5 results
Search Results
2. Women's perceptions of personalized risk-based breast cancer screening and prevention: An international focus group study
- Author
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Anna Jervaeus, Yvonne Wengström, Linda Rainey, Per Hall, D. Gareth Evans, Louise S Donnelly, Daniëlle van der Waal, Mireille J. M. Broeders, and Mattias Hammarström
- Subjects
Emotions ,risk stratification ,Breast cancer screening ,risk prediction ,0302 clinical medicine ,prevention ,Cultural diversity ,Mass Screening ,030212 general & internal medicine ,Early Detection of Cancer ,media_common ,Netherlands ,attitudes ,medicine.diagnostic_test ,Focus Groups ,Middle Aged ,Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] ,Psychiatry and Mental health ,030220 oncology & carcinogenesis ,Papers ,oncology ,Anxiety ,Female ,Thematic analysis ,medicine.symptom ,Risk assessment ,Psychology ,Attitude to Health ,Paper ,Adult ,medicine.medical_specialty ,media_common.quotation_subject ,Decision Making ,Experimental and Cognitive Psychology ,Breast Neoplasms ,Risk Assessment ,03 medical and health sciences ,All institutes and research themes of the Radboud University Medical Center ,Breast cancer ,breast cancer ,Perception ,acceptability ,medicine ,Humans ,Aged ,Sweden ,screening ,Patient Acceptance of Health Care ,medicine.disease ,Focus group ,United Kingdom ,Family medicine - Abstract
ObjectiveIncreased knowledge of breast cancer risk factors enables a shift from one‐size‐fits‐all breast cancer screening to a risk‐based approach, tailoring screening policy to a woman's individual risk. New opportunities for prevention will arise. However, before this novel screening and prevention program is introduced, its acceptability from a woman's perspective needs to be explored.MethodsWomen eligible for breast cancer screening in the Netherlands, United Kingdom, and Sweden were invited to take part in focus groups. A total of 143 women participated. Data were transcribed verbatim and analyzed using thematic analysis.ResultsAnalysis identified five themes across the three countries. The first theme “impact of knowledge” describes women's concern of not being able to unlearn their risk, perceiving it as either a motivator for change or a burden which may lead to stigma. The second theme “belief in science” explains women's need to trust the science behind the risk assessment and subsequent care pathways. Theme three “emotional impact” explores, eg, women's perceived anxiety and (false) reassurance, which may result from knowing their risk. Theme four “decision making” highlights cultural differences in shared versus individual decision making. Theme five “attitude to medication” explores the controversial topic of offering preventative medication for breast cancer risk reduction.ConclusionsAcceptability of risk‐based screening and prevention is mixed. Women's perceptions are informed by a lack of knowledge, cultural norms, and common emotional concerns, which highlights the importance of tailored educational materials and risk counselling to aid either shared or individual informed decision making.
- Published
- 2019
3. Women with bipolar disorder and pregnancy: factors influencing their decision-making
- Author
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Louise M. Howard, Ian Jones, and Clare Dolman
- Subjects
Paper ,Pregnancy ,medicine.medical_specialty ,MEDLINE ,Information needs ,Online forum ,medicine.disease ,030227 psychiatry ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,medicine ,Childbirth ,030212 general & internal medicine ,Bipolar disorder ,Thematic analysis ,Psychiatry ,Psychology ,Qualitative research ,Clinical psychology - Abstract
Background Women with bipolar disorder are at increased risk of having a severe episode of illness associated with childbirth. Aims To explore the factors that influence the decision-making of women with bipolar disorder regarding pregnancy and childbirth. Method Qualitative study with a purposive sample of women with bipolar disorder considering pregnancy, or currently or previously pregnant, supplemented by data from an online forum. Data were analysed using thematic analysis. Results Twenty-one women with bipolar disorder from an NHS organisation were interviewed, and data were used from 50 women's comments via the online forum of the UK's national bipolar charity. The centrality of motherhood, social and economic contextual factors, stigma and fear were major themes. Within these themes, new findings included women considering an elective Caesarian section in an attempt to avoid the deleterious effects of a long labour and loss of sleep, or trying to avoid the risks of pregnancy altogether by means of adoption or surrogacy. Conclusions This study highlights the information needs of women with bipolar disorder, both pre-conception and when childbearing, and the need for improved training for all health professionals working with women with bipolar disorder of childbearing age to reduce stigmatising attitudes and increase knowledge of the evidence base on treatment in the perinatal period.
