberg, Janet; Godleski, Matthew; Meyer, Laura
There is a paucity of literature on the personal experiences of burn support group members, the members' perceived benefits of group participation, and the meaning the survivors make of the support they receive. In order to provide effective psychosocial rehabilitation services and to meet the needs of burn survivors, it is important to understand the influence a support group has on its members as well as the personal experiences of those individuals who attend these groups. The purpose of this study was to explore the experiences of burn survivors in a burn survivor support group. Six self-identified burn survivors were interviewed by using a guided in-depth interview technique to explore their experiences in the support group. Key informant interviews and group observations served to triangulate the findings from the individual interviews. The experiences of the group members coalesced around four main themes: acceptance of self, perspective change, value of community, and reciprocity. The findings demonstrated the overall perceived positive impact the support group had on psychosocial recovery. For these members, the group aided the process of adjustment through the encouragement of adaptive coping strategies and the facilitation of community and relationships. Their experiences mirrored much of the literature on psychological growth from adversity. Burn survivors reported unique opportunities that allowed them to integrate their injury into their identity within an encouraging and safe environment. Using these accounts, the authors generated clinical suggestions that may encourage similar growth in other support group settings.
Jalongo, Mary Renck
College and university faculty members specializing in early childhood education face some unique challenges in scholarly writing. The purpose of this research was to use open-ended interviews as a way to gather the collective wisdom of a group of key informants about academic writing and publishing in the field. Twenty-two editors and/or authors,…
Rurup, M.L.; Pasman, H.R.W.; Goedhart, J.; Deeg, D.J.H.; Kerkhof, A.J.F.M.; Onwuteaka-Philipsen, B.D.
Background: Quantitative studies in several European countries showed that 10-20% of older people have or have had a wish to die. Aims: To improve our understanding of why some older people develop a wish to die. Methods: In-depth interviews with people with a wish to die (n = 31) were carried out.
Bishop, Danielle; Lexchin, Joel
Pressures on health care budgets have led policy makers to discuss how to balance the provision of costly technologies to populations in need and making coverage decisions under uncertainty. Coverage with evidence development (CED) is being employed to meet these challenges. Twenty-four interviews were carried out between June 2009 and December 2010 with researchers, decision makers and policy makers from Australia, Canada, United Kingdom and United States. Three phases of coding occurred, the first being manual coding where the interviews were read and notes were taken and nodes were extracted and imputed. NVIVO coding was applied to the interview transcripts, with both broad general searches for word usages and imputed nodes. Four overarching thematic areas emerged out of contextual analysis of the interviews - (1) what constitutes CED; (2) the lack of a systematic approach/governance structure; (3) the role of the pharmaceutical industry and overt political considerations in CED; and (4) alternatives and barriers to CED. We explore these themes and then use concrete examples of CED projects in each of the four countries to illustrate the political issues that our interviewees raised. Until the underlying political nature of CED is recognized then fundamental questions about its usefulness and operation will remain unresolved.
Parakh, Jal S.; Slesnick, Irwin L.
Focuses on the moral arguments for and against the controversial topic of voluntary active euthanasia. Discusses the question of legalization and decriminalization of the practice. Provides a student worksheet with questions to stimulate discussion on the issue. (MDH)
Harris, N M
Debates about the moral dilemmas of euthanasia date back to ancient times. Many of the historical arguments used for and against the practice remain valid today. Indeed, any form of discussion on the subject often provokes emotive responses, both from members of the medical profession and the general public. For this reason alone, the issue will continue to be debated at all levels of society. There are, however, other factors that ensure euthanasia will remain a subject of major controversy within medical, legal and governmental bodies. Firstly, the act of euthanasia itself is illegal, yet in its passive form occurs on a daily basis in many of our hospitals (1). Secondly, medical advances have made it possible to artificially prolong the life of an increasing number of patients far beyond what was possible only a few years ago. Furthermore, we must all contend with the reality that financial constraints are an important consideration in modern health care provision. Finally, there is an ethical difficulty in interpreting the concept of a patient's right, or autonomy, versus the rights and duty of a doctor. Before attempting to answer the questions posed by these issues, it is important to have some accurate definitions of both euthanasia and of the concept of morality. According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering" (2). The term can be further divided into voluntary and involuntary euthanasia. The former is said to occur if a competent patient makes an informed request for a life terminating event and the latter can be used if a patient does not give informed and specific consent for such treatment. It is the occurrence of involuntary euthanasia which forms one of the main arguments against legalisation. This is discussed in greater detail below. Euthanasia is frequently separated into
Brown, Sally; Guthrie, Kate
To investigate the causes of unintended pregnancies and, in particular, reasons for non-use of contraception among young women attending a day unit for surgical abortion. Women between the ages of 16 and 20 attending a day unit at a hospital in the north of England who were due to have, or had recently had, a surgical abortion were interviewed about their knowledge of and views on contraception, sex education, and sexual health services. Twenty-four young women were interviewed, 22 on the day unit, one in her home and one over the phone, after the abortion. Interviews were recorded with the consent of the interviewees and fully transcribed. Transcripts were analysed using a grounded theory approach. The most common reasons for non-use of contraception related to forgetting or 'not thinking', being 'in the moment' (i.e., being 'in the mood', not wishing to 'break a spell'), the influence of alcohol, and pressure from young men not to use condoms. Lack of knowledge was rarely cited as a reason. Young people are aware of the need to use contraception, and knowledgeable about its availability; however, they often do not think about using it, especially where sex is unplanned. Alcohol and being 'in the moment' are key factors which diminish the likelihood of contraceptive use.
Le, Jette V; Hansen, Helle P; Riisgaard, Helle; Lykkegaard, Jesper; Nexøe, Jørgen; Bro, Flemming; Søndergaard, Jens
Clinical guidelines are considered to be essential for improving quality and safety of health care. However, interventions to promote implementation of guidelines have demonstrated only partial effectiveness and the reasons for this apparent failure are not yet fully understood. To investigate how GPs implement clinical guidelines in everyday clinical practice and how implementation approaches differ between practices. Individual semi-structured open-ended interviews with seven GPs who were purposefully sampled with regard to gender, age and practice form. Interviews were recorded, transcribed verbatim and then analysed using systematic text condensation. Analysis of the interviews revealed three different approaches to the implementation of guidelines in clinical practice. In some practices the GPs prioritized time and resources on collective implementation activities and organized their everyday practice to support these activities. In other practices GPs discussed guidelines collectively but left the application up to the individual GP whilst others again saw no need for discussion or collective activities depending entirely on the individual GP's decision on whether and how to manage implementation. Approaches to implementation of clinical guidelines vary substantially between practices. Supporting activities should take this into account. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.
This article provides a critical analysis of Dutch euthanasia policy and practice. The research benefited from twenty-eight interviews conducted in the Netherlands during the summer of 1999 with some of the leading figures who dictate the decision-making process and take an active part in the debates. The discussion begins with a review of the two major Dutch reports on euthanasia and the conflicting views and interpretations offered by the literature. Next, I provide some data about the interviews, and then analysis indicating that the Dutch Guidelines on the policy and practice of euthanasia do not provide ample mechanisms against abuse. I argue that the Dutch Guidelines are insufficient, do not provide adequate control over the practice of euthanasia, and that the entire policy should be revised and made more coherent and more comprehensive.
Murphy, Mairead; Hollinghurst, Sandra; Salisbury, Chris
The Primary Care Outcomes Questionnaire (PCOQ) is a new patient-reported outcome measure designed specifically for primary care. This paper describes the developmental process of improving the item quality and testing the face validity of the PCOQ through cognitive interviews with primary care patients. Two formats of the PCOQ were developed and assessed: the PCOQ-Status (which has an adjectival scale) and the PCOQ-Change (which has the same items as the PCOQ-Status, but a transitional scale). Three rounds of cognitive interviews were held with twenty patients from four health centres in Bristol. Patients seeking healthcare were recruited directly by their GP or practice nurse, and others not currently seeking healthcare were recruited from patient participation groups. An adjusted form of Tourangeau's model of cognitive processing was used to identify problems. This contained four categories: general comprehension, temporal comprehension, decision process, and response process. The resultant pattern of problems was used to assess whether the items and scales were working as intended, and to make improvements to the questionnaires. The problems identified in the PCOQ-Status reduced from 41 in round one to seven in round three. It was noted that the PCOQ-Status seemed to be capturing a subjective view of health which might not vary with age or long-term conditions. However, as it is designed to be evaluative (measuring change over time) as opposed to discriminative (measuring change between different groups of people), this does not present a problem for validity. The PCOQ-Status was both understood by patients and was face valid. The PCOQ-Change had less face validity, and was misunderstood by three out of six patients in round 1. It was not taken forward after this round. The cognitive interviews successfully contributed to the development of the PCOQ. Through this study, the PCOQ-Status was found to be well understood by patients, and it was possible to improve
Ryan, Sara; Ziebland, Sue
There is mounting evidence that pets are associated with physiological, psychological and social benefits for humans. Much of this research has come from western countries, where there have been consistent calls for greater engagement with pet ownership and health. Drawing on a secondary analysis of 61 in-depth interviews with people, or carers of people, with long-term conditions, we explore how pets feature in people's narrative accounts of their experiences. Our findings demonstrate the multifaceted nature of people's relationships with pets, and the embedded and embodied ways in which human-nonhuman interactions are played out in narratives of chronic illness. Our study differs from other work on pets and health in that, by returning to the interview video recordings, we were able to explore the sometimes three-way interactions, the co(a)gency, between participants, pets and researchers. Pets were often presented as important family members, yet the researchers' responses to the presence or talk about pets was often markedly different from their reactions to other household members. We conclude with cautioning against the downgrading of pets in narrative health research. Narrative approaches may invite participants to talk about what is important to them, yet they clearly have limitations in practice. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Woods, Richard T A; Griffiths, Mark D
Recent research has consistently shown that a small but significant minority of youth engage in illegal lottery and scratchcard gambling. It is clear that most adolescents experience few gambling-related problems as a result of lotteries and scratchcards. However, it is less clear how gambling may be affecting them at a more general level. The present study set out to examine in more detail the perceptions identified in a previous survey. The study provided an opportunity for the participants to articulate and outline what they thought were the most salient issues through the use of semi-structured group interviews. Six separate group interviews took place (three groups of six adolescents and three groups of seven adolescents) aged 11-15 years. Results revealed many salient themes including winning money, socialization, different forms of excitement associated with these activities (entertainment, the fantasy of winning, and the "buzz"), control, (personal choice, luck, chance), and awareness of social problems. These are discussed in relation to the previous survey literature. Published by Elsevier Science Ltd.
Griffiths, Frances; Mason, Victoria; Boardman, Felicity; Dennick, Katherine; Haywood, Kirstie; Achten, Juul; Parsons, Nicholas; Griffin, Xavier; Costa, Matthew
To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services. Semistructured interviews exploring the experience of recovery from hip fracture at two time points-4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summarising the participant's experience overall. 31 participants were recruited, of whom 20 were women and 12 were cognitively impaired. Mean age was 81.5 years. Interviews were provided by 19 patients, 14 carers and 8 patient/carer dyad; 10 participants were interviewed twice. Single major trauma centre in the West Midlands of the UK. Stable mobility (without falls or fear of falls) for valued activities was considered most important by participants who had some prefracture mobility and were able to articulate what they valued during recovery. Mobility was important for managing personal care, for day-to-day activities such as shopping and gardening, and for maintenance of mental well-being. Some participants used assistive mobility devices or adapted to their limitations. Others maintained their previous limited function through increased care provision. Many participants were unable to articulate what they valued as hip fracture was perceived as part of their decline with age. The fracture and problems from other health conditions were an inseparable part of one health experience. Prefracture mobility, adaptations to reduced mobility before or after fracture, and whether or not patients perceive themselves to be declining with age influence what patients consider important during recovery from hip fracture. No single patient-reported outcome measure could evaluate quality of care for all patients following hip fracture. General health-related quality of life tools may provide useful information within
Frich, J.C.; Malterud, K.; Fugelli, P.
professionals who they felt had a moralizing attitude when counseling on lifestyle and diets. One group took this as a sign of care. Another group conveyed experiences of being humiliated in consultations. CONCLUSION: Patients with familial hypercholesterolemia may experience guilt and shame related to how...... they manage their condition. Health professionals' counseling about lifestyle and diet may induce guilt and shame in patients. PRACTICE IMPLICATIONS: Health professionals should be sensitive to a patient's readiness for counseling in order to diminish the risk of unintentionally inducing guilt and shame......OBJECTIVE: To explore patients' experiences of guilt and shame with regard to how they manage familial hypercholesterolemia. METHODS: We interviewed 40 men and women diagnosed with heterozygous familial hypercholesterolemia. Data were analyzed by systematic text condensation inspired by Giorgi...
Sveinsson, Olafur Arni
Euthanasia has been heatedly discussed in Western countries over the last years. Only a few nations have legalized euthanasia or physician assisted suicide with the Dutch at the forefront of that field...
Brom, Linda; De Snoo-Trimp, Janine C; Onwuteaka-Philipsen, Bregje D; Widdershoven, Guy A M; Stiggelbout, Anne M; Pasman, H Roeline W
Patients' preferences and expectations should be taken into account in treatment decision making in the last phase of life. Shared decision making (SDM) is regarded as a way to give the patient a central role in decision making. Little is known about how SDM is used in clinical practice in advanced cancer care. To examine whether and how the steps of SDM can be recognized in decision making about second- and third-line chemotherapy. Fourteen advanced cancer patients were followed over time using face-to-face in-depth interviews and observations of the patients' out-clinic visits. Interviews and outpatient clinic visits in which treatment options were discussed or decisions made were transcribed verbatim and analysed using open coding. Patients were satisfied with the decision-making process, but the steps of SDM were barely seen in daily practice. The creation of awareness about available treatment options by physicians was limited and not discussed in an equal way. Patients' wishes and concerns were not explicitly assessed, which led to different expectations about improved survival from subsequent lines of chemotherapy. To reach SDM in daily practice, physicians should create awareness of all treatment options, including forgoing treatment, and communicate the risk of benefit and harm. Open and honest communication is needed in which patients' expectations and concerns are discussed. Through this, the difficult process of decision making in the last phase of life can be facilitated and the focus on the best care for the specific patient is strengthened. © 2015 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
van Teijlingen Edwin R
Full Text Available Abstract Background Since Huntington's Disease (HD is a familial disease with an average onset in the mid-thirties, one might expect that spousal carers are concerned with providing care for off-spring who may turn out to be affected. Methods This study involved ten face-to-face interviews with carers of spouses affected by HD in Northeast Scotland. Carers were recruited through two channels: a genetic clinic and the Scottish Huntington's Association (SHA. Interviews were conducted in carers' own homes. A thematic analysis of the transcripts was conducted. Results Although carers did worry about their children, they did not envisage being involved in their care. Many avoided talking about the disease, both within and outwith their family; this may have greatly reduced the level of support provided by family members. Conversely, avoidance was often accompanied by symptom-spotting. For example, several people had given up driving, before they were incapable of doing so. The explanation appears to be that they avoided getting into situations in which HD may express itself. Support meetings seem to be valued amongst patients with other serious diseases and their carers, however, although all participants had had contact with the SHA, only one regularly attended meetings. It was felt that seeing others with HD provided a constant reminder of the possible effect of HD on the wider family, which seemed to outweigh the benefit of attending. Overall, the analysis highlighted 'avoidance' as a key theme. Conclusion Many denied symptoms of HD in their spouses, pre-diagnosis. All had pretended at some point that it was not happening, through ignoring early signs and 'obvious' symptoms. Some partners had refused to go to the doctor until it was no longer possible to deny symptoms. Formal health and social care seemed to play a very small role compared to informal care arrangements.
Mills, Susanna; White, Martin; Wrieden, Wendy; Brown, Heather; Stead, Martine; Adams, Jean
Food-related choices have an important impact on health. Food preparation methods may be linked to diet and health benefits. However, the factors influencing people's food choices, and how they are shaped by food preparation experiences, are still not fully understood. We aimed to study home food preparation practices, experiences and perceptions amongst adults in North East England. A matrix was used to purposively sample participants with diverse socio-demographic characteristics. Participants developed photographic food diaries that were used as prompts during semi-structured interviews. Data were analysed using the Framework Method. Interviews were conducted with 18 adults (five men and 13 women), aged approximately 20 to 80 years, to reach data saturation. Participants' practices varied widely, from reliance on pre-prepared foods, to preparing complex meals entirely from basic ingredients. Key themes emerged regarding the cook (identity), the task (process of cooking), and the context (situational drivers). Resources, in terms of time, money and facilities, were also underpinning influences on food preparation. Participants' practices were determined by both personal motivations to cook, and the influence of others, and generally reflected compromises between varied competing demands and challenges in life. Most people appeared to be overall content with their food preparation behaviour, though ideally aspired to cook more frequently, using basic ingredients. This often seemed to be driven by social desirability. Home food preparation is complex, with heterogeneous practices, experiences and perceptions both between individuals and within the same individual over time, according to shifting priorities and circumstances. Generalisability of these findings may be limited by the regional participant sample; however the results support and build upon previous research. Focussing interventions on life transition points at which priorities and circumstances change
Seedat, Farah; Hargreaves, Sally; Friedland, Jonathan S
.... We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers...
Farah Seedat; Sally Hargreaves; Jonathan S Friedland
.... We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers...
J. Seymour (Jane); J.A.C. Rietjens (Judith); S.M. Bruinsma (Sophie); L. Deliens (Luc); S. Sterckx (Sigrid); F. Mortier (Freddy); J. Brown (Jayne); N. Mathers (Nigel); A. van der Heide (Agnes)
textabstractBackground: Extensive debate surrounds the practice of continuous sedation until death to control refractory symptoms in terminal cancer care. We examined reported practice of United Kingdom, Belgian and Dutch physicians and nurses. Methods: Qualitative case studies using interviews.
Johnson, Reid Rucker
The objective of this dissertation is to examine the moral arguments commonly presented in the current debate on active and passive euthanasia in the United States. I claim the belief that there is a moral permissibility difference between active and passive euthanasia, which is that active euthanasia is impermissible and passive euthanasia is permissible, is unable to be supported by the arguments given in its defense. I first clarify what types of medical conditions commonly associated with...
Quantitative research suggests that medical students' empathy declines during their training. This meta-ethnography asks: What new understanding may be gained by a synthesis of interview-based qualitative research on medical students' views and experiences of empathy? How can such a synthesis be undertaken? A meta-ethnography synthesizes individual qualitative studies to generate knowledge increasing understanding and informing debate. A literature search yielded eight qualitative studies which met the inclusion criteria. These were analyzed from a phenomenological and interpretative perspective. The meta-ethnography revealed a conceptual confusion around empathy and a tension in medical education between distancing and connecting with patients. Barriers to empathy included a lack of patient contact and a strong emphasis on the biomedical over the psycho-social aspects of the curriculum. A number of influences discussed in the paper lead students to adopt less overt ways of showing their empathy. These insights deepen our understanding of the apparent decline in empathy in medical students. The lessons from these studies suggest that future curriculum development should include earlier patient contact, more emphasis on psycho-social aspects of care and address the barriers to empathy to ensure that tomorrow's doctors are empathetic as well as competent.
Full Text Available Tobias R Moczko,1,2,* Till J Bugaj,1,* Wolfgang Herzog,1 Christoph Nikendei1 1Department for General Internal and Psychosomatic Medicine, University Hospital of Heidelberg, Heidelberg, 2School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany *These authors contributed equally to this work Objectives: This study was designed to explore final-year medical students’ stressors and coping strategies at the transition to the clinical workplace. Methods: In this qualitative study, semi-standardized interviews with eight final-year medical students (five male, three female; aged 25.9±1.4 years were conducted during their internal medicine rotation. After verbatim transcription, a qualitative content analysis of students’ impressions of stress provoking and easing factors during final-year education was performed. Results: Students’ statements regarding burdens and dealing with stress were classified into four main categories: A perceived stressors and provoking factors, B stress-induced consequences, C personal and external resources for preventing and dealing with stress, and D final-year students’ suggestions for workplace improvement. Conclusion: Final-year medical students perceived different types of stress during their transition to medical wards, and reported both negative consequences and coping resources concerning perceived stress. As supervision, feedback, and coping strategies played an important role in the students’ perception of stress, final-year medical education curricula development should focus on these specifically. Keywords: undergraduate medical education, stress prevention, final-year medical education, workplace learning, qualitative research
Simón Lorda, Pablo; Barrio Cantalejo, Inés M
The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of the main contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain.
The passive form of euthanasia is legalized almost in every civilized country. Its active form is not a generally accepted legal institution. In Europe, active euthanasia is legalized only in The Netherlands, Belgium, Luxembourg and Switzerland. In Australia, the Act on the Rights of the Terminally Ill of 1995 legalized the institution of assisted suicide, which is not identical to active euthanasia. The difference lies in the fact that legalized active euthanasia means that the author of a murder is not punishable (under certain circumstances), whilst assisted suicide is not about murder, rather about suicide. In the first case, the patient is killed on his or her request by someone else. In the second case, the patient himself or herself executes the act of self-killing (by the assistance of a healthcare worker). In Australia, the institution of assisted suicide was repealed in 1997. Assisted suicide is legal in four USA member states: in Vermont, Washington, Montana and Oregon. In Uruguay, the active form of euthanasia has been legal since 1932.
Schleidgen, Sebastian; Marckmann, Georg
In recent years, personalized medicine (PM) has become a highly regarded line of development in medicine. Yet, it is still a relatively new field. As a consequence, the discussion of its future developments, in particular of its ethical implications, in most cases can only be anticipative. Such anticipative discussions, however, pose several challenges. Nevertheless, they play a crucial role for shaping PM's further developments. Therefore, it is vital to understand how the ethical discourse on PM is conducted, i.e. on what - empirical and normative - assumptions ethical arguments are based regarding PM's current and future developments. To gather this information, we conducted a qualitative interview study with stakeholders in the German health care system. Our purposive sample included 17 representatives of basic research, clinical research, health economics, regulatory authorities, reimbursement institutions, pharmaceutical industry, patient organizations, as well as clinicians and legal experts involved in PM developments or policy making. We used an interview guide with open-ended questions and analyzed transcriptions of the interviews by means of qualitative content analysis. The respondents addressed a multitude of concerns in the context of research on as well as application of personalized preventive and therapeutic measures both on the individual and on the societal level. Interestingly, regarding future developments of PM the ethical evaluation seemed to follow the rule: the less likely its application, the more problematic a PM measure is assessed. The more likely its application, on the other hand, the less problematic it is evaluated. The results of our study suggest re-focusing the ethical discourse on PM in Germany towards a constructive ethical monitoring which ensures to include only, nevertheless all of the actual and/or potential concerns that are ethically relevant in order to allow balancing them against the actual and potential ethically
Heckemann, Birgit; Breimaier, Helga Elisabeth; Halfens, Ruud J G; Schols, Jos M G A; Hahn, Sabine
Aggression management training for nurses is an important part of a comprehensive strategy to reduce patient and visitor aggression in healthcare. Although training is commonplace, few scientific studies examine its benefits. To explore and describe, from a nurse's perspective, the learning gained from attending aggression management training. This was a descriptive qualitative interview study. We conducted semi-structured individual interviews with seven nurses before (September/October 2012) and after they attended aggression management training (January/February 2013). Interview transcripts were content-analysed qualitatively. The study plan was reviewed by the responsible ethics committees. Participants gave written informed consent. Aggression management training did not change nurses' attitude. Coping emotionally with the management of patient and visitor aggression remained a challenge. Nurses' theoretical knowledge increased, but they did not necessarily acquire new strategies for managing patient/visitor aggression. Instead, the course refreshed or activated existing knowledge of prevention, intervention and de-escalation strategies. The training increased nurses' environmental and situational awareness for early signs of patient and visitor. They also acquired some strategies for emotional self-management. Nurses became more confident in dealing with (potentially) aggressive situations. While the training influenced nurses' individual clinical practice, learning was rarely shared within teams. Aggression management training increases skills, knowledge and confidence in dealing with patient or visitor aggression, but the emotional management remains a challenge. Future research should investigate how aggression management training courses can strengthen nurses' ability to emotionally cope with patient and visitor aggression. More knowledge is needed on how the theoretical and practical knowledge gained from the training may be disseminated more effectively
Full Text Available Abstract Background In 2004, the Malawian Ministry of Health declared a human resource crisis and launched a six year Emergency Human Resources Programme. This included salary supplements for key health workers and a tripling of doctors in training. By 2010, the number of medical graduates had doubled and significantly more doctors were working in rural district hospitals. Yet there has been little research into the views of this next generation of doctors in Malawi, who are crucial to the continuing success of the programme. The aim of this study was to explore the factors influencing the career plans of medical students and recent graduates with regard to four policy-relevant aspects: emigration outside Malawi; working at district level; private sector employment and postgraduate specialisation. Methods Twelve semi-structured interviews were conducted with fourth year medical students and first year graduates, recruited through purposive and snowball sampling. Key informant interviews were also carried out with medical school faculty. Recordings were transcribed and analysed using a framework approach. Results Opportunities for postgraduate training emerged as the most important factor in participants’ career choices, with specialisation seen as vital to career progression. All participants intended to work in Malawi in the long term, after a period of time outside the country. For nearly all participants, this was in the pursuit of postgraduate study rather than higher salaries. In general, medical students and young doctors were enthusiastic about working at district level, although this is curtailed by their desire for specialist training and frustration with resource shortages. There is currently little intention to move into the private sector. Conclusions Future resourcing of postgraduate training opportunities is crucial to preventing emigration as graduate numbers increase. The lesser importance put on salary by younger doctors may
Christianson, Monica; Johansson, Eva; Emmelin, Maria; Westman, Göran
The aim of the study was to get a deeper understanding of sexual risk-taking, by interviewing young people diagnosed with Chlamydia trachomatis. This qualitative study was conducted at a youth clinic in Umeå, Sweden. Five young women and four men, aged 18-22, participated. In-depth interviews were performed. Open questions around certain themes were posed, such as thoughts about getting CT, sexual encounters, and attitudes towards condoms. Interviews were tape-recorded and transcribed verbatim. Data were analysed according to grounded theory. Norms, events, and emotions were explored. The goal was to develop credible and applicable concepts concerning sexual relationships, risk-taking, and experiences of CT. Informants revealed that behind their sexual risk-taking was a drive to "go steady". Lust and trust were the guidelines if sex was going to take place. When discussing "one-night stands" gender stereotypes occurred. Females were expected to be less forward compared with males. We found an uneven distribution of responsibility concerning condoms. Males expected females to be "condom promoters". By catching CT, females experienced guilt, while males felt content through knowing "the source of contamination". An important public health issue is to implement how males should play an equal part in reproductive health. General CT screening of males is one suggestion.
Hall, Amanda K; Mercado, Rebeccah; Anderson-Lewis, Charkarra; Darville, Gabrielle; Bernhardt, Jay M
Games for health, including digital videogames and gaming-based approaches, are increasingly being used in health promotion research and practice. Recently published research has shown that videogames have significant potential to promote healthy behaviors among youth and adolescents. Yet, there is a lack of available evidence-based resources to guide practitioners on the integration of games into tobacco prevention and smoking cessation interventions. To address this gap, expert researchers and game developers were interviewed to further define games for health, explore the current research, and provide recommendations for developing, evaluating, and promoting effective anti-tobacco games. Nationally recognized experts on game development, games for health, tobacco, and health behavior were asked to participate. A qualitative analysis of 25 in-depth individual interviews using a constant comparative approach for emerging themes was conducted. Main themes that emerged from the data analysis included the following: (1) the current state of games for health research to facilitate health behavior change, (2) strategies for how to develop and evaluate games for quality and impact, and (3) recommendations for how to effectively design tobacco prevention and smoking cessation educational videogames that engage youth and adolescents. The synthesized findings identified through these expert interviews offer stakeholders strategies for how to incorporate games for health within their current and future work. Specific recommendations are presented for developers and researchers to consider when developing and evaluating videogames for tobacco prevention and smoking cessation targeted at youth and adolescents.
Full Text Available One of the key features affecting the transition from university to paid employment is the graduate’s perception of their capability to satisfactorily perform the work of a graduate. In some professions such as in nursing, the concept of “transition shock” is referred to. There is a need to understand how pharmacy students perceive the transition to their first job as intern pharmacists and identify potential curriculum gaps in their pharmacy studies. To date, little evidence around whether university programs are effective in equipping pharmacy graduates in transitioning to the world of work has been published.Objectives: To explore from the perspective of new pharmacy professionals, graduated from one Australian university areas that need to be addressed in pharmacy programs to prepare graduates for the transition to full-time work as interns in pharmacy. Methods: Thematic analysis of interviews with interns.Results: Subthemes were identified within the responses- relationships within the workplace and graduates needing to interest themselves in other people, adjusting to work hours and the differences between university assessments and performing in a workplace. Suggestions were made by graduates that the placement period within the pharmacy program be increased.Conclusions: Pharmacy graduates appear prepared for the world of pharmacy work. The concept of “transition shock” or “transition stress” described for graduates of other health professions commencing work was not apparent.
Organizational structure is built through dynamic processes which blend historical force and management decisions, as a part of a broader process of constructing organizational memory (OM). OM is considered to be one of the main competences leading to the organization's success. This study focuses on the impact of the Quality and Outcome Framework (QOF), which is a Pay-for-Performance scheme, on general practitioner (GP) practices in the UK. The study is based on semistructured interviews with four GP practices in the north of England involving 39 informants. The findings show that the way practices assigned different functions into specialized units, divisions or departments shows the degree of specialization in their organizational structures. More specialized unit arrangements, such as an IT division, particular chronic disease clinics or competence-based job distributions enhanced procedural memory development through enabling regular use of knowledge in specific context, which led to competence building. In turn, such competence at particular functions or jobs made it possible for the practices to achieve their goals more efficiently. This study concludes that organizational structure contributed strongly to the enhancement of OM, which in turn led to better organizational competence.
Timmermann, C; Uhrenfeldt, L; Birkelund, R
This study explores how cancer patients experience the meaning of positive sensory impressions in the hospital environment such as architecture, decoration and the interior. Data were obtained at a general hospital in Denmark by interviewing six cancer patients at two different wards. The analysis process was guided by the hermeneutical-phenomenological theory of interpretation as presented by the French philosopher Paul Ricoeur. Two main themes were identified: to preserve identity and positive thoughts and feelings. The participants experienced that positive sensory impressions in the hospital environment had a significant impact on their mood, generating positive thoughts and feelings. A view to nature also helped them to forget their negative thoughts for a while. The possibility of having a view helped some cancer patients to connect with good memories and personal life stories that enabled them to recall some of their feelings of identity. This paper adds knowledge about how cancer patients experience sensory impressions in the hospital environment. An environment that provides homeliness and offers a view to nature seems to help some patients to preserve their identity. Furthermore, positive sensory impressions and the opportunity for recreation through environmental facilities strengthen the patient's positive thoughts and feelings. © 2012 Blackwell Publishing Ltd.
