Search

This study investigates the views of contemporary Muslim jurists about withdrawing treatment of the terminally ill. Its aim is threefold. Firstly, it analyses jurists' views concerning core themes within the process of withdrawing treatment. Secondly, it provides insight into fatwas about withdrawing treatment. Thirdly, it compares these views with current medical standards in Europe and the Atlantic world on withdrawing treatment. The data consisted of six papers by Muslim jurists presented at the conference of the Islamic Fiqh Council in 2015. We conducted a directed content analysis (DCA) through a predetermined framework and compiled an overview of all previous fatwas referred to in the papers, which are also analysed. The results show that the general consensus is that if health cannot be restored, treatment may be withdrawn at the request of the patient and/or his family or on the initiative of the doctor. The accompanying fatwa emphasizes the importance of life-prolonging treatment if this does not harm the patient. It becomes apparent in the fatwa that the doctor has the monopoly in decision-making, which is inconsistent with current medical standards in Europe. Managing disclosure in view of the importance of maintaining the hope of Muslim patients may challenge the doctor's obligation to share a diagnosis with them. [ABSTRACT FROM AUTHOR]

While there is high patient acceptance for clinical staff discussing issues regarding spirituality with hospital inpatients, it is not clear which staff member patients prefer for these discussions. This unique exploratory study investigated inpatient preferences regarding which staff member should raise the topic of spirituality. A cross-sectional survey was conducted with inpatients at six hospitals in Sydney, Australia (n = 897), with a subset invited to participate in qualitative interviews (n = 41). Pastoral care staff (32.9%) were the preferred staff members with whom to discuss spiritual issues, followed by doctors (22.4%). Qualitative findings indicated that individual characteristics of the staff member are more important than their role. [ABSTRACT FROM AUTHOR]

Gynecological cancer treatment may cause dysfunction and cessation of sexual activity, adversely impacting patients' psychological health, relationship adjustment, and overall quality of life (QoL). Gynecological oncologists can significantly enhance survivors' QoL by addressing sexual concerns. However, these remain unaddressed among many cancer survivors. Hence, this qualitative study explored healthcare professionals' perceived barriers to providing sexual information to gynecological cancer patients and examined their gender blindness. We collected data through in-depth, semi-structured interviews with 14 participants recruited from the gynecological cancer ward and radiotherapy department of a northern Taiwan medical center. Using the Miles and Huberman method, the analysis yielded four themes: (1) the service system is unsupportive; (2) providers' sexual health literacy is often inadequate; (3) providers often make their own decisions about the criterion for addressing sexual health; (4) certain situations can be unfavorable for initiating a conversation about sexual health. Gender blindness was identified as a significant barrier to sexual healthcare among healthcare professionals. This highlights the need for gender sensitivity in cancer care and the awareness of gender blindness in sexual healthcare. This can help professionals identify sex and sexual health conversation barriers, promoting discussions that enhance the sexual health of patients with gynecological cancer. [ABSTRACT FROM AUTHOR]

Medical social work is gradually developing in China, and children's hospitals greatly need medical social workers. However, different groups have different perceptions of medical social workers' roles. The role of nascent Chinese medical social workers in children's hospitals is unclear, which hinders the growth of this profession. Therefore, this study aimed to resolve role ambiguity by comprehensively exploring the specific roles of Chinese medical social workers in a children's hospital. A descriptive qualitative research design was adopted. Twenty-six participants, including medical social workers (n = 8), primary caregivers of children (n = 6), and medical staff (n = 12, including 6 doctors and 6 nurses), were recruited by purposive sampling at a tertiary-level children's hospital in China between October and November 2022. Face-to-face semi-structured interviews were conducted to collect data. Three major themes with eleven roles were extracted through Colaizzi's 7-step method of phenomenological data analysis: (1) the role identified by all three groups: psychological supporter, resource linker, and consultant; (2) the role identified by healthcare professionals: coordinator, planner, assessor, advocate, organizer, promoter, and educator; and (3) the role identified by medical social workers themselves: manager. This qualitative study was the first to comprehensively describe the eleven roles assumed by Chinese pediatric medical social workers in the hospital and role ambiguity among different groups. The lack of medical background and practitioners, as well as lower social status, led to medical social workers' role ambiguity problems. Recommendations to strengthen policy support, cultivate a new medical social work culture, and increase the social understanding and recognition of medical social work to resolve role ambiguity are provided. [ABSTRACT FROM AUTHOR]

