‘One also needs a bit of trust in the doctor … ’: a qualitative interview study with pancreatic cancer patients about their perceptions and views on information and treatment decision-making
- Annals of oncology : official journal of the European Society for Medical Oncology / ESMO
- Published over 6 years ago
BACKGROUND: Information about diagnosis, treatment options and prognosis has been emphasized as a key to empower cancer patients to make treatment decisions reflecting their values. However, surveys indicate that patients' preferences regarding information and treatment decision-making differ. In this qualitative interview study, we explored pancreatic cancer patients' perceptions and preferences on information and treatment decision-making. PATIENTS AND METHODS: Qualitative in-depth interviews with patients with pancreatic cancer. Purposive sampling and qualitative analysis were carried out. RESULTS: We identified two stages of information and treatment decision-making. Patients initially emphasize trust in their physician and indicate rather limited interest in details about surgical and medical treatment. In the latter stage of disease, patients perceive themselves more active regarding information seeking and treatment decision-making. All patients discuss their poor prognosis. Reflecting on their own situation, all patients interviewed pointed out that hope was an important driver to undergo further treatment also in advanced stages of the disease. Interviewees unanimously emphasized the difficulty of anticipating the time at which stopping cancer treatment would be the right decision. CONCLUSIONS: The findings can serve as starting point for reflection on professional decision-making in pancreatic cancer and larger representative surveys on ethical issues in treatment decision-making in pancreatic cancer.
BACKGROUND: While homelessness among youth is a serious problem, there is little information about evidence-based interventions for homeless youth. In cooperation with professionals and youths, Wolf (2012) developed Houvast (Dutch for ‘grip’): a strengths based method grounded in scientific and practice evidence. The main aim of Houvast is to improve the quality of life of homeless youths by focusing on their strengths, thus stimulating their capacity for autonomy and self-reliance.Method/Design: The effectiveness and fidelity of Houvast will be tested in ten Dutch services for homeless youth which are randomly allocated to an intervention group (n = 5), or a control group which provides care as usual (n = 5). Measurements of both objective and subjective quality of life and secondary outcomes (mental and physical health, substance use, coping, resilience, psychological needs, care needs, working relationship with the professional and attainment of personal goals) will be conducted among homeless youths (n = 251). Youths in both groups will be interviewed by means of a structured interview at baseline, at time of ending care or after having received care for six months (T1) and at nine months after baseline (T2). Model fidelity will be tested around T1. DISCUSSION: This study is unique as it includes a large number of homeless youths who are followed for a period of nine months, and because it focuses on a strengths based approach. If the Houvast method proves to be effective in improving quality of life it will be the first evidence-based intervention for homeless youth.Trail registration: Netherlands Trail Register (NTR): NTR3254.
Non-verbal behaviours, including voice characteristics during speech, are an important way to communicate social status. Research suggests that individuals can obtain high social status through dominance (using force and intimidation) or through prestige (by being knowledgeable and skilful). However, little is known regarding differences in the vocal behaviour of men and women in response to dominant and prestigious individuals. Here, we tested within-subject differences in vocal parameters of interviewees during simulated job interviews with dominant, prestigious, and neutral employers (targets), while responding to questions which were classified as introductory, personal, and interpersonal. We found that vocal modulations were apparent between responses to the neutral and high-status targets, with participants, especially those who perceived themselves as low in dominance, increasing fundamental frequency (F0) in response to the dominant and prestigious targets relative to the neutral target. Self-perceived prestige, however, was less related to contextual vocal modulations than self-perceived dominance. Finally, we found that differences in the context of the interview questions participants were asked to respond to (introductory, personal, interpersonal), also affected their vocal parameters, being more prominent in responses to personal and interpersonal questions. Overall, our results suggest that people adjust their vocal parameters according to the perceived social status of the listener as well as their own self-perceived social status.
