Search

Competing Interests: Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare. Provenance and peer review: Not commissioned; externally peer reviewed.

Objective: Whether bereaved relatives should be encouraged to view the body after a traumatic death is uncertain. This analysis of narrative interviews interprets people's accounts of why and how they decided whether to view the body and their emotional reactions to this, immediately and at a later stage., Design: In depth interviews with qualitative analysis., Participants: A maximum variation sample of 80 people bereaved because of suicide or other traumatic death., Setting: Most people were interviewed in their homes., Results: For those who had the option, decisions about seeing the body varied. Some wanted someone else to identify the body, because they feared how it might look or preferred to remember their relative as they had been in life. Those who had wanted to see the body gave various reasons beyond the need to check identity. Some felt they ought to see the body. Others felt that the body had not lost its social identity, so wanted to make sure the loved one was "being cared for" or to say goodbye. Some people wanted to touch the body, in privacy, but the coroner sometimes allowed this only after the postmortem examination, which made relatives feel that the body had become police property. Seeing the body brought home the reality of death; it could be shocking or distressing, but, in this sample, few who did so said they regretted it., Conclusions: Even after a traumatic death, relatives should have the opportunity to view the body, and time to decide which family member, if any, should identify remains. Officials should prepare relatives for what they might see, and explain any legal reasons why the body cannot be touched. Guidelines for professional practice must be sensitive to the needs and preferences of people bereaved by traumatic death. The way that relatives refer to the body can be a strong indication for professionals about whether the person who died retains a social identity for the bereaved.

Objectives: To explore how children of mothers newly diagnosed with breast cancer perceive their mother's illness and its initial treatment; to contrast their accounts with the mothers' perceptions of their children's knowledge., Design: Qualitative interview study with thematic analysis., Setting: Home based interviews with mothers and children in Oxfordshire, England., Participants: 37 mothers with early breast cancer and 31 of their children aged between 6 and 18 years., Results: Awareness of cancer as a life threatening illness existed even among most of the youngest children interviewed. Children described specific aspects of their mother's treatment as especially stressful (seeing her immediately postoperatively, chemotherapy, and hair loss). Children suspected that something was wrong even before they were told the diagnosis. Parents sometimes misunderstood their children's reactions and underestimated the emotional impact or did not recognise the children's need for more preparation and age appropriate information about the illness and its treatment., Conclusions: As part of their care, parents newly diagnosed with a life threatening illness need to be supported to think about how they will talk to their children. General practitioners and hospital specialists, as well as nurses, are well placed to be able to help with these concerns and if necessary to be involved in discussions with the children. The provision of appropriate information, including recommended websites, should be part of this care. More information specifically designed for young children is needed.

Objectives: To draw on narrative interviews with patients with lung cancer and to explore their perceptions and experience of stigma., Design: Qualitative study., Setting: United Kingdom., Participants: 45 patients with lung cancer recruited through several sources., Results: Participants experienced stigma commonly felt by patients with other types of cancer, but, whether they smoked or not, they felt particularly stigmatised because the disease is so strongly associated with smoking. Interaction with family, friends, and doctors was often affected as a result, and many patients, particularly those who had stopped smoking years ago or had never smoked, felt unjustly blamed for their illness. Those who resisted victim blaming maintained that the real culprits were tobacco companies with unscrupulous policies. Some patients concealed their illness, which sometimes had adverse financial consequences or made it hard for them to gain support from other people. Some indicated that newspaper and television reports may have added to the stigma: television advertisements aim to put young people off tobacco, but they usually portray a dreadful death, which may exacerbate fear and anxiety. A few patients were worried that diagnosis, access to care, and research into lung cancer might be adversely affected by the stigma attached to the disease and those who smoke., Conclusion: Patients with lung cancer report stigmatisation with far reaching consequences. Efforts to help people to quit smoking are important, but clinical and educational interventions should be presented with care so as not to add to the stigma experienced by patients with lung cancer and other smoking related diseases.

Objective: To explore how men and women with cancer talk about using the internet., Design: Qualitative study using semistructured interviews collected by maximum variation sampling., Setting: Respondents recruited throughout the United Kingdom during 2001-2., Participants: 175 men and women aged 19-83 years, with one of five cancers (prostate, testicular, breast, cervical, or bowel) diagnosed since 1992 and selected to include different stages of treatment and follow up., Results: Internet use, either directly or via friend or family, was widespread and reported by patients at all stages of cancer care, from early investigations to follow up after treatment. Patients used the internet to find second opinions, seek support and experiential information from other patients, interpret symptoms, seek information about tests and treatments, help interpret consultations, identify questions for doctors, make anonymous private inquiries, and raise awareness of the cancer. Patients also used it to check their doctors' advice covertly and to develop an expertise in their cancer. This expertise, reflecting familiarity with computer technology and medical terms, enabled patients to present a new type of "social fitness.", Conclusion: Cancer patients used the internet for a wide range of information and support needs, many of which are unlikely to be met through conventional health care. Serious illness often undermines people's self image as a competent member of society. Cancer patients may use the internet to acquire expertise to display competence in the face of serious illness.

Objectives: To explore the attitudes of men with confirmed or suspected prostate cancer to testing for prostate specific antigen., Design: Qualitative interview study with a purposive sample., Setting: Great Britain., Participants: 52 men with suspected or confirmed prostate cancer, recruited through general practitioners, urologists, patient support groups, and charities., Results: Almost all men remembered their prostate specific antigen test but recalled being given little information beforehand. Arguments in favour of increased access to testing included the belief that early diagnosis would reduce mortality, improve quality of life, and save the NHS money. Men also thought that a national screening programme should be available because symptoms can be ambiguous, screening for cancer is responsible health behaviour, and screening would encourage men to be tested. Four men who opposed a screening programme had gathered information alerting them to uncertainty about the benefits of treatment, and two regretted that they had been tested. Others thought that access to testing is restricted in the United Kingdom because of a lack of government backing, concerns about the accuracy of the test, and a lack of resources., Conclusions: The few men in this study who subscribed to the argument that evidence of the benefits of treatment is a prerequisite for a screening programme did not want to see screening introduced. Men who proposed an alternative set of principles for testing gave reasons that did not all relate to overoptimism about the benefits of early diagnosis. People who plan services and people who respond to requests for testing need to understand men's perspectives and concerns.

Objectives: To explore general practitioners' attitudes towards and use of a computer program for assessing genetic risk of cancer in primary care., Design: Qualitative analysis of semistructured interviews and video recordings of simulated consultations., Participants: Purposive sample of 15 general practitioners covering a range of computer literacy, interest in genetics, age, and sex., Interventions: Each doctor used the program in two consultations in which an actor played a woman concerned about her family history of cancer. Consultations were videotaped and followed by interviews with the video as a prompt to questioning. MAIN OUTCOME MESURESs: Use of computer program in the Consultation., Results: The program was viewed as an appropriate application of information technology because of the complexity of cancer genetics and a sense of "guideline chaos" in primary care. Doctors found the program easy to use, but it often affected their control of the consultation. They needed to balance their desire to share the computer screen with the patient, driven by their concerns about the effect of the computer on doctor-patient communication, against the risk of premature disclosure of bad news., Conclusions: This computer program could provide the necessary support to assist assessment of genetic risk of cancer in primary care. The potential impact of computer software on the consultation should not be underestimated. This study highlights the need for careful evaluation when developing medical information systems.