The military lifestyle can be defined by a triad of unique stressors: frequent relocation, parental absence, and risk of injury, illness and/or death of a serving member. Research has suggested that this unique triad of stressors can impact the mental health of children and youth living in military families. However, research focusing on the mental health of children and youth living in military families overwhelmingly focuses on the American context. Due to key contextual differences, it is unclear to what extent the American findings are representative of military-connected children and youth living in other geographical contexts, such as Canada. A large qualitative study was conducted to explore the mental health of military-connected children in Canada from three perspectives: child, parent, and service provider. This paper reports on the service provider findings. Using individual semi-structured interviews, data were collected from 11 service providers. Data analysis was guided by qualitative content analysis. Two main themes emerged: (1) the mental health of children living in military families may be impacted by the military lifestyle stressors, and (2) the mental health of children living in military families can be impacted by the accessibility and availability of mental health services. While this qualitative study builds upon recent Canadian work that has considered the service provider perspective, additional research is needed to better understand the experiences of service providers who support military-connected children and youth. Highlights: American research shows that the military lifestyle factors can impact the mental health of military-connected children. The mental health of military-connected children has yet to be extensively explored in Canada. The mental health of children living in Canadian military families may be impacted by the military lifestyle stressors. The mental health of Canadian military-connected children can be impacted by the accessibility and availability of mental health services. Our findings can help build capacity and knowledge for service providers who support Canadian military-connected children. [ABSTRACT FROM AUTHOR]

Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness. [ABSTRACT FROM AUTHOR]

Summary: This qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide. Introduction: Fracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare. Methods: Qualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices. Results: Seven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP–patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps. Conclusion: Key challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide. [ABSTRACT FROM AUTHOR]

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition—both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label—as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence. [ABSTRACT FROM AUTHOR]

Objectives: Despite evidence for heightened psychiatric risk and unique parenting challenges during the COVID-19 pandemic, no research exists on the specific needs of parents of infants and responsiveness of pediatric care to their needs. We aimed to describe the support needs of new parents and explore their experiences with pediatric care. Methods: In late 2020 we conducted semi-structured interviews with 30 mothers of babies born or due that year. Interviews addressed perinatal experiences during the pandemic, with an emphasis on experiences related to social support. In an iterative, inductive process, thematic analysis was used to analyze the data. Results: This study identifies a set of support needs specific to the context of parenting an infant during the COVID-19 crisis: coping with the compound psychological impacts of the postpartum period and a pandemic; parenting in the absence of expected social support; risk assessment to keep infant and family safe. This study finds that policies implemented by health care providers to reduce risk of COVID-19 transmission came at a cost to new parents and parent-provider relationships. Participants reported mixed experiences with in-person and telehealth pediatric care, including inadequate and/or uncomfortable postpartum mental health screening and breastfeeding support, and identified specific features that constituted responsive care during the pandemic. Conclusions: Normative changes associated with the postpartum period combined with complex adaptations necessitated by the COVID-19 pandemic presented substantial challenges for families with infants, even relatively privileged families. Providers can incorporate these findings to enhance support for families and promote maternal and child health. [ABSTRACT FROM AUTHOR]

This qualitative study focuses on the "underground" practices of Sunni Muslim physicians and patients who are performing and undergoing religiously prohibited third-party gamete donation. It is based on face-to-face interviews with two Sunni Muslim gynecologists and 25 Sunni Muslim women who underwent third-party gamete donation treatments and gave birth to a baby. The analysis of the interviews sheds light on patients' experiences regarding donation and explores the experiences of the gynecologists. The patients shared with us their inner conflict regarding childbearing using either donated sperm or a donated egg. They expressed a subversive attitude toward the religious authorities and the Islamic fatwa (religious ruling) that prohibits third-party gamete donation. The gynecologists provide fertility care involving third-party gamete donation despite Islamic religious prohibitions; in consequence, they suffer feelings of guilt for their actions. The study participants challenge accepted binary conceptions regarding the boundaries between religious laws and the desire to produce offspring, between what is allowed and what is forbidden, between guilt and happiness, and between the desire to maintain a marital relationship and the desire to comply with cultural–religious rules. Based on Gloria Anzaldua's theory of the borderlands, and the context-informed approach, this study underscores the importance of giving voice to Sunni Muslim patients who underwent third-party gamete donation treatments and contributes to a deeper understanding of their dilemma of finding a reproductive solution that does not run counter to religious values. [ABSTRACT FROM AUTHOR]

Objective: Despite growing consensus about the clinical value of preconception care (PCC), gaps and disparities remain in its delivery. This study aimed to examine the factors influencing behavior of health care providers around PCC in outpatient clinical settings in the United States. Methods: Twenty health care providers who serve people of reproductive age were interviewed using semi-structured interviews. Data was coded based on a modified Theoretical Domains Framework and analyzed using deductive content analysis. Results: We interviewed eight family medicine physicians, four obstetricians/gynecologists, seven nurse practitioners, and one nurse midwife. Overall, we found a wide variety in practices and attitudes towards PCC. Barriers and challenges to delivering PCC were shared across sites. We identified six themes that influenced provider behavior around PCC: (1) lack of knowledge of PCC guidelines, (2) perception of lack of preconception patient contact, (3) pessimism around patient "compliance," (4) opinion about scope of practice, (5) clinical site structure, and (6) reliance on the patient/provider relationship. Conclusions for Practice: Overall, our findings call for improved provider understanding of PCC and creative incorporation into current health care culture and practice. Given that PCC-specific visits are perceived by some as outside the norm of clinical offerings, providers may need to incorporate PCC into other encounters, as many in this study reported doing. We amplify the call for providers to understand how structural inequities may influence patient behavior and the value of standardized screening, within and beyond PCC, as well as examination of implicit and explicit provider bias. [ABSTRACT FROM AUTHOR]