Scully, Jackie Leach; Banks, Sarah; Song, Robert; Haq, Jackie
This paper explores the experiences of members of faith groups deciding whether or not to use new reproductive or genetic technologies (NRGTs). It is based on 16 in-depth, semi-structured interviews with people with direct experience of NRGTs. Participants identified as members of Christian or Muslim faith traditions and had been faced with deciding whether or not to make use of novel forms of fertility treatment or genetic testing. The findings show that members of faith groups may experience specific barriers of access, and distinctive ethical difficulties, when considering the use of different forms of NRGTs. Both Christian and Muslim interviewees reported difficulties in obtaining information on the official faith teaching, or found that their faith group had not yet crafted an official position. Participants' needs for information, and the opportunity to discuss the faith implications of their clinical choices, were not being met in either the clinic or the faith setting. This paper concludes that clinics should indicate more clearly their acknowledgement of patients' faith concerns. Appropriate training is needed for both healthcare professionals and chaplains, while faith groups should be encouraged to engage with healthcare providers to ensure that guidance is available to their members.
During the summer of 1999, twenty-eight interviews with some of the leading authorities on euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that require the patient's consent as a prerequisite to performance of euthanasia.
If a physician accepts to conduct an act of euthanasia or assisted suicide, would it be possible for him to be charged with homicide or even, is patient consent or motivation of the physician, susceptible to change the nature of the criminal act? Since the 1990s, a transformation has occurred in the way of dealing with these questions and figures from the world of philosophy, ethics and law can now be found in favor of euthanasia and assisted suicide. In certain countries, legislation has even been modified to follow this pattern. In consequence, besides the philosophical and ethical dimensions of this issue, it has become necessary to reexamine, even to revise, the notion of responsibility concerning euthanasia in Muslim law from new bases constituted by the doctrine of the Ulemas.
Right to life -as the prohibition of intentionally and arbitrarily taking life, even with authorization of the concerned one- is an internationally recognized right. In many countries, debate regarding euthanasia is more centered in its convenience, social acceptability and how it is regulated, than in its substantial legitimacy. Some argue that euthanasia should be included as part of clinical practice of health professionals, grounded on individual's autonomy claims-everyone having the liberty to choose how to live and how to die. Against this, others sustain that life has a higher value than autonomy, exercising autonomy without respecting the right to life would become a serious moral and social problem. Likewise, euthanasia supporters some-times claim a 'right to live with dignity', which must be understood as a personal obligation, referred more to the ethical than to the strictly legal sphere. In countries where it is already legalized, euthanasia practice has extended to cases where it is not the patient who requests this but the family or some healthcare professional, or even the legal system-when they think that the patient is living in a condition which is not worthy to live. Generalization of euthanasia possibly will end in affecting those who need more care, such as elder, chronically ill or dying people, damaging severely personal basic rights. Nature, purpose and tradition of medicine rule out the practice of euthanasia, which ought not be considered a medical act or legitimately compulsory for physicians. Today's medicine counts with effective treatments for pain and suffering, such as palliative care, including sedative therapy, which best preserves persons dignity and keeps safe the ethos of the medical profession.
Aghababaei, Naser; Farahani, Hojjatollah; Hatami, Javad
The main purposes of the present study were to see how the term ?euthanasia? influences people?s support for or opposition to euthanasia; and to see how euthanasia attitude relates to religious orientation and personality factors. In this study two different euthanasia attitude scales were compared. 197 students were selected to fill out either the Euthanasia Attitude Scale (EAS) or Wasserman?s Attitude Towards Euthanasia scale (ATE scale). The former scale includes the term ?euthanasia?, the...
Full Text Available Euthanasia is an attempt to end someone life when he/she has an uncurable illness, euthanasia will be done in order to release his/her from suffering his/her illness. In Indonesia, euthanasia can not be done and it is classified as an illegal act. Both in the positive law and the ethics code regulate that performing an euthanasia is not allowed. Regarded to the perspective of Islamic law, also regulated that an active euthanasia is an act that is forbidden and punishable by God with a punishment of hell for those who did.
Vincent, Christopher James; Blandford, Ann
We present findings of a UK study into how those involved in purchasing interactive medical devices go about evaluating usability, the challenges that arise, and opportunities for improvement. The study focused on procurement of infusion devices because these are used by various professionals across healthcare. A semi-structured interview study was carried out involving a range of stakeholders (20 in total) involved in or impacted by medical device procurement. Data was analysed using thematic analysis, a qualitative method designed to support the identification, analysis and reporting of patterns. In principle, health service purchasing was found to accommodate consideration of equipment usability. In practice, the evaluation process was driven primarily by engineering standards; assessment of local needs did not accommodate substantive assessment of usability; and choice was limited by the availability of equipment on the marketplace. We discuss ways in which purchasing could be improved through techniques that account for social circumstances. Copyright Â© 2016 Elsevier Ltd. All rights reserved.
Höglund, Eva; Dykes, Anna-Karin
to highlight the experiences of pregnant women, experiencing preterm labour, being on sick leave at home and how they handled their daily life. qualitative, descriptive using open interviews. 10 antenatal clinics in the south of Sweden. 15 pregnant women who were on sick leave for premature labour. four categories were identified: how to interpret unpredictable contractions in the uterus? Having concern regarding premature labour of their child, handling the new situation and finding a balance, and from work to sick leave. to be on sick leave for premature contractions can be compared with enduring a situation of inactivity. The woman finds herself in a stressful situation which she must learn to handle this and find a balance. it appears that supportive information offers the women in premature labour the opportunity of increased participation and responsibility which thereby positively affects her well-being. Copyright © 2012 Elsevier Ltd. All rights reserved.
Wrapson, Wendy; Mewse, Avril J
Sickness certification poses challenges and problems for the GP. Patient factors may influence the sick leave period. To explore how sickness certification occurred based on patients' reports of medical consultations for a new episode of low back pain. A qualitative study using semi-structured interviews with 16 employees who were currently or had recently been off work with an episode of low back pain. We present a preliminary typology of sickness certification responses by medical practitioners comprising four response types: 'process', 'cued', 'consultative' and 'laissez-faire'. All but the process response allows the patient some influence in the sickness certification decision. It is possible that certain types of response may occur at specific stages of recovery. Doctors may allow patients input into the sickness certification process for a number of reasons. As yet, we do not know if this helps or hinders the return to work process.
Background In Sri Lanka, motherhood within marriage is highly valued. Sex out of wedlock is socially unacceptable and can create serious public health problems such as illegal abortions, suicide and infanticide, and single motherhood as a result of premarital sex is considered shameful. The way unmarried women facing single motherhood reflect on and make use of their agency in their social environments characterised by limited social and financial support has consequences for the health and well-being of both themselves and their children. The aim of this study was to explore and describe how unmarried women facing single motherhood in Sri Lanka handle their situation. Methods This qualitative study comprised semi-structured interviews with 28 unmarried pregnant women or single mothers. The data were analysed by qualitative content analysis and the results related to the conceptual framework of social navigation. Results The women facing single motherhood expressed awareness of having trespassed norms of sexuality through self-blame, victimhood and obedience, and by considering or attempting suicide. They demonstrated willingness to take responsibility for becoming pregnant before marriage by giving the child up for adoption, bringing up the child themselves, claiming a father for their child, refraining from marriage in the future, permanently leave their home environment, and taking up employment. Throughout the interviews, the women expressed fear of shame, and striving for familial and societal acceptance and financial survival. Conclusions A social environment highly condemning of unmarried motherhood hindered these women from making strategic choices on how to handle their situation. However, to achieve acceptance and survival, the women tactically navigated norms of femininity, strong family dependence, a limited work market, and different sources of support. Limited access to resources restricted the women’s sexual and reproductive health and rights
Moczko, Tobias R; Bugaj, Till J; Herzog, Wolfgang; Nikendei, Christoph
Objectives This study was designed to explore final-year medical students’ stressors and coping strategies at the transition to the clinical workplace. Methods In this qualitative study, semi-standardized interviews with eight final-year medical students (five male, three female; aged 25.9±1.4 years) were conducted during their internal medicine rotation. After verbatim transcription, a qualitative content analysis of students’ impressions of stress provoking and easing factors during final-year education was performed. Results Students’ statements regarding burdens and dealing with stress were classified into four main categories: A) perceived stressors and provoking factors, B) stress-induced consequences, C) personal and external resources for preventing and dealing with stress, and D) final-year students’ suggestions for workplace improvement. Conclusion Final-year medical students perceived different types of stress during their transition to medical wards, and reported both negative consequences and coping resources concerning perceived stress. As supervision, feedback, and coping strategies played an important role in the students’ perception of stress, final-year medical education curricula development should focus on these specifically. PMID:26834503
Moczko, Tobias R; Bugaj, Till J; Herzog, Wolfgang; Nikendei, Christoph
This study was designed to explore final-year medical students' stressors and coping strategies at the transition to the clinical workplace. In this qualitative study, semi-standardized interviews with eight final-year medical students (five male, three female; aged 25.9±1.4 years) were conducted during their internal medicine rotation. After verbatim transcription, a qualitative content analysis of students' impressions of stress provoking and easing factors during final-year education was performed. Students' statements regarding burdens and dealing with stress were classified into four main categories: A) perceived stressors and provoking factors, B) stress-induced consequences, C) personal and external resources for preventing and dealing with stress, and D) final-year students' suggestions for workplace improvement. Final-year medical students perceived different types of stress during their transition to medical wards, and reported both negative consequences and coping resources concerning perceived stress. As supervision, feedback, and coping strategies played an important role in the students' perception of stress, final-year medical education curricula development should focus on these specifically.
Keller, Rebecca A.
The purpose of this study is to examine how educators are working to foster sustainability through cultivating nature awareness in young children. Data were collected in the form of qualitative semi-structured interviews, which were analyzed using descriptive and deductive coding methods. Findings were viewed through the lens of critical pedagogy and the methods and models of teaching for nature awareness, which included ecological literacy, place based education, and education for sustainable development. There were five major themes and findings that emerged from the interviews with the participants in this study: terms and definitions used, personal stories, strategies for teaching nature awareness and sustainability, barriers, and current issues. This study may benefit those wishing to begin or continue to foster sustainability through teaching nature awareness. The literature review presented in the study aims to address the gap between the practice and pedagogy in teaching for nature awareness and sustainability. Keywords: teaching, nature awareness, sustainability, educators, young children, elementary, preschool, school, natural world, ecological literacy, place-based education, education for sustainable development, critical pedagogy
Wisell, Kristin; Sporrong, Sofia Kälvemark
Community pharmacies are balancing between business (selling medicines and other products) and healthcare (using the pharmacists’ knowledge in order to improve drug utilization). This balance could be affected by regulations decided upon by politicians, but also influenced by others. The aim of this study was to explore important stakeholders’ views on community pharmacy and community pharmacists in Sweden. The method used was that of semi-structured qualitative interviews. Political, professional, and patient organization representatives were interviewed. The results show that informants who are pharmacists or representatives of a professional pharmacist organization generally have a healthcare-centered view on community pharmacy/pharmacists. However, different views on how this orientation should be performed were revealed, ranging from being specialists to dealing with uncomplicated tasks. Political organization representatives generally had a more business-oriented view, where competition in the market was believed to be the main driving force for development. A third dimension in which competition was not stressed also emerged; that community pharmacies should primarily distribute medicines. This dimension was most prevalent among the political and patient organization representatives. One conclusion to be drawn is that no stakeholder seemed to have a clear vision or was willing to take the lead for the development of the community pharmacy sector. PMID:28970376
Full Text Available Community pharmacies are balancing between business (selling medicines and other products and healthcare (using the pharmacists’ knowledge in order to improve drug utilization. This balance could be affected by regulations decided upon by politicians, but also influenced by others. The aim of this study was to explore important stakeholders’ views on community pharmacy and community pharmacists in Sweden. The method used was that of semi-structured qualitative interviews. Political, professional, and patient organization representatives were interviewed. The results show that informants who are pharmacists or representatives of a professional pharmacist organization generally have a healthcare-centered view on community pharmacy/pharmacists. However, different views on how this orientation should be performed were revealed, ranging from being specialists to dealing with uncomplicated tasks. Political organization representatives generally had a more business-oriented view, where competition in the market was believed to be the main driving force for development. A third dimension in which competition was not stressed also emerged; that community pharmacies should primarily distribute medicines. This dimension was most prevalent among the political and patient organization representatives. One conclusion to be drawn is that no stakeholder seemed to have a clear vision or was willing to take the lead for the development of the community pharmacy sector.
Norum, J; Leknes, M
Euthanasia is clinical practice in several countries world-wide. Cancer patients' attitude in this field was focused through a review of case reports and questionnaire-based studies on Medline (1992-97). A total of nine publications including 459 cancer patients from USA, Canada and Holland were found. The majority of patients had poor performance status and advanced disease. At least one third reported themselves positive to euthanasia. Patients below 50 years of age, having superior performance status and not considering themselves religious, more frequently supported euthanasia. Psychological factors seem to be more significant than physical factors for support of euthanasia. Loss of control, being a burden on one's family and loss of dignity are the psychological factors most frequently reported. A "help to live" approach aimed at avoiding patient requests for help to die will mean that health care workers must allocate more of their time to these patients. Overcrowded hospitals with several patients in corridors and lack of nursing-homebeds do not make this situation easier to handle.
Full Text Available The right to live is a right guaranteed by the constitution as well as international legal acts in force in a country, and is based on the moral of a society. But does the right to live imply a parallel individual right to die? Or should the state protect the right to life of a person who does not want to live anymore, going like this against the will of that person? Albanian anthropology, as a post-communist society lacks the tradition of freedom, as in this case of the freedom that belongs to a man affected by an incurable disease. For this reason, in Albania not only we do not have a law on euthanasia, but the issue of euthanasia is not raised as an issue nor by the legislator nor by civil society. The purpose of this paper is to give an overview of euthanasia in Albania, as well as on some specific problems facing the Albanian reality. The methodology used in the paper consists with the combination of comparing legal provisions of euthanasia (or the lack of them in a vertical historical continuity.
In the Judeo-Christian tradition, human life is held to be sacred, a semblance of the divine and a gift from God which the individual cannot dispose of at his or her own will. Hence, these monotheistic religions have made of the crime of murder a transgression of God's own commandment not to kill and have extended the applicability of this commandment to the practice of euthanasia and suicide. On the other hand, some non-religious traditions offer plausible reasons favoring euthanasia. This is a delicate matter for physicians, since the Hippocratic tradition forbids euthanasia and because as care-givers they must also bear the psychological, moral and emotional burden of carrying it out. Physicians are trained to preserve life but not to bring it to an end. As human beings, they must always respect the principle of nonmaleficence, and as physicians they must always respect as well the principle of beneficence. It is difficult to accept the fact that ending a human life can be an act of beneficence. In order to differentiate between passive and active euthanasia, the concept of proportionality of medical acts must be brought into consideration. For instance, using high doses of opiates to alleviate pain or withholding the use of an extraordinary method of treatment are not passive acts aimed at ending the life of a terminally ill patient, but medical acts that are reasonable, judicious and proportionate to the condition and irreversibility of a patient's illness. Therefore, so-called passive euthanasia cannot be considered the same as euthanasia. On the other hand, medically assisted suicide is a deceitful form of active euthanasia. The aim of this act is to cause death and the physician is morally responsible for such a death, since he is providing the means for bringing a human life to an end. Many times the desire to die expressed by terminally ill elderly and helpless patients is a request for help and an expression of reproach against a society that allows for
Zeltner, Nina A; Landolt, Markus A; Baumgartner, Matthias R; Lageder, Sarah; Quitmann, Julia; Sommer, Rachel; Karall, Daniela; Mühlhausen, Chris; Schlune, Andrea; Scholl-Bürgi, Sabine; Huemer, Martina
Progress in diagnosis and treatment of patients with intoxication-type inborn errors of metabolism (IT-IEM) such as urea cycle disorders, organic acidurias or maple syrup urine disease is resulting in a growing number of long-term survivors. Consequently, health-related quality of life (HrQoL) of patients is increasingly regarded as a meaningful outcome parameter. To develop the first validated, disease-specific HrQoL questionnaire for IT-IEM, patients and parents were interviewed as content experts to identify major physical and psychosocial constraints and resources. Focus group interviews with 19 paediatric IT-IEM patients and 26 parents were conducted in four metabolic centres in Austria, Germany and Switzerland. Disease-specific HrQoL categories were established by qualitative content analysis. Fourteen disease-specific topics related to the three well-established generic HrQoL dimensions of physical, mental and social functioning were derived from the interview transcripts. Both patients and parents perceived dietary restrictions and social stigmatisation as major burdens. Dietary restrictions and emotional burdens were more important for young (years) patients, whereas cognition, fatigue and social issues were more relevant to older patients (≥8 years). Treatment-related topics had a significant effect on social and emotional HrQoL. By exploring patients' and parents' perspectives, 14 HrQoL categories were identified. These new categories will allow the development of a disease-specific, standardised questionnaire to assess HrQoL in paediatric IT-IEM patients. Age-appropriate information on the disease and psychosocial support targeted to patients' individual burdens are essential to the delivery of personalised care that takes account of physical, mental and social dimensions of HrQoL.
Hilde M Buiting
Full Text Available OBJECTIVE: To explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to anticipate on the last stage of life. DESIGN: Qualitative interview study. METHODS: In depth-interviews with 15 patients with advanced colorectal or breast cancer at the medical oncology department in a Dutch teaching hospital; interviews were analysed following the principles of thematic content-analysis. RESULTS: All patients reported to know that the chemotherapy they received was with palliative intent. Most of them did not express the wish for information about (other treatment options and put great trust in their physicians' treatment advice. The more patients were aware of the severity of their disease, the more they seemed to 'live their life' in the present and enjoy things besides having cancer. Such living in the present seemed to be facilitated by the use of chemotherapy. Patients often considered the 'chemotherapy-free period' more stressful than periods when receiving chemotherapy despite their generally improved physical condition. Chemotherapy (regardless of side-effects seemed to shift patients' attention away from the approaching last stage of life. Interestingly, although patients often discussed advance care planning, they were reluctant to bring on end-of-life issues that bothered them at that specific moment. Expressing real interest in people 'as a person' was considered an important element of appropriate care. CONCLUSIONS: Fearing their approaching death, patients deliberately focus on living in the present. Active (chemotherapy treatment facilitates this focus, regardless of the perceived side-effects. However, if anxiety for what lies ahead is the underlying reason for treatment, efforts should be made in assisting patients to find other ways to cope with this fear. Simultaneously, such an approach may reduce the use of burdensome and sometimes costly treatment in the
Pierson, C A
Euthanasia is an emerging public problem. The recent "medicalization" of the dying process in industrialized nations has engendered a fear of a painful and undignified death and the loss of control over one's final days. For people who live in societies with advanced medical resources and technology, euthanasia seems the only sure way to have "a good death." This article examines the public and private faces of euthanasia and provides another moral lens through which to view the issue. The article includes an interview with the son of a 78-year-old man who had active euthanasia performed by a family physician in the Netherlands.
Sveinsson, Olafur Arni
Euthanasia has been heatedly discussed in Western countries over the last years. Only a few nations have legalized euthanasia or physician assisted suicide with the Dutch at the forefront of that field. Proponents of euthanasia mostly argue for euthanasia on two grounds. Firstly, that the patient has a right to die and secondly, that there is no substantial difference between euthanasia and palliative care. In this paper I will argue against both of the above. I discuss the arguments against euthanasia which are in principle four. Firstly, it is held by many that taking a human life is wrong under all circumstances. Secondly, that it is an unjustifiable demand to ask a person to take another person's life. In relation to that argument, euthanasia is not in accordance with the basic principles of medicine and nursing as they have evolved over the years and could therefore easily disrupt the therapeutic relationship. Thirdly, as shown from Holland there is empirical evidence that euthanasia is not under good enough surveillance and therefore invites misuse. Fourthly, even though euthanasia might possibly be justifiable under certain circumstances, legalisation might well invite abuse because of the message and pressure that the option places on both patients and professionals in terminal care. My answer to the euthanasia demand is palliative care, where dialogue between the patient and doctor is central. But the dialogue cannot be effective, unless both partners are willing and able to engage in sincere and frank conversations.
Power, Brian T; Kiezebrink, Kirsty; Allan, Julia L; Campbell, Marion K
Unhealthy eating and physical activity behaviours are common among nurses but little is known about determinants of eating and physical activity behaviour in this population. The present study used a theoretical framework which summarises the many possible determinants of different health behaviours (the Theoretical Domains Framework; TDF) to systematically explore the most salient determinants of unhealthy eating and physical activity behaviour in hospital-based nurses. Semi-structured qualitative interviews based on the TDF were conducted with nurses ( n = 16) to explore factors that behavioural theories suggest may influence nurses' eating and physical activity behaviour. Important determinants of the target behaviours were identified using both inductive coding (of categories emerging from the data) and deductive coding (of categories derived from the TDF) of the qualitative data. Thirteen of the fourteen domains in the TDF were found to influence nurses' eating and physical activity behaviour. Within these domains, important barriers to engaging in healthy eating and physical activity behaviour were shift work, fatigue, stress, beliefs about negative consequences, the behaviours of family and friends and lack of planning. Important factors reported to enable engagement with healthy eating and physical activity behaviours were beliefs about benefits, the use of self-monitoring strategies, support from work colleagues, confidence, shift work, awareness of useful guidelines and strategies, good mood, future holidays and receiving compliments. This study used a theory-informed approach by applying the TDF to identify the key perceived determinants of nurses' eating and physical activity behaviour. The findings suggest that future efforts to change nurses' eating and physical activity behaviours should consider targeting a broad range of environmental, interpersonal and intrapersonal level factors, consistent with a socio-ecological perspective.
The growing acceptance of voluntary active euthanasia by the Dutch is examined in relation to the plastic cards requesting active euthanasia carried by many people in The Netherlands, public opinion polls, and support by leading medical figures of the movement to legalize euthanasia. The author draws upon his experience as a hospital doctor to condemn the practice of active euthanasia, arguing that its voluntariness is often counterfeit and always questionable, that it is inseparable from overtly involuntary forms of euthanasia, and that its promise of sparing the sick person agony is false. "Voluntary" euthanasia also brings an ominous change in society because of the message it sends to the elderly and sick, the weak and the dependent; because the fallibility of medical judgments are inconsistent with the irreversibility of the act; and because the fallacious reasoning of the philosophy threatens to cause irreparable damage to the medical profession.
Boudreau, J Donald; Somerville, Margaret A
The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians. In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence. Both proponents and opponents agree that the values of respect for human life and for individuals' autonomy are relevant to the debate. Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited. Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians. The impact of characterizing euthanasia as 'medical treatment' on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.
Barone, Silvana; Unguru, Yoram
As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention. Conversely, the refusal to engage in the practice of euthanasia might be conceived as iatrogenic insofar as it might inadvertently prolong patient suffering. This article will explore cultural and social factors informing families', health care professionals', and society's views on pediatric euthanasia in selected countries. © 2017 American Medical Association. All Rights Reserved.
Full Text Available Dalam KUHP tidak satu pasal pun yang menjelaskan batasan atau pengertian euthanasia. Namun demikian, pengenaan terhadap euthanasia dianalogikan dengan delik-delik yang tercantum dalam pasal 338, 340, 344 KUHP. Dengan dasar itulah maka pelaksanaan euthanasia dilarang. Larangan euthanasia pasif tidak pernah efektif karena kematian sebagai akibat ketidakmampuan ilmu dan teknologi kedokteran, dipandang sebagai kematian alamiah, sedangkan terhadap kematian alamiah tentu saja tidak ditahan-tahan atau dilarang hukum pidana maupun kode etik kedokteran. Hukum pidana dan kode etik kedokteran, tidak mewajibkan dokter untuk mengobati pasien di Iuar batas kemampuan ilmu dan teknologi kedokteran. berdasarkan penerapan karakteristik delik omisionis terbukti bahwa, larangan euthanasia pasif tidak memenuhi kriteria untuk diterapkan sebagai perbuatan pidana. Dalam hal terjadinya euthanasia pasif, walaupun dokter melakukan perbuatan positif, secara logika, kematian pasien tidak dapat dihindari. Dengan demikian sulit untuk dibuktikan adanya hubungan kausal antara akibat yang dilarang timbulnya dengan kelakuan negatif dokter.
Lohiniva, Anna L; Mokhtar, Alaa; Azer, Ashraf; Elmoghazy, Esaam; Kamal, Eman; Benkirane, Manal; Dueger, Erica
Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative data. Analysis was based on thematic analysis that aimed to identify recurrent themes and codes from the narratives. The study identified a number of factors that influence TB treatment adherence. Uncertain financial status due to limited or no employment was frequently discussed in interviews, which resulted in fear of not being able to support family, loss of pride, dependence on family and friends, fear of losing housing, food insecurity and limited food options. Respondents also feared infecting other household members and longed for opportunities to discuss their illness and treatment experiences with other individuals but their social networks were often limited. TB-related stigma was driven by shame and blame of infection. Respondents also believed stigma was based on their foreign origin. Stigma manifested in distancing and exclusion in various ways, resulting in isolation, psychological distress and reluctance to disclose TB status to others. Poverty-related factors and social context with a special focus on stigma should be considered when developing strategies for supporting long-term treatment courses for non-national patients in Cairo and other similar urban settings. © 2015 John Wiley & Sons Ltd.
Bristowe, Katherine; Horsley, Helen L; Shepherd, Kate; Brown, Heather; Carey, Irene; Matthews, Beverley; O'Donoghue, Donal; Vinen, Katie; Murtagh, Felicity E M
There is a need to improve end-of-life care for people with end-stage kidney disease, particularly due to the increasingly elderly, frail and co-morbid end-stage kidney disease population. Timely, sensitive and individualised Advance Care Planning discussions are acceptable and beneficial for people with end-stage kidney disease and can help foster realistic hopes and goals. To explore the experiences of people with end-stage kidney disease regarding starting haemodialysis, its impact on quality of life and their preferences for future care and to explore the Advance Care Planning needs of this population and the timing of this support. Semi-structured qualitative interview study of people receiving haemodialysis. Interviews were analysed using thematic analysis. Recruitment ceased once data saturation was achieved. A total of 20 patients at two UK National Health Service hospitals, purposively sampled by age, time on haemodialysis and symptom burden. Themes emerged around: Looking Back, emotions of commencing haemodialysis; Current Experiences, illness and treatment burdens; and Looking Ahead, facing the realities. Challenges throughout the trajectory included getting information, communicating with staff and the 'conveyor belt' culture of haemodialysis units. Participants reported a lack of opportunity to discuss their future, particularly if their health deteriorated, and variable involvement in treatment decisions. However, discussion of these sensitive issues was more acceptable to some than others. Renal patients have considerable unmet Advance Care Planning needs. There is a need to normalise discussions about preferences and priorities in renal and haemodialysis units earlier in the disease trajectory. However, an individualised approach is essential - one size does not fit all. © The Author(s) 2014.
Ozcelik, Hanife; Tekir, Ozlem; Samancioglu, Sevgin; Fadiloglu, Cicek; Ozkara, Erdem
In Turkey, which is a secular, democratic nation with a majority Muslim population, euthanasia is illegal and regarded as murder. Nurses and students can be faced with ethical dilemmas and a lack of a legal basis, with a conflict of religious beliefs and social and cultural values concerning euthanasia. The aim of this study was to investigate undergraduate nursing students' attitudes towards euthanasia. The study, which had a descriptive design, was conducted with 600 students. The 1st, 2nd, 3rd, and 4th year nursing students at a school of nursing were contacted in May 2009, and 383 students (63.8% of the study population of a total of 600 students) gave informed consent. Two tools were used in accordance with questionnaire preparation rules. The majority of students were female and single (96.9%), and their mean age was 21.3 ± 1.5 years. A majority (78.9%) stated they had received no training course/education on the concept of euthanasia. Nearly one-third (32.4%) of the students were against euthanasia; 14.3% of the students in the study agreed that if their relatives had an irreversible, lethal condition, passive euthanasia could be performed. In addition, 24.8% of the students agreed that if they themselves had an irreversible, lethal condition, passive euthanasia could be performed. Less than half (42.5%) of the students thought that discussions about euthanasia could be useful. There was a significant relation between the study year and being against euthanasia (p euthanasia could be abused (p euthanasia was unethical (p euthanasia.
The bachelor thesis "Attitude of nurses to euthanasia" focuses on an understanding of dying, euthanasia and palliative care and their attitude to euthanasia. The work is devided into two parts - a theoretical one and an empirical one. The theoretical part describes the methodology and results of quantitative research by the use of questionaire comparing two specified groups of nurses - hospic care nurses and intensive care nurses. There are summarised findings from the investigation in the co...
van der Wal, G.; Dillmann, R. J.
The practice of euthanasia in the Netherlands is often used as an argument in debates outside the Netherlands--hence a clear description of the Dutch situation is important. This article summarises recent data and discusses conceptual issues and relevant characteristics of the system of health care. Special emphasis is put on regulation, including relevant data on notification and prosecution. Besides the practice of euthanasia the Dutch are confronted with the gaps in reporting of cases to the public prosecutor and the existence of cases of ending a life without an explicit request. Nevertheless, the "Dutch experiment" need not inevitably lead down the slippery slope because of the visibility and openness of this part of medical practice. This will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end of life. PMID:8019226
Full Text Available Objective: This study includes evaluation of views of the nurses working in two different university hospitals on euthanasia. Methods: This research was planned in form of a cross-sectional definitive questionnaire to analyze views of the nurses on euthanasia according to their departments. A face to face interview was performed with the nurses working in Medical Faculties of Dicle and Gaziantep Universities in 2013. One hundred and fifty two volunteers were examined according to the gender, age, marital status, number of children, family type that they live in, the department that they work, their frequency to meet death, professional experience, presence of any relative confined to bed, their ideas on whether the euthanasia law should be enacted, whether they would request euthanasia for themselves and their relatives. Result: Participants included 125 (82.2% women and 27 (17.8% men; average age was 26.68 ± 12.76 (20-56 years and 21 (13.8% cases did not report their ages. Eighty-nine (58.6% participants were married, 50 (32.9% participants were single and 105 (69.1% participants lived in an elementary family environment. Fifty eight (38.2% participants expressed an opinion on requirement of a legal regulation to make euthanasia possible and 40 (26.3% reported that they were uncertain about this subject. No statistically significant difference was detected between willingness and unwillingness of euthanasia according to their departments (p>0.05. Conclusion: As a result of this study, we find that some of the nurses consider application of the passive euthanasia occurs in our country although euthanasia is forbidden.