- Published
- 2016
4. The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice
- Author
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Michelle Cleary, Catherine Hungerford, Toby Raeburn, and Virginia Schmied
- Subjects
Paper ,medicine.medical_specialty ,030504 nursing ,media_common.quotation_subject ,Declaration ,Social environment ,Participant observation ,Mental health ,030227 psychiatry ,03 medical and health sciences ,Psychiatry and Mental health ,0302 clinical medicine ,Consistency (negotiation) ,medicine ,Thematic analysis ,0305 other medical science ,Psychiatry ,Psychology ,Psychosocial ,Autonomy ,media_common - Abstract
BackgroundRecovery-oriented language has been widely adopted in mental health policy; however, little is known about how recovery practices are implemented within individual services, such as psychosocial clubhouses.AimsTo explore how recovery practices are implemented in a psychosocial clubhouse.MethodQualitative case study design informed by self-determination theory was utilised. This included 120 h of participant observation, interviews with 12 clubhouse members and 6 staff members. Field notes and interview transcripts were subject to theoretical thematic analysis.ResultsTwo overarching themes were identified, each comprising three sub-themes. In this paper, the overarching theme of ‘social environment’ is discussed. It was characterised by the sub-themes, ‘community and consistency’, ‘participation and opportunity’ and ‘respect and autonomy’.ConclusionsSocial environment was used to facilitate recovery-oriented practice within the clubhouse. Whether recovery is experienced by clubhouse members in wider society, may well depend on supports and opportunities outside the clubhouse.
- Published
- 2016
5. Access to intensive care unit beds for neurosurgery patients: a qualitative case study
- Author
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Peter Singer, Mark Bernstein, and Douglas K. Martin
- Subjects
Paper ,media_common.quotation_subject ,Decision Making ,Intensivist ,Referring Physician ,Health Services Accessibility ,Neurosurgical Procedures ,law.invention ,Health care rationing ,Patient Admission ,Nursing ,law ,Intensive care ,Health care ,Medicine ,Humans ,media_common ,Quality of Health Care ,Medical Audit ,Health Care Rationing ,business.industry ,Intensive care unit ,Psychiatry and Mental health ,Intensive Care Units ,Health Care Surveys ,Surgery ,Neurology (clinical) ,Thematic analysis ,business ,Publicity - Abstract
Objectives: The purpose of this study was to describe the process used to decide which patients are admitted to the intensive care unit (ICU) at a hospital with special focus on access for neurosurgery patients, and evaluate it using “accountability for reasonableness”. Methods: Qualitative case study methodology was used. Data were collected from documents, interviews with key informants, and observations. The data were subjected to thematic analysis and evaluated using the four conditions of “accountability for reasonableness” (relevance, publicity, appeals, enforcement) to identify good practices and opportunities for improvement. Results: ICU admissions were based on the referring physician’s assessment of the medical need of the patient for an ICU bed. Non-medical criteria (for example, family wishes) also influenced admission decisions. Although there was an ICU bed allocation policy, patient need always superceded the bed allocation policy. ICU admission guidelines were not used. Admission decisions and reasons were disseminated to the ICU charge nurse, the bed coordinator, the ICU resident, the intensivist, and the requesting physician/surgeon by word of mouth and by written documentation in the patient’s chart, but not to the patient or family. Appeals occurred informally, through negotiations between clinicians. Enforcement of relevance, publicity, and appeals was felt to be either non-existent or deficient. Conclusions: Conducting a case study of priority setting decisions for patients requiring ICU beds, with a special focus on neurosurgical patients, and applying the ethical framework “accountability for reasonableness” can help critical care units improve the fairness of their priority setting.
- Published
- 2003
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