Purpose: Seriously ill patients in low-income and minority populations have lower rates of advance care planning. Initiatives that promote serious illness (SI) conversations in community health centers (CHCs) can reach broad, diverse patient populations. This qualitative study explored the experiences of primary care physicians in conducting SI conversations at CHCs in order to understand challenges and needs in this setting. Methods: An initiative to increase SI conversations was implemented at two CHCs in the Bronx, NY. Eleven participating family physicians who together conducted 37 SI conversations underwent semi-structured in-depth interviews. The 11 interviews were analyzed using inductive thematic analysis. Results: Eight themes emerged: (1) Structured approaches to SI conversations are useful even in longstanding patient-doctor relationships; (2) Discussion of prognosis is meaningful but difficult; (3) Emotional work is humanizing but draining; (4) Poverty and underinsurance are high priorities; (5) Social context affects patient readiness; (6) Communication barriers take multiple forms; (7) Patient characteristics make it "easier" or "harder" to initiate the SI conversation; (8) Time constraints limit the ability to meet multiple patient needs. Conclusions: Physicians at CHCs identified challenges in SI conversations at personal, interpersonal, organizational, and societal levels. These challenges should be addressed by initiatives that aim to increase SI conversations in primary care, and especially at CHCs. [ABSTRACT FROM AUTHOR]

The present study is a qualitative study with ethnographic techniques that aimed to comprehend the healthcare experiences of deaf persons considering their family, healthcare professionals, and interpreter perspectives. The study included twenty-six deaf persons. The information was collected using semi-structured interviews and focus groups consisting of 5 patients per session (mean) that inquired about experiences and relationships between deaf persons and healthcare professionals. The study identified communication constraints between patients and professionals, preventing the establishment of interpersonal relationships, which limited the development of adequate healthcare. Therefore, it is recommended that the deaf person access an interpreter during healthcare processes to facilitate communication in healthcare services. [ABSTRACT FROM AUTHOR]

Background: Burnout is high in primary care physicians and negatively impacts the quality of patient care. While many studies have evaluated burnout, there have been few which investigate those physicians who are satisfied with their careers and life—a phenomenon we term "thriving." Objective: To identify factors contributing to both career and life satisfaction through qualitative interviews. Participants: The subjects were primary care physicians. Approach: Qualitative interviews were performed between July 2018 and March 2020. Physicians were identified by snowball sampling and were asked to complete validated instruments to identify job/life satisfaction and lack of burnout. Semi-structured interviews were conducted, focused on aspects of participants' career and life which contributed to their thriving, including work environment, social networks, family life, institutional support, coping strategies, and extracurricular activities. Transcripts were analyzed using thematic content analysis using a grounded theory approach. Main Measures: Personal, professional, and life factors that contributed to achieving career and life satisfaction in primary care physicians and potential solutions for burnout. Results: Thirty-two physicians were interviewed (9.4% family physicians, 9.4% combined internists-pediatricians, 40.6% internists, and 40.6% pediatricians) with a mean age 54.7 years and 23.8 years in practice. No physicians included met the criteria for burnout. All met the criteria for career and life satisfaction. Five themes were identified as critical to thriving: an intrinsic love for the work, a rich social network, a fulfilling doctor-patient relationship, a value-oriented belief system, and agency in the work environment. Conclusions: Several factors contribute to professional fulfillment and life satisfaction among primary care physicians, which we propose as a model for physicians thriving. Some factors were intrinsic, such as having value-oriented beliefs and inherent love for medicine, while others were extrinsic, such as having a fulfilling social network. Barriers and opportunities to apply these lessons for the wider physician community are discussed. [ABSTRACT FROM AUTHOR]

People with HIV (PWH) who have mental health disorders (MHD) and substance use disorders (SUD) have lower HIV medication adherence, higher unsuppressed viral loads, and higher mortality rates than those who do not. Individuals who have triple diagnoses (HIV, MHD and SUD) are at an exponential risk for these adverse outcomes. This study explored the barriers and facilitators to accessing and linking PWH with MHD and SUD services. Qualitative interviews with 90 participants were conducted to explore their experiences seeking treatment for MHD and SUD. Results of a thematic analysis found two important barriers to treatment access and utilization: unstable motivation to change and negative experiences with providers. Conversely, an internal drive to heal and rapport with providers facilitated positive treatment experiences. Findings of the study also indicate a need for an integrated treatment model where MHD, SUD, and HIV treatment are available at the same location. [ABSTRACT FROM AUTHOR]