On 10 April last, the Dutch Senat accepted a new bill concerning voluntary active euthanasia and physician assisted suicide. This bill legally embodies a ground for exemption from punishment for physicians who conducted voluntary active euthanasia or physician assisted suicide and who complied with certain requirements. Hence, the old policy of tolerance has been transformed into a legal system of acceptance of certain forms of voluntary active euthanasia and physician assisted suicide. This contribution describes these legal changes as the final stage of a process of integration of voluntary active euthanasia and physician assisted suicide in Dutch society. In this way, it endeavours to contribute to a constructive debate.
Euthanasia and assisted suicide are not part of French laws of bioethics and lack, for the time being, definition and normative framework other than their criminal prosecution. To transform them into a right, these concepts certainly call for an ethical and legal debate. This paper aims to question the ideas to be considered, the conceptual bases and normative tools that may be useful to the discussion.
McAlearney, Ann Scheck; Walker, Daniel; Moss, Alexandra D; Bickell, Nina A
Qualitative comparative analysis (QCA) is a methodology created to address causal complexity in social sciences research by preserving the objectivity of quantitative data analysis without losing detail inherent in qualitative research. However, its use in health services research (HSR) is limited, and questions remain about its application in this context. To explore the strengths and weaknesses of using QCA for HSR. Using data from semistructured interviews conducted as part of a multiple case study about adjuvant treatment underuse among underserved breast cancer patients, findings were compared using qualitative approaches with and without QCA to identify strengths, challenges, and opportunities presented by QCA. Ninety administrative and clinical key informants interviewed across 10 NYC area safety net hospitals. Transcribed interviews were coded by 3 investigators using an iterative and interactive approach. Codes were calibrated for QCA, as well as examined using qualitative analysis without QCA. Relative to traditional qualitative analysis, QCA strengths include: (1) addressing causal complexity, (2) results presentation as pathways as opposed to a list, (3) identification of necessary conditions, (4) the option of fuzzy-set calibrations, and (5) QCA-specific parameters of fit that allow researchers to compare outcome pathways. Weaknesses include: (1) few guidelines and examples exist for calibrating interview data, (2) not designed to create predictive models, and (3) unidirectionality. Through its presentation of results as pathways, QCA can highlight factors most important for production of an outcome. This strength can yield unique benefits for HSR not available through other methods.
Taylor, Katherine L; Parshuram, Christopher S; Ferri, Susan; Mema, Briseida
Communication during resuscitation is essential for the provision of coordinated, effective care. Previously, we observed 44% of resuscitation communication originated from participants other than the physician team leader; 65% of which was directed to the team, exclusive of the team leader. We called this outer-loop communication. This institutional review board-approved qualitative study used grounded theory analysis of focus groups and interviews to describe and define outer-loop communication and the role of "event manager" as an additional "leader." Participants were health care staff involved in the medical management of resuscitations in a quaternary pediatric academic hospital. The following 3 domains were identified: the existence and rationale of outer-loop communication; the functions fulfilled by outer-loop communication; and the leadership and learning of event manager skills. The role was recognized by all team members and evolved organically as resuscitation complexity increased. A "good" manager has similar qualities to a "good team leader" with strong nontechnical skills. Event managers were not formally identified and no specific training had occurred. "Outer-loop" communication supports resuscitation activities. An event manager gives direction to the team, coordinates activities, and supports the team leader. We describe a new role in resuscitation in light of structural organizational theory and cognitive load with a view to incorporating this structure into resuscitation training. Copyright © 2017 Elsevier Inc. All rights reserved.
Sverker, Annette; Thyberg, Ingrid; Ostlund, Gunnel; Waltersson, Eva; Thyberg, Mikael
To explore what work-related dilemmas are experienced by patients with early rheumatoid arthritis (RA), according to their own descriptions, and to interpret this in terms of participation categories of the International Classification of Functioning, Disability and Health (ICF). In 48 patients with early RA, qualitative interviews were analyzed, followed by linking of concepts to the activity/participation component of the ICF and interpretation of general themes. Work-related dilemmas represented different societal perspectives on work related to acquiring, keeping and terminating a job, self-employment, part-time, full-time and non-remunerative employment. Dilemmas also represented participation priorities in economic self-sufficiency, self-care such as health care, and avoiding social relationships and recreation in favor of work. Leisure time was influenced because efforts of working took energy and time of day-to-day procedures. Embedded actions in work-related dilemmas were carrying out daily routine, mobility including using transportation, self-care, domestic life and social interaction. The general themes societal perspectives, participation priorities and embedded actions, with the included ICF categories that are described in detail according to the experiences of the patients, can support clinical reasoning and research on quantitative relations to disease activity, body functions, ability and contextual factors.
Tijdink, J K; Schipper, K; Bouter, L M; Maclaine Pont, P; de Jonge, J; Smulders, Y M
To investigate the biomedical scientist's perception of the prevailing publication culture. Qualitative focus group interview study. Four university medical centres in the Netherlands. Three randomly selected groups of biomedical scientists (PhD, postdoctoral staff members and full professors). Main themes for discussion were selected by participants. Frequently perceived detrimental effects of contemporary publication culture were the strong focus on citation measures (like the Journal Impact Factor and the H-index), gift and ghost authorships and the order of authors, the peer review process, competition, the funding system and publication bias. These themes were generally associated with detrimental and undesirable effects on publication practices and on the validity of reported results. Furthermore, senior scientists tended to display a more cynical perception of the publication culture than their junior colleagues. However, even among the PhD students and the postdoctoral fellows, the sentiment was quite negative. Positive perceptions of specific features of contemporary scientific and publication culture were rare. Our findings suggest that the current publication culture leads to negative sentiments, counterproductive stress levels and, most importantly, to questionable research practices among junior and senior biomedical scientists. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Strandenæs, Margit Gausdal; Lund, Anne; Rokstad, Anne Marie Mork
Day care is assumed to promote independence in home-dwelling people with dementia, increase well-being and enhance social stimulation. Few studies have directly engaged people with dementia to better understand the benefits and impacts of such services. The aim of this study was to explore attendees' experiences with day care designed for people with dementia. This study had a qualitative descriptive design and included individual interviews with 17 users attending day care. The analysis was undertaken using content analyses. The participants reported that day care had a positive influence on their physical functioning, cognition, well-being, and situation at home because they were provided with social stimulation, meals, and activities. Day care contributed to the maintenance of a rhythm and structure in everyday life. Furthermore, the staff contributed to making the day care a safe place to be and enhanced a sense of belonging. This study reveals the positive impact of day care on the daily lives of people with dementia because this service contributes to the enhancement of activities and social support, prevents isolation, and enhances practical and cognitive functioning as experienced by the users. The staff has a major impact on the experience of the participants in the day care.
Sjöström, Rita; Melin-Johansson, Christina; Asplund, Ragnar; Alricsson, Marie
The aim of this qualitative study was to explore experiences of sick-listed persons of not returning to work during a six-year period after participation in an extensive multidisciplinary rehabilitation programme. The study comprised ten participants with musculoskeletal disorders, mainly neck and back pain. Semi-structured interviews were conducted and analysed by manifest content analysis. This led to identification of three primary categories and six sub-categories, which described the participants' experiences of barriers to and possibilities of returning to work, and indicated what strategies they used to cope with everyday life. The participants described that the main barriers to returning to work were pain and somatic symptoms, fatigue, and not fulfilling the work requirements. Participants considered physical activity a key factor in coping with pain. Most participants thought that they had residual work ability, and could utilise this if they could get a modified job adapted to their own capacity. Our study highlights the importance of utilising residual working ability at workplaces. Finding flexible work possibilities requires an understanding and supportive attitude on the part of both the employer and the social insurance office.
Full Text Available The aim of the present study was to explore four individuals' perspective of the way their speech and communication changed as a result of subthalamic nucleus deep brain stimulation treatment for Parkinson's disease. Interviews of two men and two women were analyzed using qualitative content analysis. Three themes emerged as a result of the analysis. The first theme included sub-themes describing both increased and unexpected communication difficulties such as a more vulnerable speech function, re-emerging stuttering and cognitive difficulties affecting communication. The second theme comprised strategies to improve communication, using different speech techniques and communicative support, as well as trying to achieve changes in medical and stimulation parameters. The third theme included descriptions of mixed feelings surrounding the surgery. Participants described the surgery as an unavoidable dramatic change, associated both with improved quality of life but also uncertainty and lack of information, particularly regarding speech and communication changes. Despite negative effects on speech, the individuals were generally very pleased with the surgical outcome. More information before surgery regarding possible side effects on speech, meeting with a previously treated patient and possibly voice and speech therapy before or after surgery are suggested to facilitate the adjustment to the new speech conditions.
Svendsen, Edel Jannecke; Pedersen, Reidar; Moen, Anne; Bjørk, Ida Torunn
ABSTRACT The aim of this study was to explore nurses’ and physicians’ perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology. PMID:28889788
Svendsen, Edel Jannecke; Pedersen, Reidar; Moen, Anne; Bjørk, Ida Torunn
The aim of this study was to explore nurses' and physicians' perspectives on and reasoning about the use of restraint during medical procedures on newly admitted preschoolers in somatic hospital care. We analysed qualitative data from individual interviews with a video recall session at the end with seven physicians and eight nurses. They had earlier participated in video recorded peripheral vein cannulations on preschool children. The data were collected between May 2012 and May 2013 at a paediatric hospital unit in Norway. The analysis resulted in three main themes: (1) disparate views on the concept of restraint and restraint use (2), ways to limit the use of physical restraint and its negative consequences, and (3) experience with the role of parents and their influence on restraint. Perspectives from both healthcare professions were represented in all the main themes and had many similarities. The results of this study may facilitate more informed and reflective discussions of restraint and contribute to higher awareness of restraint in clinical practice. Lack of guidance and scientific attention to restraint combined with conflicting interests and values among healthcare providers may result in insecurity, individual dogmatism, and a lack of shared discussions, language, and terminology.
de Kort, Susanne J
A recent survey showed that less than half of Dutch physicians would find it conceivable to grant a request for euthanasia from a patient suffering from psychiatric disease or dementia, or who is tired of life. Because of a broader interpretation by the Regional Review Committees of the official criteria for due care, all recent cases of euthanasia in these specific groups of patients had been accepted. In this commentary it is argued that, following recent social developments in the Netherlands (including cuts in provision of care for the elderly and of mental health care, and a narrowed view about end-of-life issues), the official euthanasia criteria for due care are no longer suitable if we are to avoid a 'slippery slope' effect in cases such as those mentioned above. The criteria of a) a voluntary and well-considered request and b) absence of reasonable treatment alternatives are particularly under pressure. A plea is hold for a return to stricter interpretation of the criteria.
Skiveren, Jette; Mortensen, Erik Lykke; Haedersdal, Merete
. METHODS: A total of 10 RTRs were individually interviewed using a semi-structured interview guide (five women, five men). The interviews were conducted in Copenhagen in June 2008. Transcriptions of the interviews were subsequently analyzed using predefined concepts from the Health Belief Model. RESULTS...
Vilela, Luciana Pricoli; Caramelli, Paulo
Euthanasia is an increasingly debated subject among specialized professionals and also among lay people, even in countries such as Brazil where it is not authorized. It is questionable, however, if the concept of euthanasia is well known by these persons. The goal of this study was to investigate knowledge about the definition of euthanasia by family caregivers of patients with dementia and by specialized physicians and also to investigate their personal opinion on this topic. We prospectively interviewed 30 physicians from three different medical specialties and 40 family caregivers of patients with Alzheimer's disease using a structured questionnaire. Two clinical vignettes were also presented to the physicians in order to ascertain their personal opinion about euthanasia. Among the caregivers, 10 (25.0%) knew the correct definition of euthanasia. Regarding their personal view, nine (22.5%) were in favor, while 20 (50.0%) were against. The remaining 11 (27.5%) caregivers were unable to define their position. Among the physicians, 19 (63.3%) gave a coherent answer regarding the definition of euthanasia. When they were presented with the clinical vignettes, less than 50% of them were in favor of euthanasia. The definition of euthanasia was unknown by most of the lay individuals and also by one third of the physicians. Although it is not officially approved in Brazil, a small proportion of family caregivers and also of specialized physicians would be in favor of the practice of euthanasia.
Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris
Background Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. Objective An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Methods Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Results Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients’ lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients’ lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients’ motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than
O'Cathain, Alicia; Drabble, Sarah J; Foster, Alexis; Horspool, Kimberley; Edwards, Louisa; Thomas, Clare; Salisbury, Chris
Evidence of benefit for telehealth for chronic conditions is mixed. Two linked randomized controlled trials tested the Healthlines Service for 2 chronic conditions: depression and high risk of cardiovascular disease (CVD). This new telehealth service consisted of regular telephone calls from nonclinical, trained health advisers who followed standardized scripts generated by interactive software. Advisors facilitated self-management by supporting participants to use Web-based resources and helped to optimize medication, improve treatment adherence, and encourage healthier lifestyles. Participants were recruited from primary care. The trials identified moderate (for depression) or partial (for CVD risk) effectiveness of the Healthlines Service. An embedded qualitative study was undertaken to help explain the results of the 2 trials by exploring mechanisms of action, context, and implementation of the intervention. Qualitative interview study of 21 staff providing usual health care or involved in the intervention and 24 patients receiving the intervention. Interviewees described improved outcomes in some patients, which they attributed to the intervention, describing how components of the model on which the intervention was based helped to achieve benefits. Implementation of the intervention occurred largely as planned. However, contextual issues in patients' lives and some problems with implementation may have reduced the size of effect of the intervention. For depression, patients' lives and preferences affected engagement with the intervention: these largely working-age patients had busy and complex lives, which affected their ability to engage, and some patients preferred a therapist-based approach to the cognitive behavioral therapy on offer. For CVD risk, patients' motivations adversely affected the intervention whereby some patients joined the trial for general health improvement or from altruism, rather than motivation to make lifestyle changes to address
Powell, John; Inglis, Nadia; Ronnie, Jennifer; Large, Shirley
Most households in the United Kingdom have Internet access, and health-related Internet use is increasing. The National Health Service (NHS) Direct website is the major UK provider of online health information. Our objective was to identify the characteristics and motivations of online health information seekers accessing the NHS Direct website, and to examine the benefits and challenges of the health Internet. We undertook an online questionnaire survey, offered to users of the NHS Direct website. A subsample of survey respondents participated in in-depth, semistructured, qualitative interviews by telephone or instant messaging/email. Questionnaire results were analyzed using chi-square statistics. Thematic coding with constant comparison was used for interview transcript analysis. In total 792 respondents completed some or all of the survey: 71.2% (534/750 with data available) were aged under 45 years, 67.4% (511/758) were female, and 37.7% (286/759) had university-level qualifications. They sought information for themselves (545/781, 69.8%), someone else (172/781, 22.0%), or both (64/781, 8.2%). Women were more likely than men to seek help for someone else or both themselves and someone else (168/509 vs 61/242, χ(2) (2) = 6.35, P = .04). Prior consultation with a health professional was reported by 44.9% (346/770), although this was less common in younger age groups (anonymity. Various challenges were discussed but no prominent theme emerged. Navigating online health information and determining what to trust was regarded as a "common sense" activity, and brand recognition was important. Specific comments about NHS Direct included the perception that the online service was integrated with traditional service provision. This study supports a model of evolutionary rather than revolutionary change in online health information use. Given increasing resource constraints, the health care community needs to seek ways of promoting efficient and appropriate health
Adriansen, Hanne Kirstine
The aim of this paper is to explain and discuss timeline interviews as a method for doing life history research. It is a ‘how to’ article explaining the strengths and weaknesses of using a timeline when conducting qualitative interviews. The method allows the interviewee to participate...... in the reporting of the interview which may give raise to ownership and sharing of the analytical power in the interview situation. Exactly for this reason, it may not be the most appropriate method for interviewing elites or for conducting insider interviews where positionality can be at play. The use...... of the timeline should not lead the nterviewer or the interviewee to assume linearity and coherence; it is an rganising principle for the events. It provides an opportunity for linking the story with the wider social, political and environmental context during the interview. hile the method is very suitable...
Engeset, Jorun; Stuge, Britt; Fegran, Liv
Background The aim of this study was to explore how pelvic girdle pain after delivery influences women’s daily life in Norway. Knowledge about living with post-partum pelvic girdle pain is lacking. Method A phenomenological–hermeneutical design with qualitative semi-structured interviews was used. A strategic selection procedure was chosen to recruit participants from physiotherapy clinics and a regio...
It is often accepted that we may legitimately speak about voluntary euthanasia only in cases of persons who are suffering because they are incurably injured or have an incurable disease. This article argues that when we consider the moral acceptability of voluntary euthanasia, we have no good reason to concentrate only on persons who are ill or injured and suffering.
Kelleher, M J; Chambers, D; Corcoran, P; Keeley, H S; Williamson, E
The present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The "slippery slope" argument is briefly considered.
Ward, Russell A.
Study explores relationship between age (and sex and race) and acceptance of euthanasia. Women and non-Whites were less accepting because of religiosity. Among older people less acceptance was attributable to their lesser education and greater religiosity. Results suggest that quality of life in old age affects acceptability of euthanasia. (Author)
Both active euthanasia and assisted suicide are legal in The Netherlands, Belgium, Luxemburg and, most recently, in Canada. Examination of national legislations of countries where both active euthanasia and assisted suicide are legal. The number of accomplished active euthanasia cases and that of assisted suicide cases. Analysis of national statistical data. Comparison of statistical data before and after 2010. Comparison of the related practices in the surveyed countries. The number of active euthanasia cases markedly predominates over the number of assisted suicide cases. Cancer is a main reason for active euthanasia, or assisted suicide. In countries with a larger population, the number of active euthanasia cases is higher than that in countries with a smaller population. Regarding the fact that the applicants for active euthanasia withdraw their requests in a smaller number than the applicants for assisted suicide, patients prefer the choice of active euthanasia. Since the related legislative product is too recent in Canada at present, it may be only presumed that a certain preference will also develop in the related practices in Canada. Orv. Hetil., 2016, 157(40), 1595-1600.
Gagliardi, Anna R; Ducey, Ariel; Lehoux, Pascale; Turgeon, Thomas; Ross, Sue; Trbovich, Patricia; Easty, Anthony; Bell, Chaim; Urbach, David
Postmarket surveillance of medical devices is reliant on physician reporting of adverse medical device events (AMDEs). Little is known about factors that influence whether and how physicians report AMDEs, an essential step in developing behaviour change interventions. This study explored factors that influence AMDE reporting. Qualitative interviews were conducted with physicians who differed by specialties that implant cardiovascular and orthopaedic devices prone to AMDEs, geography and years in practice. Participants were asked if and how they reported AMDEs, and the influencing factors. Themes were identified inductively using constant comparative technique, and reviewed and discussed by the research team on four occasions. Twenty-two physicians of varying specialty, region, organisation and career stage perceived AMDE reporting as unnecessary, not possible or futile due to multiple factors. Physicians viewed AMDEs as an expected part of practice that they could manage by switching to different devices or developing work-around strategies for problematic devices. Physician beliefs and behaviour were reinforced by limited healthcare system capacity and industry responsiveness. The healthcare system lacked processes and infrastructure to detect, capture, share and act on information about AMDEs, and constrained device choice through purchasing contracts. The device industry did not respond to reports of AMDEs from physicians or improve their products based on such reports. As a result, participants said they used devices that were less than ideal for a given patient, leading to suboptimal patient outcomes. There may be little point in solely educating or incentivising individual physicians to report AMDEs unless environmental conditions are conducive to doing so. Future research should explore policies that govern AMDEs and investigate how to design and implement postmarket surveillance systems. © Article author(s) (or their employer(s) unless otherwise stated in
Joan E Mackintosh
Full Text Available OBJECTIVES: To identify the reasons why individuals contact, or delay contacting, emergency medical services in response to stroke symptoms. DESIGN: Qualitative interview study with a purposive sample of stroke patients and witnesses, selected according to method of accessing medical care and the time taken to do so. Data were analysed using the Framework approach. SETTING: Area covered by three acute stroke units in the north east of England. PARTICIPANTS: Nineteen stroke patients and 26 witnesses who had called for help following the onset of stroke symptoms. RESULTS: Factors influencing who called emergency medical services and when they called included stroke severity, how people made sense of symptoms and their level of motivation to seek help. Fear of the consequences of stroke, including future dependence or disruption to family life, previous negative experience of hospitals, or involving a friend or relations in the decision to access medical services, all resulted in delayed admission. Lack of knowledge of stroke symptoms was also an important determinant. Perceptions of the remit of medical services were a major cause of delays in admission, with many people believing the most appropriate action was to telephone their GP. Variations in the response of primary care teams to acute stroke symptoms were also evident. CONCLUSIONS: The factors influencing help-seeking decisions are complex. There remains a need to improve recognition by patients, witnesses and health care staff of the need to treat stroke as a medical emergency by calling emergency medical services, as well as increasing knowledge of symptoms of stroke among patients and potential witnesses. Fear, denial and reticence to impose on others hinders the process of seeking help and will need addressing specifically with appropriate interventions. Variability in how primary care services respond to stroke needs further investigation to inform interventions to promote best
Varsi, Cecilie; Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M
The adoption of Internet-based patient-provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. The goal of our study was to investigate patients' views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW).
Full Text Available Abstract Background It is argued that the ways in which women express emotional distress mean that they are more likely to be diagnosed with depression, while men's relative lack of articulacy means their depression is hidden. This may have consequences for communicating with health professionals. The purpose of this analysis was to explore how men and women with depression articulate their emotional distress, and examine whether there are gender differences or similarities in the strategies that respondents found useful when engaging with health professionals. Methods In-depth qualitative interviews with 22 women and 16 men in the UK who identified themselves as having had depression, recruited through general practitioners, psychiatrists and support groups. Results We found gender similarities and gender differences in our sample. Both men and women found it difficult to recognise and articulate mental health problems and this had consequences for their ability to communicate with health professionals. Key gender differences noted were that men tended to value skills which helped them to talk while women valued listening skills in health professionals, and that men emphasised the importance of getting practical results from talking therapies in their narratives, as opposed to other forms of therapy which they conceptualised as 'just talking'. We also found diversity among women and among men; some respondents valued a close personal relationship with health professionals, while others felt that this personal relationship was a barrier to communication and preferred 'talking to a stranger'. Conclusion Our findings suggest that there is not a straightforward relationship between gender and engagement with health professionals for people with depression. Health professionals need to be sensitive to patients who have difficulties in expressing emotional distress and critical of gender stereotypes which suggest that women invariably find it easy to
Full Text Available Taste and smell alterations have been recognized as common symptoms in relation to various cancers. However, previous research suggests that patients do not receive sufficient support in managing taste and smell alterations. Therefore, the objective of this study is to investigate how persons with experience from lung cancer-related taste and smell alterations reason about resources and strategies offered and used to manage these symptoms. Data from semi-structured individual interviews with 13 women and four men were analyzed with qualitative content analysis. We used Kleinman's now classic medical anthropological model of local health care systems, consisting of the personal, professional, and folk sector, to interpret and understand how people respond to sickness experiences in their daily lives. By presenting the findings using this model, we demonstrate that most strategies for dealing with taste and smell alterations were undertaken in the personal sector, i.e. in participants' daily lives, on an individual level and in interaction with family, social networks and communities. Taste and smell alterations implied two overarching challenges: 1 adjusting to no longer being able to trust information provided by one's own senses of taste and/or smell, and 2 coming to terms with taste and smell alterations as a part of having lung cancer. Health care professionals' involvement was described as limited, but appeared to fulfil most participants' expectations. However, through provision of normalizing information, practical advice, and to some extent, emotional support, health care professionals had potential to influence strategies and resources used for dealing with taste and smell alterations. With this study, we further the understanding of how people deal with lung cancer-related taste and smell alterations and discuss the role of health care professionals for this process.
Blane, David N; Macdonald, Sara; Morrison, David; O'Donnell, Catherine A
Primary care has a key role to play in the prevention and management of obesity, but there remain barriers to engagement in weight management by primary care practitioners. The aim of this study was to explore the views of key stakeholders in adult weight management services on the role of primary care in adult weight management. Qualitative study involving semi-structured interviews with nine senior dietitians involved in NHS weight management from seven Scottish health boards. Transcripts were analysed using an inductive thematic approach. A range of tensions were apparent within three key themes: weight management service issues, the role of primary care, and communication with primary care. For weight management services, these tensions were around funding, the management model of obesity, and how to configure access to services. For primary care, they were around what primary care should be doing, who should be doing it, and where this activity should fit within wider weight management policy. With regard to communication between weight management services and primary care, there were tensions related to the approach taken (locally adapted versus centralised), the message being communicated (weight loss versus wellbeing), and the response from practitioners (engagement versus resistance). Primary care can do more to support adult weight management, but this requires better engagement and communication with weight management services, to overcome the tensions highlighted in this study. This, in turn, requires more secure, sustained funding. The example of smoking cessation in the UK, where there is a network of well-resourced NHS Stop Smoking Services, accessible via different means, could be a model to follow.
Emslie, Carol; Ridge, Damien; Ziebland, Sue; Hunt, Kate
It is argued that the ways in which women express emotional distress mean that they are more likely to be diagnosed with depression, while men's relative lack of articulacy means their depression is hidden. This may have consequences for communicating with health professionals. The purpose of this analysis was to explore how men and women with depression articulate their emotional distress, and examine whether there are gender differences or similarities in the strategies that respondents found useful when engaging with health professionals. In-depth qualitative interviews with 22 women and 16 men in the UK who identified themselves as having had depression, recruited through general practitioners, psychiatrists and support groups. We found gender similarities and gender differences in our sample. Both men and women found it difficult to recognise and articulate mental health problems and this had consequences for their ability to communicate with health professionals. Key gender differences noted were that men tended to value skills which helped them to talk while women valued listening skills in health professionals, and that men emphasised the importance of getting practical results from talking therapies in their narratives, as opposed to other forms of therapy which they conceptualised as 'just talking'. We also found diversity among women and among men; some respondents valued a close personal relationship with health professionals, while others felt that this personal relationship was a barrier to communication and preferred 'talking to a stranger'. Our findings suggest that there is not a straightforward relationship between gender and engagement with health professionals for people with depression. Health professionals need to be sensitive to patients who have difficulties in expressing emotional distress and critical of gender stereotypes which suggest that women invariably find it easy to express emotional distress and men invariably find it difficult
Eborall, Helen C; Dallosso, Helen M; McNicol, Sarah; Speight, Jane; Khunti, Kamlesh; Davies, Melanie J; Heller, Simon R
The Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) Self-monitoring Trial reported that people with newly diagnosed type 2 diabetes attending community-based structured education and randomized to self-monitoring of blood glucose (SMBG) or urine monitoring had comparable improvements in biomedical outcomes, but differences in satisfaction with, and continued use of monitoring method, well-being and perceived threat from diabetes. To explore experiences of SMBG and urine monitoring following structured education. We specifically addressed the perceived usefulness of each monitoring method and the associated well-being. Qualitative semi-structured interviews with 18 adults with newly diagnosed type 2 diabetes participating in the DESMOND Self-monitoring Trial (SMBG, N=10; urine monitoring, N=8)~12 months into the trial. Analysis was informed by the constant comparative approach. Interviewees reported SMBG as accurate, convenient and useful. Declining use was explained by having established a pattern of managing blood glucose with less frequent monitoring or lack of feedback or encouragement from health care professionals. Many initially positive views of urine monitoring progressively changed due to perceived inaccuracy, leading some to switch to SMBG. Perceiving diabetes as less serious was attributable to lack of symptoms, treatment with diet alone and-in the urine-monitoring group-consistently negative readings. Urine monitoring also provided less visible evidence of diabetes and of the effect of behaviour on glucose. The findings highlight the importance for professionals of considering patients' preferences when using self-monitoring technologies, including how these change over time, when supporting the self-care behaviours of people with type 2 diabetes. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org.
Hermsen, Maaike A; ten Have, Henk A M J
With the growth of palliative care services, interest in moral issues also seems to be growing. The controversial issue of euthanasia significantly provokes moral reflection on the care for dying patients. This article presents an analysis of the moral issue of euthanasia as it is discussed by the palliative care community in the professional journals of palliative care. Initially, the analysis will focus on describing the characteristics of the publications about euthanasia and the attitudes expressed in the articles towards this practice. Second, attention will be paid to the description of the uses of the term euthanasia in the various articles and also how frequently such uses occur. Third, the various arguments in support for or against a place for euthanasia in palliative care will be discussed.
In 2011, Frank Van Den Bleeken became the first detainee to request euthanasia under Belgium's Euthanasia Act of 2002. This article investigates whether it would be lawful and morally permissible for a doctor to accede to this request. Though Van Den Bleeken has not been held accountable for the crimes he committed, he has been detained in an ordinary prison, without appropriate psychiatric care, for more than 30 years. It is first established that Van Den Bleeken's euthanasia request plausibly meets the relevant conditions of the Euthanasia Act and that, consequently, a doctor could lawfully fulfill it. Next, it is argued that autonomy-based reasons for euthanizing him outweigh complicity-based reasons against doing so, and that, therefore, it is also morally permissible for a doctor to carry out the euthanasia request.
Recently, organ donation after euthanasia has been a topic of discussion in the Dutch media and scientific literature. Unfortunately, both the articles in question and the media interviews contained several unsubstantiated statements. This article describes the background of organ donation after
J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit)
textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample
van der Heide, Agnes
Several countries have adopted laws that regulate physician assistance in dying. Such assistance may consist of providing a patient with a prescription of lethal medication that is self-administered by the patient, which is usually referred to as (physician) assistance in suicide, or of administering lethal medication to a patient, which is referred to as euthanasia. The main aim of regulating physician assistance in dying is to bring these practices into the open and to provide physicians with legal certainty. A key condition in all jurisdictions that have regulated either assistance in suicide or euthanasia is that physicians are only allowed to engage in these acts upon the explicit and voluntary request of the patient. All systems that allow physician assistance in dying have also in some way included the notion that physician assistance in dying is only accepted when it is the only means to address severe suffering from an incurable medical condition. Arguments against the legal regulation of physician assistance in dying include principled arguments, such as the wrongness of hastening death, and arguments that emphasize the negative consequences of allowing physician assistance in dying, such as a devaluation of the lives of older people, or people with chronic disease or disabilities. Opinion polls show that some form of accepting and regulating euthanasia and physician assistance in suicide is increasingly supported by the general population in most western countries. Studies in countries where physician assistance in dying is regulated suggest that practices have remained rather stable in most jurisdictions and that physicians adhere to the legal criteria in the vast majority of cases. © 2013 Elsevier B.V. All rights reserved.