ABSTRACT Two studies examined the effect of applicants' smiling on hireability. In a pre-test study, participants were asked to rate the expected behavior for four types of applicants. Newspaper reporter applicants were expected to be more serious than applicants for other jobs. In Study 1, participants were randomly assigned to be an applicant or interviewer for a newspaper reporting job. Smiling was negatively related to hiring, and smiling mediated the relation between applicants' motivation to make a good impression and hiring. Hiring was maximized when applicants smiled less in the middle of the interview relative to the start and end. In Study 2, participants watched Study 1 clips and were randomly assigned to believe the applicants were applying to one of four jobs. Participants rated more suitability when applicants smiled less, especially for jobs associated with a serious demeanor. This research shows that job type is an important moderator of the impact of smiling on hiring.
In the present study, we interviewed 40 patients in acute inpatient mental health settings regarding their experience of, and views about, receiving pro re nata (PRN) medication. Patient requests for PRN were primarily to relieve anxiety or to aid sleep, and the majority of the participants (80%) could describe a situation where this medication was very helpful. From the perspective of patients, interactions surrounding the immediate administration of PRN medication were inadequate, in that half of the interviewees were simply told to take the medication, and three-quarters said that, in their experience, formal consent was not commonly sought. Three-quarters of respondents came up with alternatives to PRN, and half wanted more information about the medication itself. These findings could contribute to improved nursing assessment for PRN medication need, administration, and monitoring.
ABSTRACT Background: Behavioral and psychological symptoms of dementia (BPSD) have been associated with increased carer burden and early institutionalization. BPSD are more responsive to treatment than are cognitive and functional decline. Little is known about how family carers understand and try to reduce these symptoms. This study aimed to explore the strategies used by carers looking after someone with high levels of BPSD. Methods: Twenty-five carers were interviewed using a semi-structured interview with the Neuropsychiatric Inventory (NPI). They were all caring for someone eligible for an Extended Aged Care at Home Dementia Package, which targets people with BPSD. Results: Participants reported high levels of BPSD with a mean score of 8.2 for symptoms (range 2-12, SD = 2.38) and a mean NPI score of 51.4 (range 14-111, SD = 28.74). Distress scores were also high with a mean of 18.5 (range 2-42, SD = 11.33). Carers described on average, fewer than four strategies for managing BPSD. Encouraging activity, utilizing psychotropic medications, identifying triggers, restraining or treating in a paternalistic manner, and meeting physiological needs were the most commonly used strategies. Conclusion: While family carers are often at the forefront of identifying triggers and addressing unmet needs, findings from this study suggest that some carers have a limited repertoire of strategies despite experiencing a large number of symptoms. There is a clear need for ensuring evidence-based programs to educate and support carers in identifying triggers, understanding symptoms and learning to cope with these symptoms.
OBJECTIVE: To review the scientific status of the biopsychosocial (BPS) model and to propose a way to improve it. DISCUSSION: Engel’s BPS model added patients' psychological and social health concerns to the highly successful biomedical model. He proposed that the BPS model could make medicine more scientific, but its use in education, clinical care, and, especially, research remains minimal. Many aver correctly that the present model cannot be defined in a consistent way for the individual patient, making it untestable and non-scientific. This stems from not obtaining relevant BPS data systematically, where one interviewer obtains the same information another would. Recent research by two of the authors has produced similar patient-centered interviewing methods that are repeatable and elicit just the relevant patient information needed to define the model at each visit. We propose that the field adopt these evidence-based methods as the standard for identifying the BPS model. CONCLUSION: Identifying a scientific BPS model in each patient with an agreed-upon, evidence-based patient-centered interviewing method can produce a quantum leap ahead in both research and teaching. PRACTICE IMPLICATIONS: A scientific BPS model can give us more confidence in being humanistic. In research, we can conduct more rigorous studies to inform better practices.