Sinha, Vinod K.; Basu, S.; Sarkhel, S.
In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individual's right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physician's role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social ‘coercion’ in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like “death with dignity” foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature. PMID:22988327
The ethical problems of euthanasia are evolving. After a long "silent" period, two conflicting moral codes have emerged. One, backed by most of the clergy, is based on the belief that a person's life does not belong to him/her. The other, adopted by a majority of free thinkers, maintains that each person has the right to appreciate the value of his/her own life. Underlying the controversy about rendering euthanasia legal or not, there is tension between the values of life and freedom. Surprisingly, the practices themselves do not seem to be questioned. However, the uncertain situation of the non-respect of a legal prohibition can undermine the doctor-patient relationship and also seems to have led to increase in the number of voluntary interruptions of life carried out without the patient's consent. The law cannot uphold one particular ethic over another. This is the reason why the text adopted in Belgium is based on the recognition of a person's autonomy. At the heart of the reform there is also the twofold will to bring practices into the open as much as possible and to protect practitioners who "rely" on a fundamental dialogue with their patients.
Benatar, S R
Medical progress, secularisation of life, growing acceptance of individual human rights (including the right to refuse medical treatment) and of shared decision-making in medicine have focused public attention on the ways in which life may, and perhaps even ought to, be allowed to end in our complex modern era. Intense and thoughtful bio-ethical debate over many years has 'unpacked' the many different understandings and interpretations of the word euthanasia. The consequent conceptual clarification together with recognition and acknowledgement of psychological implications has facilitated a growing rational consensus on openly accepting the withholding and withdrawing of treatment (under defined conditions) within the realm of sound medical practice. This is clearly distinct from assisted suicide and active euthanasia which are generally considered unacceptable perversions of medical practice. Given the ability to sustain life for prolonged periods, often in a permanent state of unconsciousness, the unrealistic expectations of some medical personnel and the lay public, the severe constraints on health care facilities in South Africa and the totally inadequate allocation of resources for highly effective medical treatments, it is appropriate to re-open public debate on the limits of 'striving officiously to keep alive' and on the distinction between 'allowing to die' and 'killing'. Concern that 'rational' arguments reflect moral decay rather than moral progress keeps the debate open and focuses attention on some 'slippery slope' consequences.
van Marwijk, Harm; Haverkate, Ilinka; van Royen, Paul; The, Anne-Mei
There is only limited knowledge about the emotional impact that performing euthanasia has on primary care physicians (PCPs) in the Netherlands. To obtain more insight into the emotional impact on PCPs of performing euthanasia or assisted suicide, and to tailor the educational needs of vocational PCP trainees accordingly. Qualitative research, consisting of four focus group studies. The setting was primary care in the Netherlands; 22 PCPs participated, in four groups (older males, older females, younger males and a group with interest with regard to euthanasia). Various phases with different emotions were distinguished: before (tension), during (loss) and after (relief) the event. Although it is a very rare occurrence, euthanasia has a major impact on PCPs. Their relationship with the patient, their loneliness, the role of the family, and pressure from society are the main issues that emerged. Making sufficient emotional space and time available to take leave adequately from a patient is important for PCPs. Many PCPs stressed that young physicians should form their own opinions about euthanasia and other end-of-life decisions early on in their career. We recommend that these issues are officially included in the vocational training programme for general practice.
Foster Nadine E
Full Text Available Abstract Background Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation. Methods Qualitative interviews were conducted with general practitioners (GPs before (n = 32 and after (n = 9 the introduction of a subgrouping for targeted treatment system. GPs were offered an electronic six-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low' in order to help inform their decision making about treatment approaches. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all five practices. A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes. We adopted the normalisation process theory (NPT to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations. Results GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'relational' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system. Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines. Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement
Sanders, Tom; Foster, Nadine E; Ong, Bie Nio
Changing clinicians' behaviour is recognised as a major challenge. It is clear that behaviour change not only depends on demonstrating the proven effectiveness of clinical interventions; contextual and occupational factors, such as 'change readiness', may be central to their implementation. This paper highlights the context of behaviour change in relation to a healthcare innovation introduced within primary care, highlighting the importance of organisational and interpersonal factors that may help explain the dynamics of implementation. Qualitative interviews were conducted with general practitioners (GPs) before (n = 32) and after (n = 9) the introduction of a subgrouping for targeted treatment system. GPs were offered an electronic six-item subgrouping tool, to identify patients according to their risk of poor outcome ('high', 'low') in order to help inform their decision making about treatment approaches. Recruitment was based on a 'maximum diversification sample', to obtain a wide representation of views across all five practices. A coding scheme was developed based on the emergent findings, and the data were analysed using 'constant comparison', drawing upon insights and developing connections between themes. We adopted the normalisation process theory (NPT) to explain the uptake of the new system and to examine the relevance of coherence for the implementation of innovations in organisations. GPs perceived back pain as a low clinical priority, and highlighted the importance of 'practical' and 'relational' coherence in decisions to adopt and engage with the new subgrouping for targeted treatment system. Health professionals often engage in 'sense making' about new innovations to 'road test' their applicability or relevance to daily clinical routines. Low back pain was generally perceived as an 'uninteresting' and clinically unchallenging health problem by GPs, which may partly explain their lack of engagement with the new subgrouping for targeted treatment
Gammon, Deede; Wibe, Torunn; Ruland, Cornelia M
Background The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW). PMID:24220233
Gao, Fengsong; Tilse, Cheryl; Wilson, Jill; Tuckett, Anthony; Newcombe, Peter
The residential aged care industry faces shortages and high turnover rates of direct care workers. This situation is further complicated by the increasing cultural diversity of residents and staff. To retain direct care workers, it is crucial to explore their perceptions of the rewards and difficulties of care work, and their employment intentions in multicultural environments. A qualitative descriptive study was used to understand perceptions of the rewards and difficulties of residential aged care work for core direct care workers (i.e. nurses and nursing assistants), how these were related to their intentions to stay or leave, and how these varied between nurses and nursing assistants, and between locally and overseas born workers. Individual interviews were conducted between June and September 2013 with 16 direct care workers in an Australian residential aged care facility with a specific focus on people from culturally and linguistically diverse backgrounds. It was found that direct care workers' employment intentions were related to their perceptions and management of the rewards and difficulties of care work. Their experiences of care work, the employment characteristics, and the organizational resources that fitted their personality, ability, expectations, and essential needs were viewed as rewards. Evaluating their jobs as meaningful was a shared perception for direct care workers who intended to stay. Individual workers' perceptions of the rewarding aspects of care work served to counterbalance the challenges of care work, and promoted their intentions to stay. Perceptions and employment intentions varied by occupational groups and by cultural backgrounds. Overseas born direct care workers are valuable resources in residential aged care facility rather than a limitation, but they do require organizational support, such as cultural awareness of the management, English language support, a sense of family, and appropriate job responsibility. The findings
Rault, J-L; Holyoake, T; Coleman, G
Euthanasia is a necessary act for any facility keeping live animals. Nevertheless, the crucial role and responsibility of the stockperson in deciding and conducting on-farm euthanasia has been overlooked. Stockperson characteristics and knowledge that lead to appropriate decision-making and the skills to competently perform the procedure remain to be identified. An important component of the stockperson's characteristics that predict behavior is the stockperson's attitudes. This preliminary study investigated the factors that influence stockperson attitudes toward the practice of on-farm euthanasia in the pork industry. A total of 120 stockpeople from 10 Australian pig farms (ranging in size from 50 to 4,754 sows and from 2 to 32 employees) completed a questionnaire based on focus group input to assess their attitudes toward euthanasia and decision processes. Factors identified included stockperson attitudes and attributes (empathy affect, empathy attribution, feeling bad about euthanizing, and negative attitudes to pigs), beliefs about the working environment (perceived time constraints and relying on others), and factors related to decision-making (comfortable with euthanasia, trouble deciding and avoid if possible, confidence, insufficient knowledge, seeking knowledge, and using sources to get advice). Numerous significant correlations were found between these variables. Furthermore, regression analyses showed confidence as the only significant predictor of being comfortable with euthanasia (12.5% of the variance; euthanasia ( euthanasia, which comprises both a decision-making process and the act itself, can adversely affect stockpeople. This preliminary study offers insights for implementation of successful practical and humane pig euthanasia protocols on farm. This will benefit stockperson well-being and animal well-being alike.
INTRODUCTION Euthanasia represents an ethical, social, legal and medical issue, which is being disputed more and more frequently worldwide. In Serbia, it is illegal and punishable by law and subject to a prison sentence. Euthanasia verbatim, meaning "good death", refers to the practice of ending a life in order to relieve pain and suffering. It can be voluntary, when a person knowingly declares the wish to end life, and involuntary, when relatives and family make decisions on behalf of patients in coma. It can be active, when a person applies a medical procedure to end life and passive, when medical procedures which can extend a patient's life are not applied. EUTHANASIA THROUGH HISTORY: The term was known in old Greece, and Hippocrates mentioned it in his oath, which is now taken by all doctors in the world, by which they pledge not to apply a medicine which can lead to death of the patients, nor to give such counsel. Euthanasia had its most vigorous impetus in the mid-20th century when it was being carried out deliberately in Nazi Germany. All leading religions from Christianity, over Buddhism, to Islam, are directly or indirectly against any kind of euthanasia. EUTHANASIA TODAY: At the beginning of the 21st century, euthanasia was legalized in several most developed countries in the world, among them the Netherlands, Belgium, Germany, Switzerland, Japan, India and some American and Mexican federal states. The World Medical Association from 82 countries has condemned euthanasia, and called all medical workers who practice euthanasia to reconsider their attitudes and to stop this practice.
Jamison, James; Graffy, Jonathan; Mullis, Ricky; Mant, Jonathan; Sutton, Stephen
.... Semi-structured interviews were undertaken with survivors of stroke, caregivers, and GPs to explore their perspectives and views around secondary prevention and perceived barriers to medication adherence...
Anderson, Claire; Kirkpatrick, Susan
Introduction Narrative interviews place the people being interviewed at the heart of a research study. They are a means of collecting people's own stories about their experiences of health and illness. Narrative interviews can help researchers to better understand people's experiences and behaviours. Narratives may come closer to representing the context and integrity of people's lives than more quantitative means of research. Methodology Researchers using narrative interview techniques do not set out with a fixed agenda, rather they tend to let the interviewee control the direction, content and pace of the interview. The paper describes the interview process and the suggested approach to analysis of narrative interviews, We draw on the example from a study that used series of narrative interviews about people's experiences of taking antidepressants. Limitations Some people may find it particularly challenging to tell their story to a researcher in this way rather than be asked a series of questions like in a television or radio interview. Narrative research like all qualitative research does not set out to be generalisable and may only involve a small set of interviews.
Cohen, Joachim; Marcoux, Isabelle; Bilsen, Johan; Deboosere, Patrick; van der Wal, Gerrit; Deliens, Luc
We wanted to examine how the acceptance of euthanasia among the general public in Western Europe has changed in the last decades, and we wanted to look for possible explanations. We analysed data from the European Values Surveys, held in 1981, 1990, and 1999-2000 in 12 West European countries. In each country, representative samples of the general public were interviewed using the same structured questionnaire in all countries. Euthanasia was explained in the questionnaires as 'terminating the life of the incurably sick'. A total of 46 199 respondents participated in the surveys. A significant increase in acceptance of euthanasia could be observed in all countries except (West) Germany. While the average increase in euthanasia acceptance was 22%, the increase was particularly obvious in Belgium, Italy, Spain, and Sweden. Although changes in several characteristics of respondents, such as decrease in religious beliefs, rising belief in the right to self-determination, and (to a lesser extent) rise in levels of education, were associated with growing acceptance of euthanasia, they could only partly explain the increase of euthanasia acceptance over the years. An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries.
Reichel, W; Dyck, A J
Responding to an increased interest in establishing active, voluntary euthanasia as a viable medical and social policy, Reichel and Dyck consider the major arguments for and against the practice. Proponents of euthanasia support a patient's right of self determination and a compassion-motivated active ending of suffering. Opponents are concerned with the problems of determining intention and motivation, the danger of involuntary euthanasia of the aged, the handicapped, and the incompetent, and the impact on the physician patient relationship. Reichel and Dyck argue that, instead of euthanasia, physicians can offer terminally ill patients the "moral choice to die well" by alleviating pain, by respecting requests to forgo burdensome, invasive treatments, by providing comfort and support, and by communicating with patients and their families.
Abdi Omar Shuriye
Full Text Available This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain. However, as science develops ethical and religious isuues related to the subject have increasingly created fervent debates on euthanesia. ABSTRAK: Kertas ini mengkaji euthanasia dari perspektif agama dan etika. Sejarah telah melihat para pemikir Greek termasuk Aristotle secara kategorinya menerima Euthanasia dengan sebab utama untuk mengurangkan kesakitan. Bagaimanapun, apabila sains berkembang, perbahasan mengenai isu-isu agama dan etika tentang Euthanasia telah meningkat dengan nyata.KEYWORDS: mercy killing; religion; ethics; morality; euthanasia
de Nooijer, K; van de Wetering, V E; Geijteman, E C T; Postma, L; Rietjens, J A C; van der Heide, A
To present the knowledge, experiences and attitudes of the general population, patients, relatives and health care professionals concerning written advance euthanasia directives in patients who have become mentally incompetent. Systematic review of the literature. We systematically searched Medline, Cochrane Library and Embase for articles published in the period 2002-2016. The search yielded 775 articles, of which 11 met the inclusion criteria. Six studies had a quantitative design, four studies had a qualitative design and one a combination of both. Nine articles included patients with advanced dementia, two included patients with Huntington's disease. Patients, their relatives and the general population appear to have limited knowledge about written advance euthanasia directives. However, most of them were open to the practice of euthanasia based on a written advance directive. Few persons and patients had written a euthanasia directive and if they had, it was not always discussed with health care professionals. The majority of health care professionals thought - incorrectly - that euthanasia based on a written advance euthanasia directive is not permitted. Some of them had a positive attitude towards written advance euthanasia directives, and a very small number would be prepared to carry out euthanasia on the basis of a written directive. In practice, there are very few who have actually done so. There is fairly wide support from the general population and empathy from health care professionals for the idea that euthanasia based on a written advance euthanasia directive of a mentally incompetent patient should be possible. Even so, there is a discrepancy between the expectations of the general population and what health care professionals think they can actually do in this situation.
Ypma, Tjipke D; Hoekstra, Herman L
To determine how uniformly Support and Consultation on Euthanasia in the Netherlands (SCEN) doctors assess a euthanasia request in patients not in the final stages of a terminal illness. Qualitative research. Internal survey among SCEN doctors in the 'SCEN-Drenthe' peer group, who were asked to provide an opinion on the requirements of due care, items a to d, of the Termination of life on request and assisted suicide act (WTL) in three fictitious patients. Sixty assessments were received from 20 SCEN physicians. Half of the reviews were assessed as 'due care requirements not met". 45% of these were for a patient whose request was based on the grounds of a "completed life", 50% for a patient with Alzheimer's, and 55% for a patient with a reduced level of consciousness. Uncertainty about the place of Article 2.2 of the WTL, personal assessment of the unbearable nature of hopeless suffering and the rejection of alternative solutions were responsible for the heterogeneous assessments. Uniformity of assessment is important to avoid legal disparity in this patient group. We found no medical or ethical benchmarks for determining the unbearable nature of suffering. A verifying assessment by the SCEN physician can only provide an opinion regarding the presence of hopeless pain that is classified as "unbearable". A negative SCEN assessment undermines a person's sense of justice at a difficult time, while the hopeless suffering may well be accepted as unbearable in comparable cases. Adapting the KNMG "Guidelines on euthanasia for patients in a state of reduced consciousness" so that they are in line with the WTL could also contribute to greater uniformity.
Sivell, Stephanie; Prout, Hayley; Hopewell-Kelly, Noreen; Baillie, Jessica; Byrne, Anthony; Edwards, Michelle; Harrop, Emily; Noble, Simon; Sampson, Catherine; Nelson, Annmarie
To present and discuss the views of researchers at an academic palliative care research centre on research encounters with terminally ill patients in the home setting and to generate a list of recommendations for qualitative researchers working in palliative and end-of-life care. Eight researchers took part in a consensus meeting to discuss their experiences of undertaking qualitative interviews. The researchers were of varying backgrounds and all reported having experience in interviewing terminally ill patients, and all but one had experience of interviewing patients in their home environment. The main areas discussed by researchers included: whether participation in end-of-life research unintentionally becomes a therapeutic experience or an ethical concern; power relationships between terminally ill patients and researchers; researcher reflexivity and reciprocity; researchers' training needs. Qualitative methods can complement the home environment; however, it can raise ethical and practical challenges, which can be more acute in the case of research undertaken with palliative and patients at the end-of-life. The ethical and practical challenges researchers face in this context has the potential to place both participant and researcher at risk for their physical and psychological well-being. We present a set of recommendations for researchers to consider prior to embarking on qualitative research in this context and advocate researchers in this field carefully consider the issues presented on a study-by-study basis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Hartelius, Lena; Jonsson, Maria; Rickeberg, Anneli; Laakso, Katja
Background: As an effect of the cognitive, emotional and motor symptoms associated with Huntington's disease, communicative interaction is often dramatically changed. No study has previously included the subjective reports on this subject from individuals with Huntington's disease. Aims: To explore the qualitative aspects of how communication is…
van Soest-Poortvliet, M.C.; van der Steen, J.T.; Gutschow, G.; Deliens, L.; Onwuteaka-Philipsen, B.D.; de Vet, H.C.W.; Hertogh, C.M.P.M.
Objective: The aim of this study was to describe the process of advance care planning (ACP) and to explore factors related to the timing and content of ACP in nursing home patients with dementia, as perceived by family, physicians, and nurses. Design: A qualitative descriptive study. Methods: A
Soest-Poortvliet, M.C. van; Steen, J.T. van der; Gutschow, G.; Deliens, L.; Onwuteaka-Philipsen, B.D.; Vet, H.C. de; Hertogh, C.M.
OBJECTIVE: The aim of this study was to describe the process of advance care planning (ACP) and to explore factors related to the timing and content of ACP in nursing home patients with dementia, as perceived by family, physicians, and nurses. DESIGN: A qualitative descriptive study. METHODS: A
Lukas, Catherine V.; Cunningham-Sabo, Leslie
Objective: Focus group (FG) interviews with students and adults were used to obtain a rich understanding of the "Cooking with Kids" classroom experience from the child and adult participant perspectives. Methods: FG topics included students' cooking experiences at school and home and perceptions of "Cooking with Kids". Verified transcripts of…
Romer, Georg; Stavenow, Karma; Baldus, Christiane; Brüggemann, Annika; Barkmann, Claus; Riedesser, Peter
Die subjektive Verarbeitung der Erfahrung, mit einem körperlich kranken Elternteil aufzuwachsen, wurde mit einer qualitativen Analyse von Einzelinterviews von Kindern und Jugendlichen mit einem dialysepflichtigen Elternteil untersucht. Hierzu wurden halbstrukturierte Interviews mit 8 Kindern und Jugendlichen im Alter zwischen 6 und 17 Jahren sowie einer kranken Mutter, die selbst als Kind eines dialysepflichtigen Vaters aufgewachsen war, mit strukturierender Inhaltsanalyse und psychoanalytisc...
Pieters, J.J.P.M.; Verhaak, C.M.; Braat, D.D.M.; Leeuwen, E. van; Smits, A.P.T.
OBJECTIVE: Incidental findings in prenatal diagnostic testing may or may not have clear prognostic significance for the phenotype. We studied experts' opinions of the benefit and disadvantage of an incidental prenatal diagnosis of a sex chromosomal aneuploidy (SCA). METHODS: We interviewed 16
Abdi Omar Shuriye
This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain...
Euthanasia has a wide range of classifications. Confusion exists in the application of specific concepts to various studies. To analyze the concept of voluntary active euthanasia using Walker and Avant's concept analysis method. A comprehensive literature review from various published literature and bibliographies. Clinical, ethical, and policy differences and similarities of euthanasia need to be debated openly, both within the medical profession and publicly. Awareness of the classifications about euthanasia may help nurses dealing with "end of life issues" properly.
Tur, Richard H S
Those who campaign for law reform to permit "euthanasia" may seek different things and at least some of what they seek may already be permissible under the criminal law of England and Wales. In this paper I examine one means whereby the criminal law delivers outcomes acceptable to the euthanasia lobby, that is the curious notion of "causation" deployed by the law, which adds a value override to the more usual notion of factual causation such that, for example, if medical treatment falls within the acceptable range as normal and proper, the pre-existing injury or illness is treated as exclusively the cause of death and the doctor escapes criminal liability, even where the medical treatment will shorten life to the certain knowledge, possibly even the wish, of the doctor. Thus the law may already be delivering a range of outcomes--euthanasia in a weak sense--acceptable to the euthanasia lobby. If so, it achieves this by stealth. That is inappropriate to the doctor-patient relationship, which is one of trust. So there is a strong case for greater transparency. Moreover, there are limits to the acceptable outcomes which an unreformed criminal law can deliver and in a range of cases the criminal law condemns the doctor to impotence and the patient to a prolonged, miserable and undignified death. So there is also a case for going beyond the current law and legalising euthanasia in a strong sense.
Full Text Available In this study, after the definition and short historical development of Euthanasia, a questionnaire was given to 510 medical staff; 208 of whom are medical students who are in the 5th form and 302 of whom are physcians. In this questionnaire 6 multiple choice questions were asked about the knowledge level, social groups to comment and argue on the subject, the right of person to decide about his/her own life, opinions about current applications of euthanasia, whether he/she would agree on the application of the process and whether he would accept to get a responsibility in it or not. It was determined that among the people who attended the questionnaire, one third didn't have enough knowledge about the subject while 325 (63.72 % of them supported the application, still 351 (68.82 % of them refused to get a responsibility in the application of euthanasia, even if the process becomes legal. Opinions of the people who are with and against the idea were collected and summarized, it was determined that although passive euthanasia is not legal it is currently being applied when it is necessary and that physcians are biased to the legalization of the subject while they refuse to take a role in the application. Keywords : Euthanasia, Self Deliverance, Right to Life, Mercy Killing, Informed Consent
Full Text Available ohn Arras argues against the legalization of physician- assisted suicide and active euthanasia on the basis of social costs that he anticipates will result from legalization. Arras believes that the legalization of highly restricted physician-assisted suicide will result in the legalization of active euthanasia without special restrictions, a prediction I grant for the sake of argument. Arras further anticipates that the practices of physician-assisted suicide and euthanasia will be abused, so that many patients who engage in these practices will lose out as a result. He refers to these losses as social costs to legalization. But the social costs at play in typical public policy debates are borne by individuals other than the agent who engages in the controversial activity, specifically by people who cannot be held responsible for enduring those costs. Even if plausible interpretations of Arras’ predictions about the abuse of the practice are granted, legalization of physician-assisted suicide or euthanasia brings no social costs of this latter sort. For this reason, and also because a ban on euthanasia is unfair to those who would profit from it, the losses in utility brought about by legalization would have to be very great to justify a ban.
In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983. PMID:2033626
In 2002 the Dutch Euthanasia Act came into force. This Act is the result of a lengthy developmental process. It codifies the requirements that have evolved in case law and medical ethics since 1973. Empirical data indicate that the Dutch euthanasia practice is stabilising. Euthanasia and assisted
Aghababaei, Naser; Farahani, Hojjatollah; Hatami, Javad
The main purposes of the present study were to see how the term "euthanasia" influences people's support for or opposition to euthanasia; and to see how euthanasia attitude relates to religious orientation and personality factors. In this study two different euthanasia attitude scales were compared. 197 students were selected to fill out either the Euthanasia Attitude Scale (EAS) or Wasserman's Attitude Towards Euthanasia scale (ATE scale). The former scale includes the term "euthanasia", the latter does not. All participants filled out 50 items of International Personality Item Pool, 16 items of the the HEXACO openness, and 14 items of Religious Orientation Scale-Revised. Results indicated that even though the two groups were not different in terms of gender, age, education, religiosity and personality, mean score on the ATE scale was significantly higher than that of the EAS. Euthanasia attitude was negatively correlated with religiosity and conscientiousness and it was positively correlated with psychoticism and openness. It can be concluded that analyzing the attitude towards euthanasia with the use of EAS rather than the ATE scale results in lower levels of opposition against euthanasia. This study raises the question of whether euthanasia attitude scales should contain definitions and concepts of euthanasia or they should describe cases of it.
... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Euthanasia solution. 522.900 Section 522.900 Food... Euthanasia solution. (a) Specifications. Each milliliter (mL) of solution contains: (1) 390 milligrams (mg.... For humane, painless, and rapid euthanasia. (2) Amount. One mL per 10 pounds of body weight. (3...
Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse.
Griffiths, Frances; Mason, Victoria; Boardman, Felicity K.; Dennick, Kathryn J.; Haywood, Kirstie L.; Achten, Juul; Parsons, Nicholas R; Griffin, Xavier L.; Costa, Matthew L.
Objective: \\ud To explore what patients consider important when evaluating their recovery from hip fracture and to consider how these priorities could be used in the evaluation of the quality of hip fracture services.\\ud \\ud Design:\\ud Semistructured interviews exploring the experience of recovery from hip fracture at two time points—4 weeks and 4 months postoperative hip fixation. Two approaches to analysis: thematic analysis of data specifically related to recovery from hip fracture; summar...
Wolfe, J; Fairclough, D L; Clarridge, B R; Daniels, E R; Emanuel, E J
Attitudes regarding the ethics of physician-assisted suicide (PAS) and euthanasia have been examined in many cross-sectional studies. Stability of these attitudes has not been studied, and this is important in informing the dialog on PAS in this country. We evaluated the stability of attitudes regarding euthanasia and PAS among three cohorts. Subjects included 593 respondents: 111 oncology patients, 324 oncologists, and 158 members of the general public. We conducted initial and follow-up interviews separated by 6 to 12 months by telephone, regarding acceptance of PAS and euthanasia in four different clinical vignettes. The proportion of respondents with stable responses to vignettes ranged from 69.2% to 94.8%. In comparison to patients and the general public, physicians had less stable responses concerning the PAS pain vignette (69.1% v 80.8%; P =.001) and more stable responses for all euthanasia vignettes (P euthanasia in all vignettes (P euthanasia, such as Roman Catholic religion, were not predictive of stability. Up to one third of participants changed their attitudes regarding the ethical acceptability of PAS and euthanasia in their follow-up interview. This lack of consistency mandates careful interpretation of referendums and requests for physician-assisted suicide. Furthermore, in this study, we found that physicians are becoming increasingly opposed to PAS and euthanasia. The growing disparity between physicians and patients regarding the role of these practices is large enough to suggest possible conflicts in the delivery of end-of-life care.
Full Text Available Abstract Background Mortality risk in Danish dairy cows has more than doubled since 1990 (from 2% in 1990 to 5% in 2005. Until now, registrations about dead cows in the Danish Cattle Database have not included information about whether the cow died unassisted or was euthanized. Methods We interviewed a random sample of 196 Danish dairy farmers that had reported a dead cow to the Danish Cattle Database in 2002 and 196 dairy farmers that had reported a dead cow in 2006. Our objectives were to evaluate the proportion of euthanized cows, changes in the behaviour of farmers regarding euthanasia of cows over the years and possible reasons for these changes. Results It seems that the threshold for euthanasia of cows among farmers has changed. Farmers generally reported a lower threshold for euthanasia compared to 5–10 years ago. Conclusion The threshold for euthanasia of cows has, according to the dairy farmers, become lower. This might have positive impacts on animal welfare as more seriously ill cows are euthanized in the herds and not put through a period of suffering associated with disease and treatment or transported to a slaughterhouse in poor condition.
Full Text Available Motivational interviewing (MI is a method for building motivation for behaviour change that has potential for use in respiratory contexts. There is a paucity of published research exploring the feasibility of this intervention from the clinicians' perspective. This study aimed to explore respiratory clinicians' views of MI: Is it perceived as useful? Could it be integrated into practice? What training would be required to make it part of routine care? Nine respiratory clinicians attended a one-day MI workshop and a semi-structured face-to-face interview two weeks later. All interviews were audio-recorded, transcribed verbatim and analysed with thematic analysis. Four main themes are presented-1 MI's suitability for use in respiratory contexts: participants saw potential in using MI to motivate their patients to engage with prescribed respiratory interventions, such as increased physical activity. Those who experimented with new skills post-workshop were encouraged by patient responsiveness and outcomes. 2 MI's relationship with routine clinical practice: some believed they already used elements of MI, but most participants felt MI was fundamentally 'different' to their normal style of working. 3 Implementation issues: additional time would need to be made available to enable an appropriate depth of conversation. 4 Training issues: Participants sensed the complexity of MI could make it difficult to learn and that it would take them time to become competent. On-going supervision was perceived as necessary. One key challenge identified was how to suppress behaviours that are antithetical to MI. These findings lend support to the feasibility of using MI in respiratory contexts such as pulmonary rehabilitation programmes, but highlight implementation and training issues that would need to be overcome. The insights have informed the development of another study, testing the effect of a tailored training package on MI skill, specifically for
Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence
Ng, Felicity; Crawford, Gregory B; Chur-Hansen, Anna
Medical practitioners have different causal explanations for depression, and may have greater difficulty in explaining causality of depression in the palliative care setting. The objective of this study was to investigate and describe the causal explanations of depression in the palliative care setting, from the perspective of palliative medicine specialists. Palliative medicine specialists practising in Australia were recruited and purposively sampled. Individual semistructured, in-depth interviews were conducted to explore their explanatory models of depression, including a focus on causal explanations. Nine participants were interviewed to reach data saturation. Interview transcripts were analysed for themes. Six themes for causal explanations of depression were identified: (1) Depression is inexplicable; (2) Biological explanations-primarily neurotransmitter depletion; (3) Psychological explanations-including reaction to circumstances, inability to accept illness and dying, diminished self, and coping mechanisms; (4) Social explanations-including inadequate social support, and contribution from modern medicine and societal norms; (5) Interrelationships between causal factors-mainly multifactoriality; (6) Different explanation for de novo and pre-existing depressions. Participants also articulated a link between causal explanations and clinical interventions. Palliative medicine specialists hold causal explanations of depression that align with the biopsychosocial and vulnerability-stress models. They use multiple individual explanations with diverse theoretical underpinnings, and largely view depression as multifactorial in causality. Given that causal explanations are linked to clinical interventions, these findings have implications for clinical practice and medical education. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Full Text Available Abstract Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV and how they want to give birth if the baby remains breech, either by planned caesarean section (CS or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11 and health professionals who manage breech presentation (n=11 recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the
Fuller, Thomas; Pearson, Mark; Peters, Jaime; Anderson, Rob
To identify and understand, through data from multiple sources, some of the factors that affect authors' and editors' decisions to use reporting guidelines in the publication of health research. Mixed methods study comprising an online survey and semi-structured interviews with a sample of authors (online survey: n = 56; response rate = 32%; semi-structured interviews: n = 5) and journal editors (online survey: n = 43; response rate = 27%; semi-structured interviews: n = 6) involved in publishing health and medical research. Participants were recruited from an earlier study examining the effectiveness of the TREND reporting guideline. Four types of factors interacted to affect authors' and editors' likelihood of reporting guideline use; individual (e.g., having multiple reasons for use of reporting guidelines); the professional culture in which people work; environmental (e.g., policies of journals); and, practical (e.g., having time to use reporting guidelines). Having multiple reasons for using reporting guidelines was a particularly salient factor in facilitating reporting guidelines use for both groups of participants. Improving the completeness and consistency of reporting of research studies is critical to the integrity and synthesis of health research. The use of reporting guidelines offers one potentially efficient and effective means for achieving this, but decisions to use (or not use) reporting guidelines take many factors into account. These findings could be used to inform future studies that might, for example, test the factors that we have identified within a wider theoretical framework for understanding changes in professional practices. The use of reporting guidelines by senior professionals appears to shape the expectations of what constitutes best practice and can be assimilated into the culture of a field or discipline. Without evidence of effectiveness of reporting guidelines, and sustained, multifaceted efforts to improve reporting, little
Anderson, Rebecca; Walburn, Jessica; Morgan, Myfanwy
This study explored experiences of stigma in 25 adults with xeroderma pigmentosum. Analysis of semi-structured interviews revealed the changing nature of stigma over the lifetime. Bullying occurred in childhood, whereas adults were questioned about both their photoprotection and skin damage, often resulting in internalised feelings of stigma. Resilience and rejection of feelings of stigma increased with age and experiences of stigma differed across cultures. Findings indicate a need to develop social skills training to help people reject feelings of stigma. Future research should explore perspectives of families, friends and formal institutions and their potential to cause or reduce feelings of stigma.
When medical treatment becomes futile, or the patient's suffering is intractable, doctors face the agonising dilemma of whether to proceed with euthanasia. It is important for a doctor to be familiar with the law surrounding euthanasia, in order to avoid prosecution. This paper explores the law in England and Wales regarding the different categories of euthanasia: voluntary euthanasia, nonvoluntary euthanasia, passive euthanasia, and active euthanasia.
Dekker, Annet; Safi, Mahdjubah; van der Zon-van Welzenis, Evelien I; Echteld, Michael A; Evenhuis, Heleen M
To investigate how doctors can improve the advice and education about sexuality and contraception given to young people with mild intellectual disability (IQ :50-70). Semi-structured interviews. Young people attending special needs secondary schools (IQ: 50-70) were interviewed. Pupils with a known history of sexual abuse were excluded. A total of 17 of the 57 potential candidates were excluded. Of the remaining 40 pupils, 28 agreed to take part (13 male; age range: 15-18 years, average IQ: 58). Of the 28 participants, 19 had been in a relationship, 5 had experience with sexual intercourse and 11 used contraception. Just as in other studies, the participants seemed to have less knowledge, and less experience than young people of their age without a disability, but did show interest. They were at increased risk because of inappropriate use of contraception and had limited social resilience. Only knowledge about the pill and condoms was fair to good. Interest and knowledge seemed greater in those young people in a relationship. Poor verbal skills hampered their understanding of the questions asked and of the information offered, and limited their ability to express feelings and opinions. Those young people in a relationship wanted to choose their own form of contraception. In this group of vulnerable young people, provision of sexual education by the doctor at the right moment using simple language and repetition, can contribute to the timely and safe use of contraceptives.Conflict of interest and financial support: none declared.
Full Text Available BOURDIEU's theoretical concept of "classes on paper" is based on the nation-state frame. In order to include the social position of migrants, who live and work in more than one nation-state, a concept of social and structural transnationalisation is required. Using the example of highly skilled migrants, the article advances such a concept and shows, using qualitative data and "grounded theory", how and where transnational class formation takes place. The project diverges from the dominant perspective of migration research in that it does not attempt to reconstruct cultural specifics but strategically selects a sample of highly skilled migrants as a "qualitative experiment". The approach is ambitious—in transnational social spaces neither factual information nor indicators of habitus can be placed in one single frame of reference—and includes diverse kinds of data and analytical strategies to comprehend and reconstruct transnational class positions. The paper examines the notion of transnational class formation and introduces the author's empirical research before examining, in the final part of the paper, theoretical insights around (trans- national class formation. The results show that despite the differences in national origin of the highly skilled migrants, they operate within global labour markets and inhabit similar economic and social spaces within the city. However, the paper also argues that different types of highly skilled migrants in different types of political-economic contexts, whilst inhabiting similar economic positions and similar social space, move along different and unequal paths. This divergence, we suggest, can be traced to broader structural processes of global inequality. URN: urn:nbn:de:0114-fqs060326
Shekhar, Skand; Goel, Ashish
Euthanasia requests have increased as the number of debilitated patients rises in both developed and developing countries such as India due to medical, psychosocial-emotional, socioenvironmental, and existential issues amid fears of potential misuse. WORLD'S POSITION: Albania, Colombia, the Netherlands, and Switzerland permit euthanasia conditionally. Australia's legalization of euthanasia has been withdrawn. The United States permits withdrawal of life support. Mexico and Norway permit active euthanasia. INDIA'S POSITION: Following the Aruna Shanbaug case the Supreme Court granted legal sanction to passive, but not active, euthanasia that is valid till the Parliament legislates on euthanasia. HANDLING EUTHANASIA REQUESTS: Acknowledging the complexity of the problem; individualizing the palliative approach; and accepting the 'There is no alternative' or 'There is no answer' (TINA) factor.
Balard, Frédéric; Corre, Stéphanie Pin Le; Trouvé, Hélène; Saint-Jean, Olivier; Somme, Dominique
By matching needs to resource services, case management could be a useful tool for improving the care of older people with complex living conditions. Collecting and analysing the users' experiences represents a good way to evaluate the effectiveness and efficiency of a case-management service. However, in the literature, fieldwork is very rarely considered and the users included in qualitative research seem to be the most accessible. This study was undertaken to describe the challenges of conducting qualitative research with older people with complex living conditions in order to understand their experiences with case-management services. Reflective analysis was applied to describe the process of recruiting and interviewing older people with complex living conditions in private homes, describing the protocol with respect to fieldwork chronology. The practical difficulties inherent in this type of study are addressed, particularly in terms of defining a sample, the procedure for contacting the users and conducting the interview. The users are people who suffer from a loss of autonomy because of cognitive impairment, severe disease and/or psychiatric or social problems. Notably, most of them refuse care and assistance. Reflective analysis of our protocol showed that the methodology and difficulties encountered constituted the first phase of data analysis. Understanding the experience of users of case management to analyse the outcomes of case-management services requires a clear methodology for the fieldwork.
Neergaard, Mette Asbjørn; Olesen, Frede; Jensen, Anders Bonde
care setting to explore barriers and facilitators for delivery of good palliative home care. Methods: Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results: Three main categories of experience were identified: 1) The health professionals' management, where...... a need to optimize was found. 2) Shared care, which was lacking. 3) The relatives' role, which needs an extra focus. Conclusion: Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs......Background: Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary...
Choi, Namkee G; Landeros, Christina
Previous wisdom research tended to focus on cognitive and intellectual aspects, highly educated professionals and/or prominent subjects, and wisdom as the outcome not process. In this study, based on in-depth interviews of 18 low- and moderate income older adults who were nominated as being wise by their aging-service providers, we explored the ways challenging life experiences and coping may have contributed to the development of their wisdom, their ideas/beliefs about the qualities of wisdom, and the ways they may be practicing wisdom in daily life. Their emphasis on interconnectedness and interdependence, forgiveness and patience, and gratitude appears to represent self-transcendental qualities of wisdom. Social work practice and research implications are discussed.
Raunsbæk Knudsen, Line; Thurah, Annette De; Lomborg, Kirsten
OBJECTIVE: The aim was to explore the experiences of a patient-reported outcome (PRO)-based tele-health follow-up from the perspective of patients with rheumatoid arthritis (RA) and their experiences of increasing their active role and responsibility for disease control in particular. METHODS......: Adopting a strategy of interpretive description, we conducted individual, semi-structured interviews with 15 RA patients participating in a tele-health follow-up. Participants were selected purposively and consecutive from both genders and with various ages, disease durations and disease severity....... The analysis was inductive with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then, we constructed patient typologies to explain different perspectives on the tele-health follow-up. RESULTS: Five themes covered the participants' experiences: 'A...
Lafortune, Claire; Elliott, Jacobi; Egan, Mary Y; Stolee, Paul
While standardized health assessments capture valuable information on patients' demographic and diagnostic characteristics, health conditions, and physical and mental functioning, they may not capture information of most relevance to individual patients and their families. Given that patients and their informal caregivers are the experts on that patient's unique context, it is important to ensure they are able to convey all relevant personal information to formal healthcare providers so that high-quality, patient-centered care may be delivered. This study aims to identify information that older patients and families consider important but that might not be included in standardized assessments. Transcripts were analyzed from 29 interviews relating to eight patients with hip fractures from three sites (large urban, smaller urban, rural) in two provinces in Canada. These interviews were conducted as part of a larger ethnographic study. Each transcript was analyzed by two researchers using content analysis. Results were reviewed in two focus group interviews with older adults and family caregivers. Identified themes were compared with items from two standardized assessments used in healthcare settings. Three broad themes emerged from the qualitative analysis that were not covered in the standardized assessments: informal caregiver and family considerations, insider healthcare knowledge, and patients' healthcare attitudes and experiences. The importance of these themes was confirmed through focus group interviews. Focus group participants also emphasized the importance of conducting assessments in a patient-centered way and the importance of open-ended questions. A less structured interview approach may yield information that would otherwise be missed in standardized assessments. Combining both sources could yield better-informed healthcare planning and quality-improvement efforts.
von Vogelsang, Ann-Christin; Milton, Camilla; Ericsson, Ingrid; Strömberg, Lars
To describe transsexual persons' experiences of encounters with healthcare professionals during the sex reassignment process. Transsexual persons are individuals who use varying means to alter their natal sex via hormones and/or surgery. Transsexual persons may experience stigma, which increases the risk of psychological distress. Mistreatments by healthcare professionals are common. Qualitative studies addressing transsexual persons' experiences of healthcare are scarce. Qualitative descriptive design. A Swedish non-clinical convenience sample was used, consisting of six persons who had been diagnosed as transsexual, gone through sex reassignment surgery or were at the time of the interview awaiting surgery. Semi-structured interviews were undertaken, and data were analysed using manifest qualitative content analysis. Three categories and 15 subcategories were identified. The encounters were perceived as good when healthcare professionals showed respect and preserved the transsexual person's integrity, acted in a professional manner and were responsive and built trust and confidence. However, the participants experienced that healthcare professionals varied in their level of knowledge, exploited their position of power, withheld information, expressed gender stereotypical attitudes and often used the wrong name. They felt vulnerable by having a condescending view of themselves, and they could not choose not to be transsexual. They felt dependent on healthcare professionals, and that the external demands were high. Transsexual persons are in a vulnerable position during the sex reassignment surgery process. The encounters in healthcare could be negatively affected if healthcare professionals show inadequate knowledge, exploit their position of power or express gender stereotypical attitudes. A good encounter is characterised by preserved integrity, respect, responsiveness and trust. Improved education on transgender issues in nursing and medical education is
Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life--if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.
Emotional status and its brain bases change in a chronic pain patient and this change affects his/her decision making ability. Moreover, it is accepted that a mentally disturbed individual is not competent to make critical decisions. According to these bases, this article demonstrates that such patients are not entitled to request voluntary euthanasia.
Feb 17, 2004 ... South African Psychiatry Review - February 2004. 10. Euthanasia: a problem for psychiatrists done to those people had no connection whatsoever with what was in their interests. Here the term “euthanasia” was simply a euphemism for the massacre of persons regarded as undesirable by others in power.
This article deals with the intentional distinction between murder of first degree and passive euthanasia. In Hungary, active euthanasia is considered to be a murder of first degree, whilst the Netherlands, Belgium, Luxemburg and Switzerland have legalized the active form of mercy killing in Europe. The palliative terminal care, when e.g. giving pain-killer morphine to the patient, might result in decreasing the patient's life-span, and thus causing indirect euthanasia. However, the legal institution of living will exists in several counter-euthanasia countries. The living will allows future patients to express their decision in advance to refuse a life-sustaining treatment, e.g. in case of irreversible coma. The institution of living will exists in Germany and in Hungary too. Nevertheless, the formal criteria of living will make it hardly applicable. The patient ought to express his/her will before a notary public in advance, and he/she should hand it over when being hospitalized. If the patient is not able to present his/her living will to his/her doctor in the hospital, then his/her only hope remains that he/she has given a copy of the living will to the family doctor previously, and the family doctor will notify the hospital.
Verdonk, Petra; Räntzsch, Viktoria; de Vries, Remko; Houkes, Inge
Medical students report high stress levels and in particular, the clinical phase is a demanding one. The field of medicine is still described as having a patriarchal culture which favors aspects like a physicians' perceived certainty and rationalism. Also, the Effort-Recovery Model explains stress as coming from a discrepancy between job demands, job control, and perceived work potential. Gendered differences in stress are reported, but not much is known about medical interns' perceptions of how gender plays in relation to stress. The aim of this study is to explore how medical interns experience and cope with stress, as well as how they reflect on the gendered aspects of stress. In order to do this, we have performed a qualitative study. In 2010-2011, semi-structured qualitative interviews were conducted with seventeen medical interns across all three years of the Masters programme (6 male, 11 female) at a Dutch medical school. The interview guide is based on gender theory, the Effort-Recovery Model, and empirical literature. Transcribed interviews have been analyzed thematically. First, stress mainly evolves from having to prove one's self and show off competencies and motivation ("Show What You Know…"). Second, interns seek own solutions for handling stress because it is not open for discussion (… "And Deal With Stress Yourself"). Patient encounters are a source of pride and satisfaction rather than a source of stress. But interns report having to present themselves as 'professional and self-confident', remaining silent about experiencing stress. Female students are perceived to have more stress and to study harder in order to live up to expectations. The implicit message interns hear is to remain silent about insecurities and stress, and, in particular, female students might face disadvantages. Students who feel less able to manifest the 'masculine protest' may benefit from a culture that embraces more collaborative styles, such as having open conversation
Hackett, Julia; Glidewell, Liz; West, Robert; Carder, Paul; Doran, Tim; Foy, Robbie
A range of policy initiatives have addressed inequalities in healthcare and health outcomes. Local pay-for-performance schemes for primary care have been advocated as means of enhancing clinical ownership of the quality agenda and better targeting local need compared with national schemes such as the UK Quality and Outcomes Framework (QOF). We investigated whether professionals' experience of a local scheme in one English National Health Service (NHS) former primary care trust (PCT) differed from that of the national QOF in relation to the goal of reducing inequalities. We conducted retrospective semi-structured interviews with primary care professionals implementing the scheme and those involved in its development. We purposively sampled practices with varying levels of population socio-economic deprivation and achievement. Interviews explored perceptions of the scheme and indicators, likely mechanisms of influence on practice, perceived benefits and harms, and how future schemes could be improved. We used a framework approach to analysis. Thirty-eight professionals from 16 general practices and six professionals involved in developing local indicators participated. Our findings cover four themes: ownership, credibility of the indicators, influences on behaviour, and exacerbated tensions. We found little evidence that the scheme engendered any distinctive sense of ownership or experiences different from the national scheme. Although the indicators and their evidence base were seldom actively questioned, doubts were expressed about their focus on health promotion given that eventual benefits relied upon patient action and availability of local resources. Whilst practices serving more affluent populations reported status and patient benefit as motivators for participating in the scheme, those serving more deprived populations highlighted financial reward. The scheme exacerbated tensions between patient and professional consultation agendas, general practitioners
Full Text Available The effect of atomic bomb radiation exposure on the survivors and their children has been a worrisome problem since soon after the 1945 Hiroshima and Nagasaki bombings. Researchers have examined physical and genetic effects; however, no research has focused on second-generation survivors’ (SGS psychological effects. Consequently, this study shed light on the SGS’ experience of discrimination and prejudice and their anxiety concerning the genetic effects of radiation exposure. This study utilized semi-structured interviews with 14 SGS (10 women, mean age = 56 ± 6.25 years, range = 46–68 years. Data were analyzed using a modified version of the grounded theory approach. Three categories were extracted: low awareness as an SGS, no health anxiety regarding the effect of radiation, and health anxiety regarding the effect of radiation. The results did not reveal that SGS who grew up in the bombed areas experienced discrimination or prejudice. They had little health anxiety from childhood to adolescence. In this study, some of the SGS developed health anxiety about their third-generation children, but only among female participants. Perhaps the transgenerational transmission of anxiety concerning the genetic effects of radiation exposure causes stress, particularly among women with children. However, a change was seen in adulthood health anxiety regarding the effects of radiation, suggesting the possibility that changes in the psychological experiences of SGS can be observed throughout their lifetimes and that their own health status, and that of their children, the third-generation survivors, affects their health anxiety regarding radiation.
Full Text Available Abstract Background Knowledge about the quality and organisation of care to terminally ill cancer patients with a relatives' view in a primary health care setting is limited. The aim of the study is to analyse experiences and preferences of bereaved relatives to terminally ill cancer patients in a primary care setting to explore barriers and facilitators for delivery of good palliative home care. Methods Three focus group interviews with fourteen bereaved relatives in Aarhus County, Denmark. Results Three main categories of experience were identified: 1 The health professionals' management, where a need to optimize was found. 2 Shared care, which was lacking. 3 The relatives' role, which needs an extra focus. Conclusion Relatives experience insufficient palliative care mainly due to organizational and cultural problems among professionals. Palliative care in primary care in general needs improvement and attention should be drawn to the "professionalization" of the relatives and the need to strike a balance between their needs, wishes and resources in end-of-life care and bereavement.
Werner, Anne; Malterud, Kirsti
Children of parents with alcohol problems are at risk for serious long-term health consequences. Knowledge is limited about how to recognize those in need of support and how to offer respectful services. From nine interviews with adult children from families with alcohol problems, we explored childhood experiences, emphasizing issues concerning potentially unmet needs for professional support. Smart's perspective on family secrets and Goffman's dramaturgical metaphor on social order of the family focusing on the social drama and the dramaturgy enacted by the children supported our cross-case thematic analysis. The social interaction in the family was disrupted during childhood because of the parent's drinking problems. An everyday drama characterized by tension and threats, blame and manipulation was the backstage of their everyday life. Dealing with the drama, the children experienced limited parental support. Some children felt betrayed by the other parent who might trivialize the problems and excuse the drinking parent. Family activities and routines were disturbed, and uncertainty and insecurity was created. The children struggled to restore social order within the family and to act as normally as possible outside the family. It was a dilemma for the children to disclose the difficulties of the family. Altogether, the children worked hard to perform a normally functioning family, managing a situation characterized by unmet needs for professional support. Adequate support requires recognition of the children's efforts to perform a normally functioning family.
Skjeggestad, Erik; Gerwing, Jennifer; Gulbrandsen, Pål
To explore how language barriers influence communication and collaboration between newly-employed international medical doctors and Norwegian health personnel. Interviews were conducted with 16 doctors who had recently started working in Norway and 12 Norwegian born health personnel who had extensive experience working with international medical doctors. Analyses were consistent with principles of systematic text condensation. All participants experienced that language barriers caused difficulties in their everyday collaboration. Furthermore, the participants' descriptions of "language barriers" encompassed a wide range of topics, including semantics (e.g., specialized professional vocabulary, system knowledge), pragmatics (e.g., using language in doctor-patient and interprofessional interactions), and specific culturally sensitive topics. All participants described that language barriers provoked uncertainty about a doctor's competence. Newly employed international medical doctors and their colleagues are concerned by ineffective communication due to language barriers. Experiences of language barriers threaten professional identity as a competent and effective doctor. Newly employed doctors who are non-native speakers could benefit from support in understanding and handling the array of barriers related to language. Copyright © 2017 Elsevier B.V. All rights reserved.
Mayda, Atilla Senih; Ozkara, Erdem; Corapçioğlu, Funda
There have been intensive debates about euthanasia and attempts to change laws on euthanasia in all countries. What doctors and particularly oncologists think about euthanasia must be taken into consideration, as their voices are crucial in this dialogue. The aim of this study was to find out how Turkish doctors approach euthanasia in the context of cancer. A questionnaire was used to collect data from 85 oncologists out of a total 800 in active oncology practice. Of the oncologists surveyed, 43.8% did not object to euthanasia. Some 33.7% had been asked to perform euthanasia and 41.5% believed that euthanasia was performed secretly although it is against the law in Turkey. Forty-two doctors (50.6%) noted that they had withdrawn treatment in patients. Doctors who encounter terminally ill patients with cancer should update their knowledge about patients' rights and euthanasia. Doctors, who are often asked to perform euthanasia, especially in the cancer setting, can help to illuminate the debates about euthanasia.
MacArtney, John; Malmström, Marlene; Overgaard Nielsen, Trine; Evans, Julie; Bernhardson, Britt-Marie; Hajdarevic, Senada; Chapple, Alison; Eriksson, Lars E; Locock, Louise; Rasmussen, Birgit; Vedsted, Peter; Tishelman, Carol; Andersen, Rikke Sand; Ziebland, Sue
To illuminate patterns observed in International Cancer Benchmarking Programme studies by extending understanding of the various influences on presentation and referral with cancer symptoms. Cross-country comparison of Denmark, England and Sweden with qualitative analysis of in-depth interview accounts of the prediagnostic process in lung or bowel cancer. 155 women and men, aged between 35 and 86 years old, diagnosed with lung or bowel cancer in 6 months before interview. Participants recruited through primary and secondary care, social media and word of mouth. Interviews collected by social scientists or nurse researchers during 2015, mainly in participants' homes. Participants reported difficulties in interpreting diffuse bodily sensations and symptoms and deciding when to consult. There were examples of swift referrals by primary care professionals in all three countries. In all countries, participants described difficulty deciding if and when to consult, highlighting concerns about access to general practitioner appointments and overstretched primary care services, although this appears less prominent in the Swedish data. It was not unusual for there to be more than one consultation before referral and we noted two distinct patterns of repeated consultation: (1) situations where the participant left the primary care consultation with a plan of action about what should happen next; (2) participants were unclear about under which conditions to return to the doctors. This second pattern sometimes extended over many weeks during which patients described uncertainty, and sometimes frustration, about if and when they should return and whether there were any other feasible investigations. The latter pattern appeared more evident in the interviews in England and Denmark than Sweden. We suggest that if clear action plans, as part of safety netting, were routinely used in primary care consultations then uncertainty, false reassurance and the inefficiency and distress
van Heest, Florien B; Finlay, I G; Kramer, J J E; Otter, R; Meyboom-de Jong, B
GPs with a special interest and with specific training in palliative medicine (GP advisors) supported professional carers (mostly GPs) through a telephone advisory service. Each telephone call was formally documented on paper and subsequently evaluated. Data from 2003 were analysed independently to reveal how often and in what way palliative sedation and euthanasia were discussed. The telephone documentation forms and corresponding evaluation forms of two GP advisors were systematically analysed for problems relating to the role of sedation and/or euthanasia both quantitatively and qualitatively. In 87 (21%) of 415 analysed consultations, sedation and/or euthanasia were discussed either as the presenting question (sedation 26 times, euthanasia 37 times and both 10 times) or arising during discussion (sedation 11 times and euthanasia three times). Qualitative analysis revealed that GPs telephoned to explore therapeutic options and/or wanted specific information. Pressure on the GP (either internal or external) to relieve suffering (including shortening life by euthanasia) had often precipitated the call. On evaluation, 100% of the GPs reported that the advice received was of value in the patient's care. GPs caring for patients dying at home encountered complex clinical dilemmas in end-of-life care (including palliative sedation therapy and euthanasia). They valued practical advice from, and open discussion with, GP advisors. The advice often helped the GP find solutions to the patient's problems that did not require deliberately foreshortening life.
Aicken, Catherine R H; Fuller, Sebastian S; Sutcliffe, Lorna J; Estcourt, Claudia S; Gkatzidou, Voula; Oakeshott, Pippa; Hone, Kate; Sadiq, S Tariq; Sonnenberg, Pam; Shahmanesh, Maryam
Control of sexually transmitted infections (STI) is a global public health priority. Despite the UK's free, confidential sexual health clinical services, those at greatest risk of STIs, including young people, report barriers to use. These include: embarrassment regarding face-to-face consultations; the time-commitment needed to attend clinic; privacy concerns (e.g. being seen attending clinic); and issues related to confidentiality. A smartphone-enabled STI self-testing device, linked with online clinical care pathways for treatment, partner notification, and disease surveillance, is being developed by the eSTI(2) consortium. It is intended to benefit public health, and could do so by increasing testing among populations which underutilise existing services and/or by enabling rapid provision of effective treatment. We explored its acceptability among potential users. In-depth interviews were conducted in 2012 with 25 sexually-experienced 16-24 year olds, recruited from Further Education colleges in an urban, high STI prevalence area. Thematic analysis was undertaken. Nine females and 16 males participated. 21 self-defined as Black; three, mixed ethnicity; and one, Muslim/Asian. 22 reported experience of STI testing, two reported previous STI diagnoses, and all had owned smartphones. Participants expressed enthusiasm about the proposed service, and suggested that they and their peers would use it and test more often if it were available. Utilizing sexual healthcare was perceived to be easier and faster with STI self-testing and online clinical care, which facilitated concealment of STI testing from peers/family, and avoided embarrassing face-to-face consultations. Despite these perceived advantages to privacy, new privacy concerns arose regarding communications technology: principally the risk inherent in having evidence of STI testing or diagnosis visible or retrievable on their phone. Some concerns arose regarding the proposed self-test's accuracy, related to
Aicken, Catherine R H; Sutcliffe, Lorna J; Gibbs, Jo; Tickle, Laura J; Hone, Kate; Harding-Esch, Emma M; Mercer, Catherine H; Sonnenberg, Pam; Sadiq, S Tariq; Estcourt, Claudia S; Shahmanesh, Maryam
We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. Within exploratory studies of the eSHC (2014-2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18-35, 20 female, 16 male). Thematic analysis was conducted. Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support. The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences
McMahon, Naoimh E; Visram, Shelina; Connell, Louise A
There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session). Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme), alumni support (face-to-face and online) and family attendance at exercise sessions. Data were collected through interviews with programme providers (n = 2) and focus groups with participants (n = 12). Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Clients' interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. There is an urgent need to establish robust interventions that can support people who are overweight and obese to achieve a healthy weight and maintain this change. Third
Naoimh E. McMahon
Full Text Available Abstract Background There is a need for theory-driven studies that explore the underlying mechanisms of change of complex weight loss programmes. Such studies will contribute to the existing evidence-base on how these programmes work and thus inform the future development and evaluation of tailored, effective interventions to tackle overweight and obesity. This study explored the mechanisms by which a novel weight loss programme triggered change amongst participants. The programme, delivered by a third sector organisation, addressed both diet and physical activity. Over a 26 week period participants engaged in three weekly sessions (education and exercise in a large group, exercise in a small group and a one-to-one education and exercise session. Novel aspects included the intensity and duration of the programme, a competitive selection process, milestone physical challenges (e.g. working up to a 5 K and 10 K walk/run during the programme, alumni support (face-to-face and online and family attendance at exercise sessions. Methods Data were collected through interviews with programme providers (n = 2 and focus groups with participants (n = 12. Discussions were audio-recorded, transcribed and analysed using NVivo10. Published behaviour change frameworks and behaviour change technique taxonomies were used to guide the coding process. Results Clients’ interactions with components of the weight loss programme brought about a change in their commitment, knowledge, beliefs about capabilities and social and environmental contexts. Intervention components that generated these changes included the competitive selection process, group and online support, family involvement and overcoming milestone challenges over the 26 week programme. The mechanisms by which these components triggered change differed between participants. Conclusions There is an urgent need to establish robust interventions that can support people who are overweight and
Macey, Kat; Gregory, Angela; Nunns, David; das Nair, Roshan
Recent research has highlighted controversies in the conceptualisation, diagnosis and treatment of vaginismus. Vaginal trainers are currently the most widely used treatment. Critiques have highlighted concerns that the evidence-base of its effectiveness is limited, with controlled trials reporting disappointing results, and its prescription promotes 'performance-based' sexuality which may be detrimental. Despite this, little has been done to seek women's views about their treatment. This study set out to explore women's experiences of vaginismus treatment with vaginal trainers, and to use their voices to propose guidelines for improving treatment. 13 women who had used vaginal trainers for vaginal penetration difficulties diagnosed as vaginismus were recruited through a specialist clinic, university campuses, and online forums. The women took part in semi-structured individual interviews (face-to-face/telephone/Skype), which were audio-recorded, transcribed verbatim and analysed using Thematic Analysis. Four superordinate themes were elicited and used to draft 'better treatment' guidelines. Themes were: (1) Lack of knowledge, (2) Invalidation of suffering by professionals, (3) Difficult journey, and (4) Making the journey easier. This paper describes themes (3) and (4). Difficult Journey describes the long and arduous 'Journey into treatment', including difficulties asking for help, undergoing physical investigations and negotiating 'the system' of medical referrals. It also describes the sometimes demoralising process of 'being in treatment', which includes emotional and practical demands of treatment. Making the journey easier highlights the importance of and limits to 'partner support'. 'Professional support' comprises personal qualities of professionals/therapeutic relationship, the value of specialist skills and knowledge and the need for facilitating couple communication about vaginismus. 'Peer support/helping each other' describes the importance of
Sommerbakk, Ragni; Haugen, Dagny Faksvåg; Tjora, Aksel; Kaasa, Stein; Hjermstad, Marianne Jensen
Implementation of quality improvements in palliative care (PC) is challenging, and detailed knowledge about factors that may facilitate or hinder implementation is essential for success. One part of the EU-funded IMPACT project (IMplementation of quality indicators in PAlliative Care sTudy) aiming to increase the knowledge base, was to conduct national studies in PC services. This study aims to identify factors perceived as barriers or facilitators for improving PC in cancer and dementia settings in Norway. Individual, dual-participant and focus group interviews were conducted with 20 employees working in different health care services in Norway: two hospitals, one nursing home, and two local medical centers. Thematic analysis with a combined inductive and theoretical approach was applied. Barriers and facilitators were connected to (1) the innovation (e.g. credibility, advantage, accessibility, attractiveness); (2) the individual professional (e.g. motivation, PC expertise, confidence); (3) the patient (e.g. compliance); (4) the social context (e.g. leadership, culture of change, face-to-face contact); (5) the organizational context (e.g. resources, structures/facilities, expertise); (6) the political and economic context (e.g. policy, legislation, financial arrangements) and (7) the implementation strategy (e.g. educational, meetings, reminders). Four barriers that were particular to PC were identified: the poor general condition of patients in need of PC, symptom assessment tools that were not validated in all patient groups, lack of PC expertise and changes perceived to be at odds with staff's philosophy of care. When planning an improvement project in PC, services should pay particular attention to factors associated with their chosen implementation strategy. Leaders should also involve staff early in the improvement process, ensure that they have the necessary training in PC and that the change is consistent with the staff's philosophy of care. An important
Emanuel, E J; Daniels, E R; Fairclough, D L; Clarridge, B R
Despite intense debates about legalization, there are few data examining the details of actual euthanasia and physician-assisted suicide (PAS) cases in the United States. To determine whether the practices of euthanasia and PAS are consistent with proposed safeguards and the effect on physicians of having performed euthanasia or PAS. Structured in-depth telephone interviews. Randomly selected oncologists in the United States. Adherence to primary and secondary safeguards for the practice of euthanasia and PAS; regret, comfort, and fear of prosecution from performing euthanasia or PAS. A total of 355 oncologists (72.6% response rate) were interviewed on euthanasia and PAS. On 2 screening questions, 56 oncologists (15.8%) reported participating in euthanasia or PAS; 53 oncologists (94.6% response rate) participated in in-depth interviews. Thirty-eight of 53 oncologists described clearly defined cases of euthanasia or PAS. Twenty-three patients (60.5%) both initiated and repeated their request for euthanasia or PAS, but 6 patients (15.8%) did not participate in the decision for euthanasia or PAS. Thirty-seven patients (97.4%) were experiencing unremitting pain or such poor physical functioning they could not perform self-care. Physicians sought consultation in 15 cases (39.5%). Overall, oncologists adhered to all 3 main safeguards in 13 cases (34.2%): (1) having the patient initiate and repeat the request for euthanasia or PAS, (2) ensuring the patient was experiencing extreme physical pain or suffering, and (3) consulting with a colleague. Those who adhered to the safeguards had known their patients longer and tended to be more religious. In 28 cases (73.7%), the family supported the decision. In all cases of pain, patients were receiving narcotic analgesia. Fifteen patients (39.5%) were enrolled in a hospice. While 19 oncologists (52.6%) received comfort from having helped a patient with euthanasia or PAS, 9 (23.7%) regretted having performed euthanasia or PAS, and
... veterinarian induce its death quietly and humanely through euthanasia. A decision concerning euthanasia may be one of the most difficult decisions ... sure it has a good quality of life, euthanasia may be the right decision. Quality of life ...