Therapist attitudes and strategies to client-centred approaches in the provision of mobility devices to older clients
- Disability and rehabilitation. Assistive technology
- Published almost 7 years ago
Abstract Purpose: This study explored therapists' attitudes to and strategies for developing client-centred approaches in relation to the provision of mobility devices. Method: Four physiotherapists and eight occupational therapists in a Swedish municipality context were interviewed according to a semi-structured interview guide. Data collection and analysis were guided by a qualitative approach, applying manifest content analysis. Results: The analysis resulted in a main theme: “Awareness and positive attitudes towards a client-centred approach” and two sub-themes: “Challenges to a client-centred approach” and “Strategies for developing a client-centred approach”. Conclusions: Therapists in municipality-based geriatric rehabilitations are aware of and have ambitions to apply a client-centred approach in mobility device provision, despite different kinds of obstacles for client interaction. The examples of different strategies they suggested to facilitate a client-centred approach can be used to improve clinical practice. While more research is needed in this field, the results can be used as a basis for practice development which may increase activity among older clients. Implications for Rehabilitation The fact that therapists seem aware of the client’s legal right to interact with them in the rehabilitation process, in relation to the provision of mobility devices, is promising and an important prerequisite for the development of more client-centred practices. The identification of different types of obstacles that could interfere with applying a client-centred approach has the potential to increase the therapists' attention to such aspects. The results show that it is necessary for practitioners to develop strategies to be successful in applying a client-centred approach. The examples provided can serve as a basis for continuing discussions among practitioners, increasing their awareness of strategies and opportunities for client interaction.
Nearly all employment interviews, even those considered highly structured, begin with a brief meet-and-greet conversation typically coalescing around non-job-related topics (i.e., rapport building). Although applicants and interviewers often view rapport building as an essential, value-adding component of the interview, it may contaminate interviewers' evaluations of answers to subsequently asked structured questions (Levashina, Hartwell, Morgeson, & Campion, 2014). Yet research has not determined the extent to which initial impressions developed during rapport building influence subsequent interviewer ratings through job-related interview content versus non-job-related content; whether these effects extend beyond more commonly examined image-related factors that can bias interviewers (i.e., self-presentation tactics); or how these effects are temporally bound when influencing interviewer ratings during the formal structured interview question-and-answer process. Addressing these questions, we integrate interview research with the extant social psychology literature to clarify rapport building’s unique effects in the employment interview. In contrast to prior assumptions, findings based on 163 mock interviews suggest that a significant portion of initial impressions' influence overlaps with job-related interview content and, importantly, that these effects are distinct from other image-related constructs. Finally, initial impressions are found to more strongly relate to interviewer evaluations of applicant responses earlier rather than later in the structured interview. (PsycINFO Database Record
Background and Objectives: Positive interviewer feedback should encourage positive experiences and outcomes for interviewees. Yet, positive feedback is inconsistent with socially anxious interviewees' negative self-views. Socially anxious interviewees might experience increased self-focus while attempting to reconcile the inconsistency between their self-perceptions and that feedback. This could interfere with successful interview performance. Design: This study used a 3 (Feedback: Positive, Negative, No) X 2 (Social Anxiety: High, Low) between subjects design. Method: Undergraduate students (N = 88) completed a measure of dispositional social anxiety. They then engaged in a simulated interview with a White confederate trained to adhere to a standardized script. Interviewees received positive, negative, or no interviewer feedback. Each interview was video recorded to code anxiety displays, impression management tactics, and interview success. Results: Following positive feedback, socially anxious interviewees displayed more anxiety, less assertiveness, and received lower success ratings. Among anxious interviewees, increased self-focus provided an indirect path between positive feedback and lower success. Conclusions: Consistent with self-verification theory, anxious interviewees had poorer interview performance following positive feedback that contradicted their negative self-views. Thus, socially anxious interviewees might be at a disadvantage when interviewing, especially following positive feedback. Implications for interviewees and interviewers are discussed.