Mori, Hiroko; Sugawara, Yasuhiro; Obuchi, Shuichi P; Shimmei, Masaya; Takahashi, Ryutaro
The roles of adult daycare services during disaster evacuations in the relationships with community resilience are unknown. The initial 72 hours after a disaster are crucial because people in the disaster area depend on their own efforts or the resources available at the moment until the arrival of external support. To clarify the evacuation-related decision making of the administrators of adult daycare services within 72 hours after the Great East Japan Earthquake and to describe the roles of adult daycare services during the month following the earthquake. Qualitative study using semistructured interviews. The transcribed interviews were analyzed anonymously through an inductive qualitative content analysis using ATLAS.ti. Kesennuma City, Miyagi Prefecture. Eleven key informants (3 primary care providers and 8 administrators) from 8 institutions. Immediately after the disaster, 6 institutions implemented shelter-in-place. The evacuation behaviors of the adult daycare institutions were diverse, but each institution was transformed repeatedly within 72 hours. With respect to evacuation decision making, the primary issues involved whether to go to mandatory evacuation sites. However, after 3 days, the institutions relocated from these sites to other places. During a period of approximately 1 month, 7 institutions managed the evacuation of service users and care providers. The expanded institutional roles were as follows: "confirming the safety of the users' families," "substituting residential facilities," and "imposing leadership during the evacuation." If institutions choose to shelter-in-place, it should be sustained for as long as possible. Sufficiently planned stores of food and water to accommodate daytime users are needed. Institutions that employ shelter-in-place as an evacuation plan should maintain close contact with local governments. Furthermore, local governments should predetermine how to manage these institutions in the event of a disaster. To build
Hayashi, Fumi; Akamatsu, Rie; Ebina, Ryoko; Nishimura, Setsuko; Okuyama, Megumi; Matsuoka, Yukiyo; Nakamura, Masakazu; Sakane, Naoki; Adachi, Yoshiko; Takemi, Yukari
A qualitative analysis was conducted to identify factors important for weight loss through a specific health guidance program and to understand the processes that were crucial in achieving success. Twenty-six male workers aged 41-59 years from five corporate health insurance societies in four prefectures who had lost > or = 4% weight by attending the six-month specific health guidance program were invited to participate in the in-depth interviews. Data were collected between October and December 2009. We audio taped the 30-minute interviews and performed qualitative analysis on the transcripts using a grounded theory. The discussion by the expert panel strengthened the validity of the analysis. The mean age was 49.9 +/- 5.6 years, and the average weight loss was 6.8 +/- 2.5%. All subjects were somewhat concerned about their health status and body shape before the first appointment, but two major prosesses, "critical feeling" and "sense of obligation," were identified after the first appointment. We also identified innovative efforts in all subjects during the process. Those who reported a "sense of obligation" at the beginning and those who had a negative perception during the program were found to have higher risks of weight rebound after the program was over. We considered personality, values, attitudes toward the program, and support from both family and workplace as the intervening conditions for behavior modification. Since everyone aged 40-74 years with a certain risk of metabolic syndromes is obligated by law to participate in the specific health guidance program, weight loss is challenging for those who are not motivated enough to change their behaviors. Therefore, the initial assessment of one's motivations, followed by interventions taken in consideration of one's lifestyle and social background, are crucial for the success of a weight loss program, as is the use of a client-centered approach.
Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z
This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).
Poreddi, Vijayalakshmi; Nagarajaiah; Konduru, Reddemma; Math, Suresh Bada
Euthanasia provokes controversies in various domains, such as the moral, ethical, legal, religious, scientific, and economic. India legalised passive euthanasia (withdrawal of life support) for patients with brain death or who are in a permanent vegetative state in 2011, but research on perceptions of euthanasia among people in India is limited. This study aimed to examine nurses' perceptions of the practice of euthanasia as well as factors influencing those perceptions. A non-probability quantitative, cross-sectional design was adopted for a sample of 214 nurses working at a tertiary care centre. Data was collected through self-reported questionnaires at the nurses workplace.The findings revealed mixed opinions on euthanasia among the nurses. However, the majority of the participants did not agree with the practice of euthanasia. Nonetheless, further research is needed on this issue across the country among various health professionals in the context of current legislation.
Chiriţă, V; Chiriţă, Roxana; Duică, Lavinia; Talau, Gh
Euthanasia/Assisted Suicide are viewed differently by moral and religious references. In a religious way, cardinal confessions (Christianity, Judaism, Islamism, Buddhism) condemn euthanasia/assisted suicide and, in the same time have a more relaxed attitude regarding passive euthanasia. Other aspects of euthanasia regard financial/economic and ethical-medical considerations. All these contradictory standpoints are expressed in some legal acts that make specifications on the concept of "euthanasia"--Oregon's Death with Dignity Act (1994) and Netherlands's Euthanasia Law (2001).
Alphen, J.E. van; Donker, G.A.; Marquet, R.L.
The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. AIM: To investigate changes in the number of, and reasons for, requests for
Moreau, Alain; Carol, Laurent; Dedianne, Marie Cécile; Dupraz, Christian; Perdrix, Corinne; Lainé, Xavier; Souweine, Gilbert
To understand patients' perceptions of decision making and identify relationships among decision-making models. This qualitative study was made up of four focus group interviews (elderly persons, users of health support groups, students, and rural inhabitants). Participants were asked to report their perceptions of decision making in three written clinical scenarios (hypertension, breast cancer, prostate cancer). The analysis was based on the principles of grounded theory. Most patients perceived decision making as shared decision making, a deliberative question-response interaction with the physician that allowed patients to be experts in obtaining clearer information, participating in the care process, and negotiating compromises with physician preferences. Requesting second opinions allowed patients to maintain control, even within the paternalistic model preferred by elderly persons. Facilitating factors (trust, qualitative non-verbal communication, time to think) and obstacles (serious/emergency situations, perceived inadequate scientific competence, problems making requests, fear of knowing) were also part of shared decision making. In the global concept of patient-centered care, shared decision making can be flexible and can integrate paternalistic and informative models. Physicians' expertise should be associated with biomedical and relational skills through listening to, informing, and advising patients, and by supporting patients' choices. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Abdi Omar Shuriye
This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain. However, as science develops ethical and religious isuues related to the subject have increasingly created fervent debates on euthanesia. ABSTRAK: Kertas ini mengkaji euthanasia dari perspektif agama dan etika. Sejarah telah melihat para pemikir Greek termasuk Aristotle sec...
There has been renewed interest in the moral arguments surrounding euthanasia. Some patients are now apprehensive of advanced medical technology which they fear may result in a prolonged and undignified death. In the current situation of scarce resources for health care, both patients and doctors could be coerced into considering active euthanasia if it was legally available. In this paper it is argued that doctors now need to make a clear statement rejecting active euthanasia but affirming t...
Full Text Available The topic of euthanasia can be defined and analyzed upon considering several perspectives, such as the legal, religious, historical, philosophical, medical or ethical ones. This article attempts to supply a brief presentation of these perspectives, indicating the existing trends and standpoints at world level in connection to perceptions regarding the phenomenon mentioned, exemplified by opinions described in the doctrine and relevant jurisprudence. At the same time, in this article I will try to indicate the weak spots of the Romanian legislation in the euthanasia area, upon supplying some proposals for legislative intervention. Concomitantly, it should appear the idea that not the right to die per se is to receive motivations and be included in the law, but the duty to live. This should be done first by drafting an adequate law to the terminal states that would guide their medical practice and comply with the world legislative trends.
Yuvraj Dilip Patil
Full Text Available Dying has become imposition upon humans, who seek to avoid it as they encounter the inevitably fatal aging process. After the case of Aruna Shanbag a nurse who spent 42 years in a vegetative state as a result of sexual assault, the issue of euthanasia-mercy killing gained attention. The formulation of regulatory provision for euthanasia was earlier examined in Health Ministry in th 2006 based on the 196 report of the law commission of India however; health ministry at that time had opted not to make law on it. Interestingly the health ministry has enacted bill for terminally ill patient in 2016. In this article author has discussed The Medical Treatment of Terminally Ill Patients (Protection of patients and medical practitioners bill- 2016 with position in other countries.
Murray, Scott A; Kendall, Marilyn; Boyd, Kirsty; Grant, Liz; Highet, Gill; Sheikh, Aziz
To assess if family care givers of patients with lung cancer experience the patterns of social, psychological, and spiritual wellbeing and distress typical of the patient, from diagnosis to death. Secondary analysis of serial qualitative interviews carried out every three months for up to a year or to bereavement. South east Scotland. 19 patients with lung cancer and their 19 family carers, totalling 88 interviews (42 with patients and 46 with carers). Carers followed clear patterns of social, psychological, and spiritual wellbeing and distress that mirrored the experiences of those for whom they were caring, with some carers also experiencing deterioration in physical health that impacted on their ability to care. Psychological and spiritual distress were particularly dynamic and commonly experienced. In addition to the "Why us?" response, witnessing suffering triggered personal reflections in carers on the meaning and purpose of life. Certain key time points in the illness tended to be particularly problematic for both carers and patients: at diagnosis, at home after initial treatment, at recurrence, and during the terminal stage. Family carers witness and share much of the illness experience of the dying patient. The multidimensional experience of distress suffered by patients with lung cancer was reflected in the suffering of their carers in the social, psychological, and spiritual domains, with psychological and spiritual distress being most pronounced. Carers may need to be supported throughout the period of illness not just in the terminal phase and during bereavement, as currently tends to be the case.
Low, J A; Pang, W S
There has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for care of the terminally ill and dying. There have also been calls by certain groups to actually legalize voluntary euthanasia and physician-assisted suicide for patients who meet certain conditions, some of which are as follows: that the patient be of a sound mind, suffering from an incurable or terminal illness, experiencing unbearable suffering and uncontrollable pain. The rationale for legalizing euthanasia is based on the principle of the patient's right of self-determination and the duty of doctors to relieve pain and suffering at all times. A few within the medical community quickly saw certain similarities in terms of goals and aims between euthanasia and palliative care and, thus, proposed that euthanasia be an option or choice for difficult palliative care cases. Some even went as far as to suggest that euthanasia and palliative care be part of the continuum of care for terminally ill patients. When palliative medicine fails to fully control pain and suffering for the patient, euthanasia can be the logical next step in the continuum of care. This article seeks to discuss why the rationale for legalizing euthanasia is flawed, why euthanasia goes against the fundamental principles of Medicine in general and why it is incompatible with the practice of palliative medicine.
Sanders, K; Chaloner, C
Euthanasia is a highly emotive and contentious subject, giving rise to a great deal of debate. However, despite its frequent exposure in public and professional media, there appears to be a lack of clarity about the concepts and definitions used in the euthanasia debate. This suggests that discussions on this subject are inadequately informed and ineffectual. The ethical focus of the euthanasia debate concerns the moral legitimacy of 'voluntary euthanasia'. This article provides an overview and clarification of some of the key ethical issues at the centre of that debate.
In 2002 the Dutch Euthanasia Act came into force. This Act is the result of a lengthy developmental process. It codifies the requirements that have evolved in case law and medical ethics since 1973. Empirical data indicate that the Dutch euthanasia practice is stabilising. Euthanasia and assisted suicide occur in 2.7% of all deaths. Now that the Act has been passed, the focus is on improving the quality of medical decision-making. From an international perspective, the Dutch legislation is exceptional. However, it appears that other countries and international organisations are considering euthanasia legislation as well. It remains to be seen how influential the Dutch model will prove to be.
Kirmes, Tomasz; Wilk, Mateusz; Chowaniec, Czesław
This article is an attempt to complete and holistically discuss problem of euthanasia, especially its ethical and legal aspects, comparing to Polish law. The subject of euthanasia arouse interest of the society because it touches one of the most important aspects of life, which is the death. Even bigger emotions are aroused amongst physicians. They are forced to put on the line the life as biggest value on the one side and autonomy of human being on the other. It also touches the empathy for suffering. The euthanasia was divided into three forms: active euthanasia, passive euthanasia and assisted suicide. Any form of euthanasia is illegal in Poland according to both the Penal Code and Code of Medical Ethics. Range of possible penal consequences perpetrator is very wide from waiver of punishment to life imprisonment and it comes from different penal qualification of the euthanasia. Qualification of the euthanasia is based on terms of intent of perpetrator's act, request of patient, strong empathy for suffering if the patient and decision based on up-to-date medical knowledge. It is valuable to mention "do-not-resuscitate" DNR procedure, which in case of medical futility is legally accepted in Poland, but in other form may be qualified as passive euthanasia.
There has been renewed interest in the moral arguments surrounding euthanasia. Some patients are now apprehensive of advanced medical technology which they fear may result in a prolonged and undignified death. In the current situation of scarce resources for health care, both patients and doctors could be coerced into considering active euthanasia if it was legally available. In this paper it is argued that doctors now need to make a clear statement rejecting active euthanasia but affirming that in certain cases passive euthanasia, or letting die, may be morally justifiable.
Edwards, M J; Jago, R; Sebire, S J; Kesten, J M; Pool, L; Thompson, J L
The present study uses qualitative data to explore parental perceptions of how their young child's screen viewing and physical activity behaviours are influenced by their child's friends and siblings. Telephone interviews were conducted with parents of year 1 children (age 5-6 years). Interviews considered parental views on a variety of issues related to their child's screen viewing and physical activity behaviours, including the influence that their child's friends and siblings have over such behaviours. Interviews were transcribed verbatim and analysed using deductive content analysis. Data were organised using a categorisation matrix developed by the research team. Coding and theme generation was iterative and refined throughout. Data were entered into and coded within N-Vivo. Parents were recruited through 57 primary schools located in Bristol and the surrounding area that took part in the B-ProAct1v study. Fifty-three parents of children aged 5-6 years. Parents believe that their child's screen viewing and physical activity behaviours are influenced by their child's siblings and friends. Friends are considered to have a greater influence over the structured physical activities a child asks to participate in, whereas the influence of siblings is more strongly perceived over informal and spontaneous physical activities. In terms of screen viewing, parents suggest that their child's friends can heavily influence the content their child wishes to consume, however, siblings have a more direct and tangible influence over what a child watches. Friends and siblings influence young children's physical activity and screen viewing behaviours. Child-focused physical activity and screen viewing interventions should consider the important influence that siblings and friends have over these behaviours. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Parsons, Suzanne; Starling, Bella; Mullan-Jensen, Christine; Tham, Su-Gwan; Warner, Kay; Wever, Kim
To explore European-based pharmaceutical industry professionals' beliefs about patient and public involvement (PPI) in medicines research and development (R&D). Pharmaceutical companies in the UK, Poland and Spain. 21 pharmaceutical industry professionals, four based in the UK, five with pan-European roles, four based in Spain and eight based in Poland. Qualitative interview study (telephone and face-to-face, semistructured interviews). All interviews were audio taped, translated (where appropriate) and transcribed for analysis using the Framework approach. 21 pharmaceutical industry professionals participated. Key themes were: beliefs about (1) whether patients and the public should be involved in medicines R&D; (2) the barriers and facilitators to PPI in medicines R&D and (3) how the current relationships between the pharmaceutical industry, patient organisations and patients influence PPI in medicines R&D. Although interviewees appeared positive about PPI, many were uncertain about when, how and which patients to involve. Patients and the public's lack of knowledge and interest in medicines R&D, and the pharmaceutical industry's lack of knowledge, interest and receptivity to PPI were believed to be key challenges to increasing PPI. Interviewees also believed that relationships between the pharmaceutical industry, patient organisations, patients and the public needed to change to facilitate PPI in medicines R&D. Existing pharmaceutical industry codes of practice and negative media reporting of the pharmaceutical industry were also seen as negative influences on these relationships. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Background Medical students report high stress levels and in particular, the clinical phase is a demanding one. The field of medicine is still described as having a patriarchal culture which favors aspects like a physicians’ perceived certainty and rationalism. Also, the Effort-Recovery Model explains stress as coming from a discrepancy between job demands, job control, and perceived work potential. Gendered differences in stress are reported, but not much is known about medical interns’ perceptions of how gender plays in relation to stress. The aim of this study is to explore how medical interns experience and cope with stress, as well as how they reflect on the gendered aspects of stress. Methods In order to do this, we have performed a qualitative study. In 2010–2011, semi-structured qualitative interviews were conducted with seventeen medical interns across all three years of the Masters programme (6 male, 11 female) at a Dutch medical school. The interview guide is based on gender theory, the Effort-Recovery Model, and empirical literature. Transcribed interviews have been analyzed thematically. Results First, stress mainly evolves from having to prove one’s self and show off competencies and motivation (“Show What You Know…”). Second, interns seek own solutions for handling stress because it is not open for discussion (… “And Deal With Stress Yourself”). Patient encounters are a source of pride and satisfaction rather than a source of stress. But interns report having to present themselves as ‘professional and self-confident’, remaining silent about experiencing stress. Female students are perceived to have more stress and to study harder in order to live up to expectations. Conclusions The implicit message interns hear is to remain silent about insecurities and stress, and, in particular, female students might face disadvantages. Students who feel less able to manifest the ‘masculine protest’ may benefit from a culture that
Full Text Available The right to life is one of the fundamental rights of people that have to be respected and protected by each state’s legislation. The connection between the right to life and criminal law is a significant one, as the Criminal Code incriminates a few categories of crimes that can prejudice it. Although that as an object of crimes against life, a person’s life is recognized, the right to life remains a value that can suffer from criminal attempts. Often, in literature, the correlation or the relation between certain criminal acts is discussed, such as the genocide, illegal abortion, euthanasia, infanticide and the right to life, the possibility of mutual influence and their coexistence. Furthermore, the problem ofeuthanasia involves also the examination of practical and juridical connotations connected to the free accomplishment of the human fundamental rights and the right to life in particular. Can thecompatibility or the incompatibility of euthanasia with the right to law be decisive? The answer can only be an affirmative one, as through this approach the judicial statute and the scope of euthanasia can be determined.
Harvey, J C; Pellegrino, E D
The outcome of the physician-assisted suicide and euthanasia debate will profoundly influence physicians' role in society, the kind of society we become, and the way physicians and patients relate to one another. Three forces account for the move to physician-assisted suicide and euthanasia: an abuse of scientific advancement, a new political philosophy, and the erosion of religious consensus. The relationship between patients and physicians has often been understood as a convenant with rights on patients' part and duties on physicians' part. Physicians' duties in this covenantal relationship are to act for patients' good (a positive duty) and to do no harm (a negative duty). Euthanasia and assisted suicide are morally wrong because, as the Judeo-Christian ethic teaches, human beings are creatures of God and have only stewardship, not dominion, over life. But in our pluralistic society, which seems to lack consensus on religion, on communal responsibility, and on common values, one cannot argue against mercy killing and assisted suicide on theological grounds. Our society generally agrees, however, that a discussion of values may take place in the language of moral philosophy, a language that expresses right reason.
Presents interview with Dame Cicely Saunders, founder of international hospice care movement. Saunders describes her background and experiences that led her to form the hospice movement and discusses the need for pain control for terminally ill patients. Saunders also notes her opposition to euthanasia and physician-assisted suicide. (NB)
Full Text Available Christine Holmberg,1,2 Julia Rappenecker,1 Julia J Karner,1 Claudia M Witt1,3 1Institute for Social Medicine, Epidemiology, and Health Economics, 2Berlin School of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany; 3Center for Complementary and Integrative Medicine, University Hospital Zurich, Zurich, Switzerland Abstract: Chronic pain is prevalent in elderly populations. The goals of this study were 1 to understand the results of a randomized clinical trial – Qigong and Exercise Therapy for Elderly Patients with Chronic Neck Pain (QIBANE – that showed no difference between qigong, exercise therapy, and no-treatment on quality of life, and 2 to understand how elderly individuals with chronic pain experience interventions of qigong and exercise therapy. A qualitative interview study was conducted with 20 QIBANE participants. Interviews asked about motivation for and expectations of trial participation, experiences with the exercise classes (qigong or exercise therapy, and changes in pain experience. Interviews were transcribed, entered into the software program ATLAS.ti, and coded thematically by two coders. Content analysis was performed. All interviewees reflected positively on their QIBANE experience and described their participation in QIBANE as helpful. However, what was discussed in both groups when they talked about “positive experiences” in the study differed between the two groups. For example, themes that emerged in the exercise-therapy group related to difficulties associated with aging and staying physically active. In the interviews with qigong group members, emergent themes related to qigong as a method that improved bodily experiences and influenced daily activities. The effects that exercise therapy and qigong have on an elderly population cannot be captured by health-related quality-of-life measurements, such as the Short Form (36 Health Survey. Broader concepts of quality of life that include the
Bolt, Eva E; Pasman, H Roeline W; Deeg, Dorly J H; Onwuteaka-Philipsen, Bregje D
To determine whether older people with advance directive for euthanasia (ADEs) are stable in their advance desire for euthanasia in the last years of life, how frequently older people with an ADE eventually request euthanasia, and what factors determine this. Mortality follow-back study nested in a cohort study. The Netherlands. Proxies of deceased members of a cohort representative of Dutch older people (n = 168) and a cohort of people with advance directives (n = 154). Data from cohort members (possession of ADE) combined with after-death proxy information on cohort members' last 3 months of life. Multiple logistic regression analysis was performed on determinants of a euthanasia request in individuals with an ADE. Response rate was 65%. One hundred forty-two cohort members had an ADE at baseline. Three months before death, 87% remained stable in their desire for euthanasia; 47% eventually requested euthanasia (vs 6% without an ADE), and 16% died after euthanasia. People with an ADE were more likely to request euthanasia if they worried about loss of dignity. The majority of older adults who complete an ADE will have a stable preference over time, but an advance desire for euthanasia does not necessarily result in a euthanasia request. Writing an ADE may reflect a person's need for reassurance that they can request euthanasia in the future. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Rogelberg, Steven G; Reeve, Charlie L; Spitzmüller, Christiane; DiGiacomo, Natalie; Clark, Olga L; Teeter, Lisa; Walker, Alan G; Starling, Paula G; Carter, Nathan T
To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. Cross-sectional original study. 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.
Proponents and opponents of euthanasia have argued passionately about whether it should be legalized. In Australia in the mid-1990s, following the world's first legal euthanasia deaths, Dr. Philip Nitschke initiated a different approach: a search for do-it-yourself technological means of dying with dignity. The Australian government has opposed…
Each of the Benelux countries (Belgium, Luxembourg, Netherlands) has enacted legislation that partially decriminalises euthanasia, defined as an act that intentionally terminates someone's life at their request. In the Netherlands and Luxembourg, but not in Belgium, the legislation partially decriminalised assisted suicide at the same time. In all three countries, euthanasia can only be performed by a doctor, in response to the patient's voluntary and well-considered request, and for patients who have an incurable disease that causes unbearable suffering, without any prospect of relief. In the Netherlands, minors can request euthanasia as of the age of 12 years. In 2011, reported euthanasia accounted for about 1% of deaths in Belgium and 3% in the Netherlands. In 75% of cases, cancer was the disease leading to a request for euthanasia. In the Netherlands, the number of cases of euthanasia reported by doctors in surveys matches the number that is officially declared. In Belgium, it is thought that there are as many unreported as reported cases of euthanasia. Since the enactment of euthanasia legislation, fewer deaths involve the intentional administration of lethal drugs without an explicit request from the patient.
The article examines current opinions toward euthanasia of persons with mental retardation in light of the history of public and professional attitudes. It also discusses the rejection of euthanasia on moral and religious grounds, and notes the use of lifelong incarceration, based on eugenics principles, to accomplish similar ends. (DB)
The Dutch euthanasia legislation has been lauded as well as criticized by legal scholars and physicians in the Netherlands and abroad. The legal framework so established is renowned for setting a number of valuable due-care criteria for the physician to follow when performing euthanasia on a
In 2002, Belgium became the second country to legalise euthanasia after the Netherlands. Three biannual reports have been published by the Federal Control and Evaluation Commission, the body which monitors the application of the law. This article explores how the Belgian law works and what is known about Belgian euthanasia practice both before and since legalisation.
Bassett, A M; Baker, C; Cross, S
There is limited research around how mental health (MH) student nurses interpret and differentiate between people's religious and cultural beliefs and the existence of psychopathological symptomatology and experiences. Here we focus on one cultural issue that arose from research exploring how MH student nurses approach and interpret religion and culture in their practice - that is, the difficulties in determining the clinical significance of the religious beliefs and experiences expressed by the people they care for. While problems with establishing the cultural boundaries of normality in clinical assessments are an important area of debate in cultural psychiatry, it remains a peripheral issue in MH nurse education. An anthropologically informed qualitative research design underpinned 'critical incident' (CI)-focused ethnographic interviews with 36 second and third-year MH nursing field students and seven undergraduate MH branch lecturers. Follow up focus groups were also carried out. Interview transcripts were subject to thematic analysis. Four subthemes were identified under the broad theme of the clinical significance of religious-type expression and experience: (1) identifying the difference between delusions and religious belief; (2) identifying whether an experience was hallucination or religious experience; (3) the clinical implications of such challenges; and (4) applying religion-specific knowledge. There are clinical implications that may result from the difficulties with assessing the clinical significance of religious beliefs and experiences, identified in both our research and within international cultural psychiatry literature and research. Misinterpretation and therefore wrongly assessing someone's experience as pathological is a significant concern. It is suggested that CI analysis could be adapted to help nurses, nursing students and nurse educators recognize the religious dimensions of mental distress, particularly those that then potentially
Experiences of burden, needs, rewards and resilience in family caregivers of people living with Motor Neurone Disease/Amyotrophic Lateral Sclerosis: A secondary thematic analysis of qualitative interviews.
Weisser, Fabia B; Bristowe, Katherine; Jackson, Diana
Family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, an incurable, mostly rapidly fatal neurodegenerative disease, face many challenges. Although there is considerable research on caregiver burden in Motor Neurone Disease/Amyotrophic Lateral Sclerosis, there is less knowledge of the positive aspects of caring. To explore the experiences of family caregivers of people with Motor Neurone Disease/Amyotrophic Lateral Sclerosis, specifically the relationship between positive and negative experiences of caring, and to identify possible ways to better support these caregivers. Secondary thematic analysis of 24 semi-structured qualitative interviews conducted longitudinally with 10 family caregivers. Interviews explored rewarding and unrewarding aspects of caring. Themes emerged around burden, needs, rewards and resilience. Resilience included getting active, retaining perspective and living for the moment. Burden was multifaceted, including social burden, responsibility, advocacy, ambivalence, guilt and struggling with acceptance. Rewards included being helped and 'ticking along'. Needs were multifaceted, including social, practical and psychological needs. The four main themes were interrelated. A model of coping was developed, integrating resilience (active/positive), burden (active/negative), needs (passive/negative) and reward (passive/positive). Burden, resilience, needs and rewards are interrelated. Caregivers' ability to cope with caring for a person with Motor Neurone Disease/Amyotrophic Lateral Sclerosis oscillates between positive and negative aspects of caring, being at times active, at times passive. Coping is a non-linear process, oscillating between different states of mind. The proposed model could enable clinicians to better understand the caregiver experience, help family caregivers foster resilience and identify rewards, and develop appropriate individualised caregiver support plans. © The Author(s) 2015.
Anna R Gagliardi
Full Text Available Physician relationships with device industry representatives have not been previously assessed. This study explored interactions with device industry representatives among physicians who use implantable cardiovascular and orthopedic devices to identify whether conflict of interest (COI is a concern and how it is managed.A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites, and interviewed about their relationships with device industry representatives. Sampling was concurrent with data collection and analysis. Data were analyzed and discussed using constant comparative technique by all members of the research team.Twenty-two physicians (10 cardiovascular, 12 orthopedic were interviewed. Ten distinct representative roles were identified: purchasing, training, trouble-shooting, supplying devices, assisting with device assembly and insertion, supporting operating room staff, mitigating liability, conveying information about recalls, and providing direct and indirect financial support. Participants recognized the potential for COI but representatives were present for the majority of implantations. Participants revealed a tension between physicians and representatives that was characterized as "symbiotic", but required physicians to be vigilant about COI and patient safety, particularly because representatives varied regarding disclosure of device defects. They described a concurrent tension between hospitals, whose policies and business practices were focused on cost-control, and physicians who were required to comply with those policies and use particular devices despite concerns about their safety and effectiveness.Given the potential for COI and threats to patient safety, further research is needed to establish the clinical implications of the role of, and relationship with device industry representatives; and whether and how
Jones, Leah Ffion; Ricketts, Ellie; Town, Katy; Rugman, Claire; Lecky, Donna; Folkard, Kate; Nardone, Anthony; Hartney, Thomas Nathan; McNulty, Cliodna
Opportunistic chlamydia screening is actively encouraged in English general practices. Based on recent policy changes, Public Health England piloted 3Cs and HIV in 2013-2014, integrating the offer of chlamydia testing with providing condoms, contraceptive information, and HIV testing (referred to as 3Cs and HIV) according to national guidelines. To determine young adults' opinions of receiving a broader sexual health offer of 3Cs and HIV at their GP practice. Qualitative interviews were conducted in a general practice setting in England between March and June 2013. Thirty interviews were conducted with nine male and 21 female patients aged 16-24 years, immediately before or after a routine practice attendance. Data were transcribed verbatim and analysed using a thematic framework. Participants indicated that the method of testing, timing, and the way the staff member approached the topic were important aspects to patients being offered 3Cs and HIV. Participants displayed a clear preference for 3Cs and HIV to be offered at the GP practice over other sexual health service providers. Participants highlighted convenience of the practice, assurance of confidentiality, and that the sexual health discussion was appropriate and routine. Barriers identified for patients were embarrassment, unease, lack of time, religion, and patients believing that certain patients could take offence. Suggested facilitators include raising awareness, reassuring confidentiality, and ensuring the offer is made in a professional and non-judgemental way at the end of the consultation. General practice staff should facilitate patients' preferences by ensuring that 3Cs and HIV testing services are made available at their surgery and offered to appropriate patients in a non-judgemental way. © British Journal of General Practice 2017.
The Dutch Euthanasia Act states that an advance directive can replace an actual request for euthanasia in cases in which a patient has become unable to make autonomous decisions. In Euthanasia and the Severely Demented, I agree with Keizer that the severely demented can suffer unbearably, but contrary to Keizer I do not believe that it is impossible to state in advance the conditions under which one would not wish to go on living any longer. Consequently, euthanasia can be permissible even in patients with late-stage dementia, provided that the other due-care criteria are met. Permissibility by itself, however, will not settle disputes about borderline cases. Due to the erratic course of the disease, the right moment for euthanasia may very well be impossible to determine.
Most arguments against active euthanasia, as do most arguments in applied ethics generally, take place within the framework of what can broadly be referred to as a modern, as opposed to an ancient, approach to moral theory. In this paper, I argue that this fact works to the disadvantage of opponents of active euthanasia, and that if there is a successful argument against active euthanasia, it will be of the latter sort. In Part I, I attempt to clarify the distinction between modern and ancient approaches with which I am concerned. In Part II, I attempt to show that any argument against active euthanasia that is of the first sort is bound to fail. In Part III, I propose an argument against active euthanasia of the second sort that I believe has a better chance for success. In Part IV, I consider some objections that can be raised against this argument and attempt to show how they can be overcome.
Current opinions on euthanasia of persons with mental retardation were discussed within the framework of the development of social policy towards this population. Historians of mental retardation have emphasized that incarceration and sterilization were the only two policy options available in the late 19th and early 20th centuries, but a third option, euthanasia, was also suggested. The significance of the euthanasia option as the nation struggled to find a solution to the question of how to deal with what was thought to be a sharp rise in the number of people with mental retardation in the United States in the late 19th and early 20th centuries was examined. The responses of service providers to suggestions that euthanasia be implemented were reviewed. The rejection of proposals for euthanasia on moral and religious grounds and on the basis that custodial institutions, based on eugenics principles, were able to achieve the same end through a scientifically justifiable means was explored.
Full Text Available Abstract Background The populations of industrialised countries are ageing; as this occurs, those who continue to use alcohol and illicit drugs age also. While alcohol use among older people is well documented, use of illicit drugs continues to be perceived as behaviour of young people and is a neglected area of research. This is the first published qualitative research on the experiences of older drug users in the United Kingdom. Methods Semi-structured interviews were conducted in Merseyside, in 2008, with drug users aged 50 and over recruited through drug treatment services. Interviews were recorded and transcribed and analysed thematically. Only health status and health service contact are reported here. Results Nine men and one woman were interviewed (age range: 54 to 61 years; all but one had been using drugs continuously or intermittently for at least 30 years. Interviewees exhibited high levels of physical and mental morbidity; hepatitis C was particularly prevalent. Injecting-related damage to arm veins resulted in interviewees switching to riskier injecting practices. Poor mental health was evident and interviewees described their lives as depressing. The death of drug-using friends was a common theme and social isolation was apparent. Interviewees also described a deterioration of memory. Generic healthcare was not always perceived as optimal, while issues relating to drug specific services were similar to those arising among younger cohorts of drug users, for example, complaints about inadequate doses of prescribed medication. Conclusion The concurrent effects of drug use and ageing are not well understood but are thought to exacerbate, or accelerate the onset of, medical conditions which are more prevalent in older age. Here, interviewees had poor physical and mental health but low expectations of health services. Older drug users who are not in contact with services are likely to have greater unmet needs. The number of drug users
Dudley, Louise; Gamble, Carrol; Allam, Alison; Bell, Philip; Buck, Deborah; Goodare, Heather; Hanley, Bec; Preston, Jennifer; Walker, Alison; Williamson, Paula; Young, Bridget
Training in patient and public involvement (PPI) is recommended, yet little is known about what training is needed. We explored researchers' and PPI contributors' accounts of PPI activity and training to inform the design of PPI training for both parties. We used semi-structured qualitative interviews with researchers (chief investigators and trial managers) and PPI contributors, accessed through a cohort of clinical trials, which had been funded between 2006 and 2010. An analysis of transcripts of audio-recorded interviews drew on the constant comparative method. We interviewed 31 researchers and 17 PPI contributors from 28 trials. Most researchers could see some value in PPI training for researchers, although just under half had received such training themselves, and some had concerns about the purpose and evidence base for PPI training. PPI contributors were evenly split in their perceptions of whether researchers needed training in PPI. Few PPI contributors had themselves received training for their roles. Many informants across all groups felt that training PPI contributors was unnecessary because they already possessed the skills needed. Informants were also concerned that training would professionalise PPI contributors, limiting their ability to provide an authentic patient perspective. However, informants welcomed informal induction 'conversations' to help contributors understand their roles and support them in voicing their opinions. Informants believed that PPI contributors should be confident, motivated, intelligent, focussed on helping others and have relevant experience. Researchers looked for these qualities when selecting contributors, and spoke of how finding 'the right' contributor was more important than accessing 'the right' training. While informants were broadly receptive to PPI training for researchers, they expressed considerable reluctance to training PPI contributors. Providers of training will need to address these reservations. Our
Rurup, Mette L; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J
To estimate the incidence of (compliance with) advance euthanasia directives of patients suffering from dementia in the Netherlands and to gain knowledge about the experiences of physicians. Retrospective interview study. Physicians in the Netherlands. Four hundred ten physicians. Physicians were interviewed about their demented patients who had an advance euthanasia directive. Nursing home physicians were interviewed more extensively. Approximately 2,200 demented patients with an advance euthanasia directive die annually after being treated by a physician who knows about this directive. In 76% of such cases, compliance with the directive was discussed, but euthanasia was seldom performed. In two-thirds of the cases of demented nursing home patients with an advance euthanasia directive, the physician was able to identify during the course of the disease a situation for which the patient had intended the directive. One-quarter of the nursing home physicians thought that their most recent patient suffered unbearably to a (very) high degree, and half of them thought that the patient suffered hopelessly to a (very) high degree. In three-quarters of the cases, the relatives did not want the nursing home physician to comply with the directive, but they did want to respect the patient's wishes by forgoing life-prolonging treatment, which occurred in approximately 90% of cases. Most nursing home physicians think that the suffering of patients with dementia can be unbearable and hopeless as a consequence of dementia, but most physicians do not consider dementia to be grounds for euthanasia, unless perhaps the patient has an additional illness.
Eliott, Jaklin A; Olver, Ian N
Within developed nations, there is increasing public debate about and apparent endorsement of the appropriateness of euthanasia as an autonomous choice to die in the face of intolerable suffering. Surveys report socio-demographic differences in rates of acceptance of euthanasia, but there is little in-depth analysis of how euthanasia is understood and positioned within the social and moral lives of individuals, particularly those who might be considered suitable candidates-for example, terminally-ill cancer patients. During discussions with 28 such patients in Australia regarding medical decisions at the end of life, euthanasia was raised by 13 patients, with the others specifically asked about it. Twenty-four patients spoke positively of euthanasia, 19 of these voicing some concerns. None identified euthanasia as a currently favoured option. Four were completely against it. Endorsement for euthanasia was in the context of a hypothetical future or for a hypothetical other person, or temporally associated with acute pain. Arguments supporting euthanasia framed the issue as a matter of freedom of choice, as preserving dignity in death, and as curbing intolerable pain and suffering, both of the patient and of those around them. A common analogy featured was that of euthanising a dog. These arguments were typically presented as self-evident justification for euthanasia, construed as an appropriate choice to die, with opposers positioned as morally inferior or ignorant. The difficulties of ensuring 'choice' and the moral connotations of 'choosing to die,' however, worked to problematise the appropriateness of euthanising specific individuals. We recommend further empirical investigation of the moral and social meanings associated with euthanasia.
Gastmans, C; Van Neste, F; Schotsmans, P
On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world (after the Netherlands) to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia.
Gastmans, C; Van Neste, F; Schotsmans, P
On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world (after the Netherlands) to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia. PMID:15082821
Bertschy, Sue; Geyh, Szilvia; Pannek, Jürgen; Meyer, Thorsten
Women after a spinal cord injury (SCI), who decide to get pregnant and to become mothers, have special health care service needs. This study aims to identify the perceived service needs of woman with SCI during pregnancy and childbirth in Switzerland and to reconstruct their experiences of healthcare service utilization based on their accounts. A qualitative content analysis based on focus groups and individual interviews was conducted. 17 mothers with SCI who had given birth following SCI within the past 15 years participated. The data were transcribed verbatim before content analyses were carried out. Primary data was collected from August 2012 to September 2013 at the Swiss Paraplegic Research Centre, Nottwil; the University of Lausanne and at the homes of the participants. Mothers reported a broad spectrum of medical needs, including the need for access to improved integrated care. They also reported difficulties finding providers with knowledge of both paraplegiology (i.e. spinal cord medicine) and gynaecology. Mothers preferred using local health care services and regular birth hospitals, and reported receiving no additional benefit from the services of specialised SCI centres during pregnancy. A pre-existing provider-patient relationship was helpful for optimizing care processes. This study showed that pregnant women with SCI have various perceived healthcare needs and health care service use. Effective programs to improve these women's access to integrated care during pregnancy and childbirth and policies requiring the provision of specific pregnancy information and pre-birth services are necessary.
Brands, Brigitte; Egan, Bernadette; Györei, Eszter; López-Robles, Juan Carlos; Gage, Heather; Campoy, Cristina; Decsi, Tamás; Koletzko, Berthold; Raats, Monique M
Nutrition is one of the many factors that influence a child's cognitive development and performance. Understanding the relationship between nutrition and mental performance in children is important in terms of their attainment and productivity both in school and later life. Since parents are seen as nutritional gatekeepers for their children's diets, their views and beliefs are of crucial importance. The present study aims to qualitatively examine parents' perceptions of the relationship between diet and mental performance of children. The study was conducted with a total of 124 parents in four European countries using a semi-structured interview schedule. Parents speak of the effects of diet at two levels; the nature of the effects of diet and the characteristics of the foods responsible for these effects. Mental outcomes are related to diet, with the effects perceived to be associated with attention and concentration, often mediated by effects on children's mood and behaviour. Parents categorise foods as 'good' or 'bad' with positive effects related generally to a healthy balanced diet while negative effects are perceived to be associated with sugary and fatty foods. Understanding parental perceptions is important for many purposes including the targeting of dietary advice and prioritising of public health issues. Copyright Â© 2012 Elsevier Ltd. All rights reserved.
Bristowe, Katherine; Carey, Irene; Hopper, Adrian; Shouls, Susanna; Prentice, Wendy; Higginson, Irene J; Koffman, Jonathan
Methods to improve care, trust and communication are important in acute hospitals. Complex interventions aimed at improving care of patients approaching the end of life are increasingly common. While evaluating outcomes of complex interventions is essential, exploring healthcare professionals' perceptions is also required to understand how they are interpreted; this can inform training, education and implementation strategies to ensure fidelity and consistency in use. To explore healthcare professionals' perceptions of using a complex intervention (AMBER care bundle) to improve care for people approaching the end of life and their understandings of its purpose within clinical practice. Qualitative study of healthcare professionals. Analysis informed by Medical Research Council guidance for process evaluations. A total of 20 healthcare professionals (12 nursing and 8 medical) interviewed from three London tertiary National Health Service hospitals. Healthcare professionals recruited from palliative care, oncology, stroke, health and ageing, medicine, neurology and renal/endocrine services. Three views emerged regarding the purpose of a complex intervention towards the end of life: labelling/categorising patients, tool to change care delivery and serving symbolic purpose indirectly affecting behaviours of individuals and teams. All impact upon potential utility of the intervention. Participants described the importance of training and education alongside implementation of the intervention. However, adequate exposure to the intervention was essential to witness its potential added value or embed it into practice. Understanding differing interpretations of complex interventions is essential. Consideration of ward composition, casemix and potential exposure to the intervention is critical for their successful implementation.
Crocker, Joanna C; Boylan, Anne-Marie; Bostock, Jennifer; Locock, Louise
There are mounting calls for robust, critical evaluation of the impact of patient and public involvement (PPI) in health research. However, questions remain about how to assess its impact, and whether it should be assessed at all. The debate has thus far been dominated by professionals. To explore the views of PPI contributors involved in health research regarding the impact of PPI on research, whether and how it should be assessed. Qualitative interview study. Thirty-eight PPI contributors involved in health research across the UK. Participants felt that PPI has a beneficial impact on health research. They described various impactful roles, which we conceptualize as the 'expert in lived experience', the 'creative outsider', the 'free challenger', the 'bridger', the 'motivator' and the 'passive presence'. Participants generally supported assessing the impact of PPI, while acknowledging the challenges and concerns about the appropriateness and feasibility of measurement. They expressed a range of views about what impacts should be assessed, by whom and how. Individual feedback on impact was seen as an important driver of improved impact and motivation to stay involved. While there appears to be widespread support for PPI impact assessment among PPI contributors, their views on what to assess and how are diverse. PPI contributors should be involved as equal partners in debates and decisions about these issues. Individual feedback on impact may increase PPI contributors' potential impact and their motivation to stay involved. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
Ogden, U; Kinnison, T; May, S A
Several reasons have been suggested for the elevated risk of suicide experienced by those in the veterinary profession. The current study aimed to investigate possible links between veterinarians' attitudes to 'convenience' or non-justified animal euthanasia and attitudes towards human euthanasia and suicide. Veterinary students and graduates had a negative attitude towards convenience animal euthanasia, but their attitudes changed over time (pre-clinical studies, clinical studies and recently graduated). A greater tolerance to euthanasia was displayed in the later years of study and post qualification - primarily by males. Attitudes towards both human euthanasia and suicide, however, remained stable over time and indicated on average a neutral stance. No correlations were found between attitudes to convenience euthanasia and either human euthanasia or suicide, suggesting a tolerance to convenience euthanasia of animals does not lead to desensitisation in valuing human life and a changed attitude to human euthanasia or suicide, or vice versa. Attitudes to human euthanasia and suicide were predictably correlated, perhaps suggesting an overarching attitude towards control over human death. The results of the current study throw into question the argument that it is the changes in attitudes to animal life that affect veterinarian's attitudes to human life and contribute to the high suicide rate.
Kuře, Josef; Vaňharová, Michaela
Both in the general public and in the professional communities, very diverse notions of euthanasia can be found. At the same time determining of the precise semantics of euthanasia is one of the crucial prerequisites for subsequent meaningful ethical discussion of euthanasia. The paper analyzes an empirical study investigating the understanding of euthanasia by medical students. The aim of the conducted research was to identify the semantic definitions of euthanasia used by the first-year medical students.
van Zyl, Liezl
Following the recent revival of virtue ethics, a number of ethicists have discussed the moral problems surrounding euthanasia by drawing on concepts such as compassion, benevolence, death with dignity, mercy, and by inquiring whether euthanasia is compatible with human flourishing. Most of these writers assert, or simply assume, that their arguments concerning the morality of euthanasia also support their views with regard to legislation. I argue, against these writers, that legislation cannot and should not be based on our moral and religious beliefs concerning whether euthanasia allows a person to die a good death. I then outline an Aristotelian approach to the role of law and government in a good society, according to which the task of the legislator is not to ensure that people actually act virtuously, but is instead to make it possible for them to choose to live (and die) well by ensuring that they have access to the goods that are necessary for flourishing. In the second half of the paper I apply this approach to the question of whether voluntary active euthanasia should be legalised by asking (1) whether euthanasia always deprives people of the necessary conditions for flourishing, and (2) whether the option to request euthanasia is ever necessary for flourishing.
Naseh, Ladan; Heidari, Mohammad
One of the most common morally controversial issues in endof-life care is euthanasia. Examining the attitudes of nursing students to this issue is important because they may encounter situations related to euthanasia during their clinical courses. The aim of our study was to examine nursing students' attitudes to euthanasia in Shahrekord city in western Iran. This was done using the Euthanasia Attitude Scale. The scale is divided into four categories, ie ethical considerations, practical considerations, treasuring life and naturalistic beliefs. Of 132 nursing students, 120 participated in the study (response rate 93.1%). According to the study's findings, 52.5%, 2.5% and 45% of the students reported a negative, neutral and positive attitude to euthanasia, respectively. There was a significant correlation between the nursing students' attitudes to euthanasia and some demographic characteristics, including sex, age and religious beliefs. Iranian Muslim nursing students participating in the study had a negative attitude to euthanasia. Further studies are recommended among nursing students from different cultures and of different religious faiths.
Direct active euthanasia is prohibited in most countries while passive and indirect is not. However, many arguments against the legalization of voluntary active euthanasia are flawed. Ethical differences between active and passive or indirect euthanasia are difficult to maintain especially when the passivity of the actor causes death. The crucial point is not activity or passivity but respect for the autonomy of individual human beings. In particular there appears to be little ethical difference between active and indirect euthanasia. Indirect euthanasia has often been justified by the principle of double effect, which traces back to Thomas Aquinas. But resorting to this rule contains a logical fallacy. The principle of double effect does not allow foreseen and unwanted adverse effects of an action to occur when they are avoidable. In terminal sedation, an example for indirect euthanasia, hypoxemia and dehydration can easily be prevented by respirator therapy and fluid administration. Therefore the rule of double effect is not applicable. Indirect and direct active euthanasia cannot be ethically distinguished by resorting to the principle of double effect.
De Bal, Nele; Gastmans, Chris; Dierckx de Casterlè, Bernadette
The aim of this paper is to thoroughly examine the involvement and experiences of nurses in the care of mentally competent, adult patients requesting euthanasia (i.e. administration of lethal drugs by someone other than the person concerned with the explicit intention of ending a patient's life, at the latter's explicit request) by means of a literature review. A keyword search was used to identify relevant journal articles and books published between 1990 and 2007. Manual searches of review article bibliographies were also conducted as well as searches of archives and collections of key journals. The electronic databases Medline, Cinahl, PsycINFO, The Cochrane Library, Social Sciences Citation Index, and Invert were searched using a combination of keywords and carefully constructed inclusion criteria. Forty-two publications of empirical research were identified and included in the present study after critical appraisal. The included publications represented 35 separated studies (20 quantitative, 11 qualitative and 4 mixed-method publications) and 28 different research samples. Analysis of these studies revealed that nurses across diverse geographic and clinical settings play a major role in caring for and showing a personal interest in patients requesting euthanasia. The nurses' feelings about euthanasia and their involvement are extremely complex. Descriptions of personal conflict, moral uncertainty, frustration, fear, secrecy,and guilt appear to reflect a complex array of personal and professional values as well as social, religious, and legal rules. Nurses can make a significant contribution to the quality of care by assisting and counseling patients and their families, physicians, and their nursing colleagues in a professional manner, even in countries where euthanasia is not legal. However, research on nurses' involvement in euthanasia has methodological and terminological problems,leading to our recommendation for more carefully designed qualitative studies
Jordal, Malin; Wijewardena, Kumudu; Öhman, Ann; Essén, Birgitta; Olsson, Pia
Gender norms have been challenged by unmarried rural women's migration for employment to urban Sri Lankan Free Trade Zones (FTZ). Men are described as looking for sexual experiences among the women workers, who are then accused of engaging in premarital sex, something seen as taboo in this context. Increased sexual and reproductive health and rights (SRHR) risks for women workers are reported. To improve SRHR it is important to understand the existing gender ideals that shape these behaviours. This qualitative study explores men's perspectives on gender relations in an urban Sri Lankan FTZ, with a focus on heterosexual relationships and premarital sex. Further, possible implications for SRHR of women workers in FTZs are discussed. Eighteen qualitative semi-structured interviews were conducted with men living or working in an urban Sri Lankan FTZ and were analysed using thematic analysis. Two conflicting constructions of masculinity; the 'disrespectful womaniser' and the 'respectful partner', were discerned. The 'disrespectful womaniser' was perceived to be predominant and was considered immoral while the 'respectful partner' was considered to be less prevalent, but was seen as morally upright. The migrant women workers' moral values upon arrival to the FTZ were perceived to deteriorate with time spent in the FTZ. Heterosexual relationships and premarital sex were seen as common, however, ideals of female respectability and secrecy around premarital sex were perceived to jeopardize contraceptive use and thus counteract SRHR. The 'disrespectful' masculinity revealed in the FTZ is reflective of the patriarchal Sri Lankan society that enables men's entitlement and sexual domination over women. Deterioration of men's economic power and increase of women's economic and social independence may also be important aspects contributing to men's antagonistic attitudes towards women. The promotion of negative attitudes towards women is normalized through masculine peer pressure
Blank, K; Robison, J; Prigerson, H; Schwartz, H I
The objective of this study was to examine the interest of non-terminally ill hospitalized elderly patients in euthanasia and physician assisted suicide (PAS) and to determine the stability of these interests over time. Patients age 60 or older (n=158), including both a depressed sample and non-depressed control sample, underwent a structured interview evaluating their interest in euthanasia and PAS in the event of a series of hypothetical outcome scenarios. Substantial proportions of subjects (varying from 13.3%-42% depending on the scenario) expressed hypothetical acceptance of euthanasia and PAS. After six months a subset of patients changed their minds about euthanasia and PAS (8% - 26% depending on the scenario), most often in the direction of initial acceptance to later rejection. Patients depressed in the hospital and interested in PAS for the outcome of their current (non-terminal) condition were significantly more likely express unstable opinions, with most rejecting it six months later. Other correlations of instability, in specific scenarios, included being male, experiencing higher baseline suffering, poorer subjective health and lower instrumental support. Because euthanasia and PAS actions are irreversible, findings of instability have important implications both clinically and for design of PAS legislation.
Smets, Tinne; Cohen, Joachim; Bilsen, Johan; Van Wesemael, Yanna; Rurup, Mette L; Deliens, Luc
Since the legalization of euthanasia, physicians in Belgium may, under certain conditions, administer life-ending drugs at the explicit request of a patient. To study the attitudes of Belgian physicians toward the use of life-ending drugs and euthanasia law, factors predicting attitudes, and factors predicting whether a physician has ever performed euthanasia. In 2009, we sent a questionnaire to a representative sample of 3006 Belgian physicians who, because of their specialty, were likely to be involved in the care of the dying. Response rate was 34%. Ninety percent of physicians studied were accepting of euthanasia for terminal patients who had extreme uncontrollable pain/symptoms. Sixty-six percent agreed that the euthanasia law contributes to the carefulness of physicians' end-of-life behavior; 10% agreed that the law impedes the development of palliative care. Religious beliefs and geographic region were strong determinants of attitude. Training in palliative care did not influence attitudes regarding euthanasia, but trained physicians were less likely to agree that the euthanasia law impedes the development of palliative care than were nontrained physicians. One in five physicians had performed euthanasia; they were more likely to be nonreligious, older, specialist, trained in palliative care, and to have had more experience in treating the dying. Most physicians studied support euthanasia for terminal patients with extreme uncontrollable pain/symptoms and agree that euthanasia can be part of good end-of-life care. Although physicians had little involvement in the process of legalizing euthanasia, they now generally endorse the euthanasia law. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Full Text Available This study aimed to carry out an analysis of the figure of euthanasia and its ethical implications. Addressed to aspects of bioethics and principlism, the theory developed by Beauchamp and Childress. Also presented is the right philosopher Ronald Dworkin position, in favor of euthanasia. Euthanasia is a complex, multidisciplinary subject, your debate is very timely because of the medical possibilities of keeping a person alive indefinitely, regardless of their suffering. The search for alternatives should continue in order to defend the autonomy of patients in their end of life choices and to respect their dignity.
Beca, J P; Leiva, A
The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.
Full Text Available Death is a universal phenomenon, it happens touches every person. One of the aspects of wide concern regarding death is euthanasia. It invokes much controversy, with some people being supporters whilst others being opposed against it. In some countries euthanasiahas been legalized. The Catholic Church is decidedly against euthanasia, but at the same time is critical of the use of excessive therapy. Public opinion in Western Europe, the USA, Canada and Australia supports the allowance of the use of euthanasia. In Poland most people reject such a possibility; however the number of supporters of “death by personal choice” in recent years has increased.
Full Text Available Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C. Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community
Rowland, Emma; Plumridge, Gill; Considine, Anna-Marie; Metcalfe, Alison
Women carrying the mutated BRCA gene, have approximately an 80% life-time risk of developing breast cancer with 50% risk of their children inheriting the gene mutation. Many parents find it difficult to know when and how to disclose this information to their children and how such disclosure might affect their child's future decision-making. This study explored the communication of genetic risk information in families using qualitative semi-structured interviews conducted with parents, children (7-11years) and young people (12-18years) affected or at risk from a BRCA gene mutation. Thematic analysis was applied to coded transcripts producing four themes; family communication, perception of cancer risks, risk management strategies and impact of genetic risk communication in children and young people's decision making. Twenty-seven individuals from 11 families took part, recruited through purposive sampling techniques. Cancer risk caused by a BRCA gene mutation induced a sense of fear in parents about their children's future. As a result, parents with hereditary breast cancer disclosed limited information about the risks associated with prophylactic surgery and/or the psychological and emotional impacts of surgery on body image. This had implications to children and young people's perceptions of prophylactic procedures, which were already influenced by cultural understandings of the 'desirable body' and increasing acceptance and proliferation cosmetic surgery. Lack of risk management information and the acculturation of cosmetic surgery combined to limit children and young people's understanding of the impact of hereditary breast cancer; reducing their ability to actualise the physiological, psychological and emotional consequences of surgery. Copyright © 2016. Published by Elsevier Ltd.
Full Text Available Abstract Background Every year, more than 650,000 Europeans die because they smoke. Smoking is considered to be the single most preventable factor influencing health. General practitioners (GP are encouraged to advise on smoking cessation at all suitable consultations. Unsolicited advice from GPs results in one of 40-60 smokers stopping smoking. Smoking cessation advice has traditionally been given on an individual basis. Our aim was to gain insights that may help general practitioners understand why people smoke, and why smokers stop and then remain quitting and, from this, to find fruitful approaches to the dialogue about stopping smoking. Methods Interviews with 18 elderly smokers and ex-smokers about their smoking and decisions to smoke or quit were analysed with qualitative content analysis across narratives. A narrative perspective was applied. Results Six stages in the smoking story emerged, from the start of smoking, where friends had a huge influence, until maintenance of the possible cessation. The informants were influenced by "all the others" at all stages. Spouses had vital influence in stopping, relapses and continued smoking. The majority of quitters had stopped by themselves without medication, and had kept the tobacco handy for 3-6 months. Often smoking cessation seemed to happen unplanned, though sometimes it was planned. With an increasingly negative social attitude towards smoking, the informants became more aware of the risks of smoking. Conclusion "All the others" is a clue in the smoking story. For smoking cessation, it is essential to be aware of the influence of friends and family members, especially a spouse. People may stop smoking unplanned, even when motivation is not obvious. Information from the community and from doctors on the negative aspects of smoking should continue. Eliciting life-long smoking narratives may open up for a fruitful dialogue, as well as prompting reflection about smoking and adding to the
Toma, Madalina; Dreischulte, Tobias; Gray, Nicola M; Campbell, Diane; Guthrie, Bruce
As quality improvement (QI) programmes have become progressively larger scale, the risks of implementation having unintended consequences are increasingly recognised. More routine use of balancing measures to monitor unintended consequences has been proposed to evaluate overall effectiveness, but in practice published improvement interventions hardly ever report identification or measurement of consequences other than intended goals of improvement. We conducted 15 semistructured interviews and two focus groups with 24 improvement experts to explore the current understanding of balancing measures in QI and inform a more balanced accounting of the overall impact of improvement interventions. Data were analysed iteratively using the framework approach. Participants described the consequences of improvement in terms of desirability/undesirability and the extent to which they were expected/unexpected when planning improvement. Four types of consequences were defined: expected desirable consequences ( goals ); expected undesirable consequences ( trade-offs ); unexpected undesirable consequences ( unpleasant surprises ); and unexpected desirable consequences ( pleasant surprises ). Unexpected consequences were considered important but rarely measured in existing programmes, and an improvement pause to take stock after implementation would allow these to be more actively identified and managed. A balanced accounting of all consequences of improvement interventions can facilitate staff engagement and reduce resistance to change, but has to be offset against the cost of additional data collection. Improvement measurement is usually focused on measuring intended goals , with minimal use of balancing measures which when used, typically monitor trade-offs expected before implementation. This paper proposes that improvers and leaders should seek a balanced accounting of all consequences of improvement across the life of an improvement programme, including deliberately pausing
von Engelhardt, Dietrich
Euthanasia signifies in antiquity an easy and happy death and not at all an active termination of life, which was forbidden in the Hippocratic oath, but justified by philosophers. In the Christian middle ages active euthanasia and abortion are explicitly refused. At the beginnings of modern times MORE (1516) and BACON (1623) plead for euthanasia and differentiate for the first time between "euthanasia interior" as a mental preparation and "euthanasia exterior" as a physical and direct termination of life. Around 1900 a change takes place--in medicine as well as in the humanities and arts. The lawyer Karl BINDING and the psychiatrist Alfred HOCHE (1920) support active euthanasia in the case of mental deficiency; similar views are taken by the population. Under the "Third Reich" euthanasia unlawfully is carried out as termination of life without or even against consent. Today oaths, declarations and laws are intended to prevent such a "medicine without humanity" (MITSCHERLICH and MIELKE 1947). Active voluntary euthanasia is under certain conditions allowed by the legislation in some countries (Netherlands, Belgium, Luxembourg). Essential seem the consideration of different types of euthanasia and above all a psychical-mental assistance in the process of dying. The height of culture is measured by dealing with death and dying.
Saad, Toni C
This article describes and evaluates the Belgian euthanasia experience by considering its practice and policy, both before and after the formal decriminalisation of euthanasia in 2002. The pre-legal practice of euthanasia, the evolution of euthanasia legislation, criticism of this legislation, the influence of politics, and later changes to the 2002 Act on Euthanasia are discussed, as well as the subject of euthanasia of minors and the matter of organ procurement. It is argued that the Belgian euthanasia experience is characterised by political expedition, and that the 2002 Act and its later amendments suffer from practical and conceptual flaws. Illegal euthanasia practices remain a live concern in Belgium, something which nations who are seeking to decriminalise euthanasia should consider. Copyright © 2017 by the National Legal Center for the Medically Dependent and Disabled, Inc.
Several circumstances may require the euthanasia of a cetacean: stranding, entanglement in fishing gear, entrapment in ice, significant injury of a free-swimming cetacean from ship-strike, or a terminally ill animal in a captive situation...
In The Netherlands, euthanasia is defined as the deliberate termination of the life of a person on his request by another person. Although, in this limited sense, euthanasia is only one of the issues raised by medical decision-making at the end of life, it is, in particular, the acceptance of euthanasia in this country that has attracted attention from abroad. Also, in The Netherlands itself, the toleration of the courts of euthanasia (if carried out by a physician under strict conditions) has given rise to much debate. This contribution surveys the developments in the law (including recent legislation), and in medical practice, and explores the relation between the two, with particular attention to the position of the physician.
Cristina Otovescu Frasie; Andreea Bandoiu
.... Subsequently, it examines the issues regarding the euthanasia and it presents different cases of citizens from Great Britain, France, and Romania who claimed for their right to assisted suicide...
Eduard Verhagen, A A
Decisions about neonatal end-of-life care have been studied intensely over the last 20 years in The Netherlands. Nationwide surveys were done to quantify these decisions, provide details and monitor the effect of guidelines, new regulations and other interventions. One of those interventions was the Groningen Protocol for newborn euthanasia in severely ill newborns, published in 2005. Before publication, an estimated 20 cases of euthanasia per year were performed. After publication, only two cases in five years were reported. Studies suggested that this might be partly caused by the lack of consensus about the dividing line between euthanasia and palliative care. New recommendations about paralytic medication use in dying newborns were issued to increase transparency and to improve reporting of euthanasia. New surveys will be needed to measure the effects of these interventions. This cycle of interventions and measurements seems useful for continuous improvement of end-of-life care in newborns. Copyright © 2014 Elsevier Ltd. All rights reserved.
This article counters arguments made by Bartels and Otlowski in 2010 regarding euthanasia. It suggests that the authors over-emphasised the importance of individual autonomy in its bearing on the euthanasia debate. Drawing on literature concerning elder abuse as well as the "mercy-killing" cases reviewed by Bartels and Otlowski, the article contends that legalising euthanasia may increase the risk that some patients are pressured, inadvertently or deliberately, to request access. Safeguards to detect and deter pressure may be of limited effectiveness against such pressure. Regarding slippery slope arguments, the article discusses the potential for an Australian euthanasia system to eventually be extended in scope to encompass mental suffering. The article encourages consideration of long-term potentialities, including changes in macro-economic conditions.
Banović, Božidar; Turanjanin, Veljko
Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public...
Perrett, R W
Damien and John Keown claim that there is important common ground between Buddhism and Christianity on the issue of euthanasia and that both traditions oppose it for similar reasons in order to espouse a "sanctity of life" position. I argue that the appearance of consensus is partly created by their failure to specify clearly enough certain key notions in the argument: particularly Buddhism, euthanasia and the sanctity of life. Once this is done, the Keowns' central claims can be seen to be e...
Schmiedebach, H-P; Woellert, K
Many of the judicial and ethical questions raised by euthanasia are still the subject of controversial discussions. In this context the article broaches the issues of the doctor- patient relationship, patient's right to autonomy, and advance directive. It deals with the present judicial possibilities of euthanasia in Germany with reference to the situation in the Netherlands. Finally, there is an outlook on the role of palliative care and of hospices.
Is there a moral difference between euthanasia for terminally ill adults and euthanasia for terminally ill children? Luc Bovens considers five arguments to this effect, and argues that each is unsuccessful. In this paper, I argue that Bovens' dismissal of the sensitivity argument is unconvincing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Thienpont, Lieve; Verhofstadt, Monica; Van Loon, Tony; Distelmans, Wim; Audenaert, Kurt; De Deyn, Peter P
To identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research. Retrospective analysis of data obtained through medical file review. Outpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012. 100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21-80 years). Patient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up. Most patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1). Depression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request euthanasia due to unbearable psychological suffering. Published by the BMJ Publishing
Thienpont, Lieve; Verhofstadt, Monica; Van Loon, Tony; Distelmans, Wim; Audenaert, Kurt; De Deyn, Peter P
Objectives To identify patterns in euthanasia requests and practices relating to psychiatric patients; to generate recommendations for future research. Design Retrospective analysis of data obtained through medical file review. Setting Outpatient psychiatric clinical setting in the Dutch-speaking region of Belgium, between October 2007 and December 2011; follow-up at the end of December 2012. Participants 100 consecutive psychiatric patients requesting euthanasia based on psychological suffering associated with psychiatric disorders (77 women, 23 men; mean age 47 years; age range 21–80 years). Main outcome measures Patient sociodemographic characteristics; diagnoses; decisions on euthanasia requests; circumstances of euthanasia procedures; patient outcomes at follow-up. Results Most patients had been referred for psychiatric counselling by their physician (n=55) or by LEIF (Life End Information Forum) (n=36). 90 patients had >1 disorder; the most frequent diagnoses were depression (n=58) and personality disorder (n=50). 38 patients required further testing and/or treatment, including 13 specifically tested for autism spectrum disorder (ASD); 12 received an ASD diagnosis (all Asperger syndrome). In total, 48 of the euthanasia requests were accepted and 35 were carried out. Of the 13 remaining patients whose requests were accepted, 8 postponed or cancelled the procedure, because simply having this option gave them enough peace of mind to continue living. In December 2012, 43 patients had died, including 35 by euthanasia; others died by suicide (6), palliative sedation (1) and anorexia nervosa (1). Conclusions Depression and personality disorders are the most common diagnoses in psychiatric patients requesting euthanasia, with Asperger syndrome representing a neglected disease burden. Further research is needed, especially prospective quantitative and qualitative studies, to obtain a better understanding of patients with psychiatric disorders who request
Rise, Marit B; Gismervik, Sigmund Ø; Johnsen, Roar; Fimland, Marius S
Occupational medicine has shifted emphasis from disease treatment to disability rehabilitation and management. Hence, newly developed occupational rehabilitation programs are often generic and multicomponent, aiming to influence the sick-listed persons' perception on return to work, and thereby support the return to work process. The aim of this study was to explore sick-listed persons' experiences with taking part in an in-patient occupational rehabilitation program based on Acceptance and Commitment Therapy. Twenty-nine adults on sickness benefit or work assessment allowance due to musculoskeletal and/or common mental health disorders participated in this study. They were interviewed in focus groups at the beginning and at the end of a 3.5 week inpatient group-based occupational rehabilitation program in Central Norway. Key elements in the program were Acceptance and Commitment Therapy (ACT), physical exercise and creating a work-participation plan. The program was mainly group-based including participants with different diagnoses. Data was analyzed according to a phenomenological approach. At the start of the program most participants expressed frustration regarding being sick-listed, external anticipations as well as hindrances towards returning to work, and described hope that the program would provide them with the skills and techniques necessary to cope with health problems and being able to return to work. At the end of the program the participants described that they had embarked upon a long process of increased awareness. This process encompassed four areas; an increased awareness of what was important in life, realizing the strain from external expectations and demands, a need to balance different aspects of life, and return to work as part of a long and complex process. The occupational rehabilitation program induced a perceived meaningful reorientation encompassing several aspects of life. However, the return to work process was described as diffuse
Background This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Methods Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis. Results The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Conclusions Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the
von Knorring, Mia; de Rijk, Angelique; Alexanderson, Kristina
This study focused on the manager role in the manager-physician relationship, considered from the manager perspective. The aim was to understand how top executives in Swedish healthcare regard management of physicians in their organisations, and what this implies for the manager role in relation to the medical profession. Abbott's theory of professional jurisdiction was used to inform thinking about managerial control and legitimacy in relation to physicians. Data from semi-structured individual interviews with 18 of the 20 county council chief executive officers (CEOs) in Sweden were subjected to qualitative analysis. The results show that, when asked about their views on management of physicians, the CEOs talked about "how physicians are" rather than describing their own or their subordinate managers' managerial behaviour or strategies. Three types of descriptions of physicians were identified: 1) they have high status and expertise; 2) they lack knowledge of the system; 3) they do what they want in the organisation. The CEOs seldom reported that general management strategies were used to manage physicians. Instead, they described four types of physician-specific management strategies that were used in their organisations: organisational separation of physicians; "nagging and arguing"; compensations; relying on the physician role. These strategies seemed to reflect pragmatic behaviour on behalf of the managers that helped them to maintain control over physicians in daily work. However, in a longer perspective, they seemed to decrease the legitimacy of the manager role and also contribute to weakening of that role in the organisation. Many CEOs seemed to regard the manager role in their organisations as weak and described difficulties in both taking and defining that role (for themselves or others) in relation to the physician role. Further research is needed to elucidate how managers in healthcare organisations assume the manager role in relation to the medical
Smets, Tinne; Cohen, Joachim; Bilsen, Johan; Van Wesemael, Yanna; Rurup, Mette L; Deliens, Luc
... and controversial medical acts possible, the law includes a mandatory notification procedure requiring physicians to report each euthanasia case to the Federal Control and Evaluation Committee, which assesses whether the physician has respected all the requirements of the law. 2 Since the enactment of the euthanasia law, the frequency and characteris...
Musgrave, C F
To discuss the critical issues involved in the legalization of active euthanasia and physician-assisted suicide. Nursing, medical, legal, and ethics literature; newspaper articles; book chapters. The major terms employed in the discussion of active euthanasia and physician-assisted suicide are defined. The implications of the recent Supreme Court decision on these practices are outlined. The Dutch euthanasia and the American abortion scenarios are used as models for the interpretation of the effects of future legislation on such practices. Oncology nurses need to be cognizant of the crucial issues involved in the practices of active euthanasia and physician-assisted suicide and determine their philosophical stance regarding the practices. If active euthanasia and physician-assisted suicide practices are legalized, oncology nurses will have to make decisions about their desired degree of involvement in acts that will end their patients' lives.
Kinsella, T D; Verhoef, M J
To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. Alberta. A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.
van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L
The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalizing euthanasia under strict conditions influences the number and nature of euthanasia requests. To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Retrospective dynamic cohort study comparing 5 years before (1998-2002) and 5 years after (2003-2007) implementation of the Act. Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. The mean annual incidence of requests before implementation amounted to 3.1/10,000 and thereafter to 2.8/10,000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10,000 to 2.6/10,000 (P = 0.008); the requests by females increased non-significantly from 2.6/10,000 to 3.1/10,000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females.
van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L
Background The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. Aim To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Design of study Retrospective dynamic cohort study comparing 5 years before (1998–2002) and 5 years after (2003–2007) implementation of the Act. Method Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. Results The mean annual incidence of requests before implementation amounted to 3.1/10 000 and thereafter to 2.8/10 000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10 000 to 2.6/10 000 (P = 0.008); the requests by females increased non-significantly from 2.6/10 000 to 3.1/10 000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). Conclusion There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females. PMID:20353671
Kinsella, T D; Verhoef, M J
OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada. PMID:8500029
Ysebaert, D; Van Beeumen, G; De Greef, K; Squifflet, J P; Detry, O; De Roover, A; Delbouille, M-H; Van Donink, W; Roeyen, G; Chapelle, T; Bosmans, J-L; Van Raemdonck, D; Faymonville, M E; Laureys, S; Lamy, M; Cras, P
Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients (3 in Antwerp and 1 in Liège) expressed their will for organ donation after their request for euthanasia was granted. Patients were aged 43 to 50 years and had a debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is necessary.
Valentim, A M; Guedes, S R; Pereira, A M; Antunes, L M
Several questions have been raised in recent years about the euthanasia of laboratory rodents. Euthanasia using inhaled agents is considered to be a suitable aesthetic method for use with a large number of animals simultaneously. Nevertheless, its aversive potential has been criticized in terms of animal welfare. The data available regarding the use of carbon dioxide (CO2), inhaled anaesthetics (such as isoflurane, sevoflurane, halothane and enflurane), as well as carbon monoxide and inert gases are discussed throughout this review. Euthanasia of fetuses and neonates is also addressed. A table listing currently available information to ease access to data regarding euthanasia techniques using gaseous agents in laboratory rodents was compiled. Regarding better animal welfare, there is currently insufficient evidence to advocate banning or replacing CO2 in the euthanasia of rodents; however, there are hints that alternative gases are more humane. The exposure to a volatile anaesthetic gas before loss of consciousness has been proposed by some scientific studies to minimize distress; however, the impact of such a measure is not clear. Areas of inconsistency within the euthanasia literature have been highlighted recently and stem from insufficient knowledge, especially regarding the advantages of the administration of isoflurane or sevoflurane over CO2, or other methods, before loss of consciousness. Alternative methods to minimize distress may include the development of techniques aimed at inducing death in the home cage of animals. Scientific outcomes have to be considered before choosing the most suitable euthanasia method to obtain the best results and accomplish the 3Rs (replacement, reduction and refinement). © The Author(s) 2015.
Ruijs, Cees D M; Kerkhof, A J F M; van der Wal, G; Onwuteaka-Philipsen, B D
In the Netherlands, many (45%) cancer patients die at home, in the care of GPs. About 1 out of 10 end-of-life cancer deaths is hastened by GPs through euthanasia or physician-assisted suicide. However, the relationship between depression and requests for euthanasia has never been prospectively studied directly in primary care. This study aimed to assess the prevalence of depression in end-of-life cancer patients requesting euthanasia in primary care, as well as to assess the relationship between depression and requesting euthanasia. Primary care patients with incurable cancer and an estimated life expectancy of half a year or shorter were interviewed every 2 months, using standardized psychometric instruments. Also, non-recruited eligible patients were monitored. Out of 258 eligible patients, 76 patients were recruited, of whom 64 patients were followed up until death. Of these, 27% (n = 17) explicitly requested euthanasia. One patient suffered from major depression. According to the depression subscale of the Hospital Anxiety and Depression Scale, 47% of the patients who explicitly requested euthanasia versus 28% of those without an euthanasia request suffered from a depressed mood at inclusion; the difference was not significant (P = 0.2). Corresponding figures for the last interview before death were 40% and 41% (P = 0.6). Major depression was not a major factor in explicit requests for euthanasia in end-of-life cancer patients in primary care. Further depressed mood was not associated with explicitly requesting euthanasia in this patient group, although statistical underpower cannot be ruled out in this small sample.
Smith, J. David
The issue of pediatric euthanasia for handicapped newborns is examined and contrasting viewpoints emphasizing the quality and the sanctity of life are considered. The author asserts that advocacy for handicapped children involves decisions regarding the euthanasia question. (CL)
Carter, Brian S
Recent laws in Europe now allow for pediatric euthanasia. The author reviews some rationale for caution, and addresses why ensuring the availability of pediatric palliative care is an important step before allowing pediatric euthanasia. © The Author(s) 2014.
Mojalefa L.J. Koenane
Debates on euthanasia (or �mercy killing�) have been a concern in moral, philosophical, legal, theological, cultural and sociological discourse for centuries. The topic of euthanasia inspires a variety of strong views of which the �slippery slope� argument is one. The latter warns that the principle(s) underlying any ethical issue (including euthanasia) may be distorted. Scholars� views on euthanasia are influenced mainly by cultural, personal, political and religious convictions. In South Af...
Struggles over euthanasia can be examined in terms of tactics used by players on each side of the issue to reduce outrage from actions potentially perceived as unjust. From one perspective, the key injustice is euthanasia itself, especially when the person or relatives oppose death. From a different perspective, the key injustice is denial of euthanasia, seen as a person's right to die. Five types of methods are commonly used to reduce outrage from something potentially seen as unjust: covering up the action; devaluing the target; reinterpreting the action, including using lying, minimising consequences, blaming others and benign framing; using official channels to give an appearance of justice; and using intimidation. Case studies considered include the Nazi T4 programme, euthanasia in contemporary jurisdictions in which it is legal, and censorship of Exit International by the Australian government. By examining euthanasia struggles for evidence of the five types of tactics, it is possible to judge whether one or both sides use tactics characteristic of perpetrators of injustice. This analysis provides a framework for examining tactics used in controversial health issues.
BANOVIĆ, Božidar; TURANJANIN, Veljko
Abstract Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public to its supporters and opponents. It also appears as one of the points where all three major religions (Catholic, Orthodox, and Islamic) have the same view. They are strongly against legalizing mercy killing, emphasizing the holiness of life as a primary criterion by which the countries should start in their considerations. Studying criminal justice systems in the world, the authors concluded that the issue of deprivation of life from compassion is solved on three ways. On the first place, we have countries where euthanasia is murder like any other murder from the criminal codes. Second, the most numerous are states where euthanasia is murder committed under privilege circumstances. On the third place, in the Western Europe we have countries where euthanasia is a legal medical procedure, under requirements prescribed by the law. In this paper, authors have made a brief comparison of the solutions that exist in some Islamic countries, where euthanasia is a murder, with Western countries, where it represents completely decriminalized medical procedure. PMID:26056652
Banović, Božidar; Turanjanin, Veljko
Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public to its supporters and opponents. It also appears as one of the points where all three major religions (Catholic, Orthodox, and Islamic) have the same view. They are strongly against legalizing mercy killing, emphasizing the holiness of life as a primary criterion by which the countries should start in their considerations. Studying criminal justice systems in the world, the authors concluded that the issue of deprivation of life from compassion is solved on three ways. On the first place, we have countries where euthanasia is murder like any other murder from the criminal codes. Second, the most numerous are states where euthanasia is murder committed under privilege circumstances. On the third place, in the Western Europe we have countries where euthanasia is a legal medical procedure, under requirements prescribed by the law. In this paper, authors have made a brief comparison of the solutions that exist in some Islamic countries, where euthanasia is a murder, with Western countries, where it represents completely decriminalized medical procedure.
Amaraskekara, Kumar; Bagaric, Mirko
The recent Dutch law legalising active voluntary euthanasia will reignite the euthanasia debate. An illuminating method for evaluating the moral status of a practice is to follow the implications of the practice to its logical conclusion. The argument for compassion is one of the central arguments in favour of voluntary active euthanasia. This argument applies perhaps even more forcefully in relation to incompetent patients. If active voluntary euthanasia is legalised, arguments based on compassion and equality will be directed towards legalising active non-voluntary euthanasia in order to make accelerated termination of death available also to the incompetent. The removal of discrimination against the incompetent has the potential to become as potent a catch-cry as the right to die. However, the legalisation of non-voluntary euthanasia is undesirable. A review of the relevant authorities reveals that there is no coherent and workable "best interests" test which can be invoked to decide whether an incompetent patient is better off dead. This provides a strong reason for not stepping onto the slippery path of permitting active voluntary euthanasia.
The ethics of physician- assisted suicide and euthanasia. In attempting to seize the moral high ground in the debate on the ethics of physician-assisted suicide and euthanasia,. Professor ... Euthanasia is the ultimate form of therapeutic nihilism in this situation ... The issue of what are termed dehumanising diseases, such as ...
This paper discusses the ethics of euthanasia. Situations are described in which the normal duty to sustain life is overridden by other duties towards the patient; but these situations are contrasted with euthanasia properly so called. Arguments for euthanasia are considered, and a refutation of those arguments is offered.
Van Wesemael, Yanna; Cohen, Joachim; Bilsen, Johan; Smets, Tinne; Onwuteaka-Philipsen, Bregje; Deliens, Luc
Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated. To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician. A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request. The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians' characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted. Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not. Copyright Â© 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Haverkate, I; van der Wal, G; van der Maas, P J; Onwuteaka-Philipsen, B D; Kostense, P J
The objectives of this study are to describe: (a) the presence of; and (b) compliance with guidelines in cases of euthanasia and intensifying the alleviation of pain and symptoms; (c) the opinions of physicians about written guidelines; and (d) the relationship between meeting the requirements for prudent practice and presence of, and compliance with guidelines for euthanasia or assisted suicide (EAS). In 1990 and 1995 interviews were held with 405 physicians (general practitioners, nursing home physicians and clinical specialists). The response rate for the 2 years was 91 and 89%, respectively. The percentage of physicians who reported the existence of EAS guidelines increased from 50% in 1990 to 59% in 1995, and the compliance with these guidelines increased from 51 to 75%, respectively. Of the physicians, 17% stated that there were written guidelines for intensifying the alleviation of pain and symptoms. With regard to meeting the requirements for prudent practice, we found mostly no differences between cases of euthanasia in which EAS guidelines were present, and cases in which there were no guidelines. However, when guidelines did exist and were actually used, it seems there was a better adherence to consultation and notification, although numbers were small. The increase since 1990 in agreement with the statement that an institution should formulate a policy with regard to euthanasia, may reflect the growing awareness of the specific role of the management, and not only the physician, in this matter.
Gesundheit, Benjamin; Steinberg, Avraham; Glick, Shimon; Or, Reuven; Jotkovitz, Alan
End-of-life care poses fundamental ethical problems to clinicians. Defining euthanasia is a difficult and complex task, which causes confusion in its practical clinical application. Over the course of history, abuse of the term has led to medical atrocities. Familiarity with the relevant bioethical issues and the development of practical guidelines might improve clinical performance. To define philosophical concepts, to present historical events, to discuss the relevant attitudes in modern bioethics and law that may be helpful in elaborating practical guidelines for clinicians regarding euthanasia and end-of-life care. Concepts found in the classic sources of Jewish tradition might shed additional light on the issue and help clinicians in their decision-making process. An historical overview defines the concepts of active versus passive euthanasia, physician-assisted suicide and related terms. Positions found in classical Jewish literature are presented and analyzed with their later interpretations. The relevance and application in modern clinical medicine of both the general and Jewish approaches are discussed. The overview of current bioethical concepts demonstrates the variety of approaches in western culture and legal systems. Philosophically and conceptually, there is a crucial distinction between active and passive euthanasia. The legitimacy of active euthanasia has been the subject of major controversy in recent times in various countries and religious traditions. The historical overview and the literature review demonstrate the need to provide clearer definitions of the concepts relating to euthanasia, for in the past the term has led to major confusion and uncontrolled abuse. Bioethical topics should, therefore, be included in medical training and continuing education. There are major debates and controversies regarding the current clinical and legal approaches. We trust that classical Jewish sources might contribute to the establishment of clinical
It is increasingly asserted that the disagreements of abstract principle between adversaries in the euthanasia debate fail to account for the complex, particular and ambiguous experiences of people at the end of their lives. A greater research effort into experiences, meaning, connection, vulnerability, and motivation is advocated, during which the euthanasia 'question' should remain open. I argue that this is a normative strategy, which is felicitous to the status quo and further medicalises the end of life, but which masquerades as a value-neutral assertion about needing more knowledge.
Perrett, R W
Damien and John Keown claim that there is important common ground between Buddhism and Christianity on the issue of euthanasia and that both traditions oppose it for similar reasons in order to espouse a "sanctity of life" position. I argue that the appearance of consensus is partly created by their failure to specify clearly enough certain key notions in the argument: particularly Buddhism, euthanasia and the sanctity of life. Once this is done, the Keowns' central claims can be seen to be either false or only restrictedly true.
Thomas, J M
In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors.
Goolam, N M
The constitutional justifiability of euthanasia will depend upon interpretation of the right to life and the right to respect for and protection of one's dignity. Pertinent issues arising hereto are: In our new value-based constitutional interpretation, what are the values underlying our multi-cultural society? Issues of death and dying are inter-linked to a civilization's world view and its approach to human dignity. Western, African and Islamic approaches will be compared. Does euthanasia negate the essential content of the right to life and is its limitation on such right reasonable/justifiable in an open and democratic society based on freedom and equality.
Bethge, M; Köhler, L; Kiel, J; Thren, K; Gutenbrunner, C
The study investigated specific motives and barriers of sports activities in elderly patients with hip or knee arthroplasty. We conducted guided interviews and analysed them by content analysis. 7 women and 8 men were interviewed. In total, we coded 520 passages; on average 34.7 (SD=11.1) per interview. Our findings document severe preoperative handicaps and identified a variety of sports activities which were practiced before treatment. The most emphasized motive was the social function of sports. The main barriers were the self-definition as a sick and elderly person and insecurity and concerns over the course of illness and healing. Very constraining advises on sports activities without consideration of the individual experience in sports were not perceived as helpful. Counselling on sports activities following joint replacement needs to consider individual motives, barriers and previous sports experience in order to be perceived as supportive. © Georg Thieme Verlag KG Stuttgart · New York.
Emanuel, Ezekiel J; Onwuteaka-Philipsen, Bregje D; Urwin, John W; Cohen, Joachim
The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices. To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices. Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016. Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving
Chong, Alice Ming-Lin; Fok, Shiu-Yeu
This article reports the findings of a randomized general household survey that examined the attitudes of 618 Chinese respondents toward different types of euthanasia. The general public is found to agree with active euthanasia and non-voluntary euthanasia, but is neutral about passive euthanasia. Support for euthanasia is predicted by decreasing importance of religious belief, higher family income, experiences in taking care of terminally ill family members, being non-Protestants, and increasing age. Patients were perceived as the chief decision makers in euthanasian decisions. Finally, suggestions on social work practice and professional training are made.
Matthews-Brzozowska, M; Filipowski, H; Musielak, M; Matthews-Brzozowska, T
Euthanasia and a doctor-assisted suicide are not only practiced worldwide, but also legalized in some countries. In Poland they are broadly discussed. The purpose of this paper was to define dentistry students attitude towards human right to ask for death and euthanasia. In the research 148 students of both sexes were questioned. Generally students were against euthanasia in the world as well as in Poland, although men were in majority for euthanasia. Believers were against it due to ethically-religious reasons, while non-believers were for euthanasia motivating it by rational reasons.
Gielen, Joris; van den Branden, Stef; van Iersel, Trudie; Broeckaert, Bert
To adequately measure the attitudes of Flemish palliative care nurses toward euthanasia, and assess the relationship between these attitudes and demographic factors and the (perceived) influence of experience in palliative care on death anxiety. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium: 70.5% of the nurses (n=415) responded. A majority of the nurses supported the Belgian law regulating euthanasia but also believed that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care. Three clusters were discovered: staunch advocates of euthanasia (150 nurses, 41.1%); moderate advocates of euthanasia (135 nurses, 37%); and (moderate) opponents of euthanasia (80 nurses, 21.9%). An absolute opposition between advocates and opponents of euthanasia was not observed. A statistically significant relationship was found between the euthanasia clusters and years of experience in palliative care, and (perceived) influence of experience in palliative care on anxiety when a patient dies. Flemish palliative care nurses' attitudes toward euthanasia are nuanced and contextual. By indicating that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care, the nurses applied a 'palliative filter' a standard procedure in the case of a euthanasia request.
Allen, Katherine R.; Pickett, Robert S.
Combined life course perspective with life history interviewing to compare 15 lifelong unmarried, childless women and 15 ever-married mothers from the 1910 birth cohort. Results suggest that linear progression from family of origin to family of procreation reveals one stream in family life course; experiences of lifelong single women revealed…
Sayers, Gwen M
Non-voluntary passive euthanasia, the commonest form of euthanasia, is seldom mentioned in the UK. This article illustrates how the legal reasoning in Airedale NHS Trust v Bland contributed towards this conceptual deletion. By upholding the impermissibility of euthanasia, whilst at the same time permitting 'euthanasia' under the guise of 'withdrawing futile treatment', it is argued that the court (logically) allowed (withdrawing futile treatment and euthanasia). The Bland reasoning was incorporated into professional guidance, which extended the court's ruling to encompass patients who, unlike Anthony Bland, were sentient. But since the lawfulness of (withdrawing futile treatment and euthanasia) hinges on the futility of treatment, and since the guidance provides advice about withdrawing treatment from patients who differ from those considered in court, the lawfulness of such 'treatment decisions' is unclear. Legislation is proposed in order to redress the ambiguity that arose when moral decisions about 'euthanasia' were translated into medical decisions about 'treatment'.
If we accept euthanasia for adults, should we also accept voluntary euthanasia for children? In 'Child Euthanasia: Should We Just Not Talk about It?', Luc Bovens answers this question affirmatively. Bovens examines five arguments against extending euthanasia to minors, the arguments being weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care. He rejects each of these arguments. In this paper, I provide a rejoinder for each of his responses. I also critique his view that opponents of euthanasia have extra responsibility to promote palliative care. On the contrary, if euthanasia is legalised, advocates of euthanasia have a special obligation to promote improvements in palliative care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Hanson, Stephen S
Since the Netherlands produced the Groningen protocol describing the methods to be used for pediatric euthanasia and Belgium passed laws authorizing euthanasia for children who consent to it, the issue of pediatric euthanasia has becom