Treating patients with colorectal cancer in rural and urban areas: a qualitative study of the patients' perspective.
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OBJECTIVES: The aim of the present study was to explore the perspectives of patients receiving treatment for colorectal cancer and compare priorities and attitudes in rural and urban areas. METHOD: A qualitative study was carried out involving four focus groups in the Aberdeen and Northern Centre for Haematology, Oncology and Radiotherapy. The sample comprised 22 patients at various stages of treatment for colorectal cancer and 10 of their relatives from different locations of Northeast Scotland and Shetland. The main themes generated by participants were identified, and similarities and differences between urban and rural patients were noted within these themes. RESULTS: Components of care that were important to rural and urban patients were speed of referral to specialists for treatment and issues of communication including test results and delivery of bad news. Tensions were perceived at the interface of primary and secondary care and these were blamed for delays in referral and communication breakdowns. For some, the referral process comprised a series of barriers to be overcome, and there were additional hurdles for remote patients referred initially to local (non-specialist) hospitals. Rural patients appeared to be less demanding than their urban counterparts when evaluating their care, and this was extended to the acceptance of some clear transport problems. CONCLUSIONS: For patients, the most important components of cancer care were similar, whether rural or urban residents. The main differences for rural patients were lower expectations of care and more hurdles before reaching specialist care. These differences might explain the trend to more advanced disease at diagnosis in rural patients if they lead to significant delays. GPs have major influences on this and all the patients' priorities. (+info)
What are the characteristics of the competent general practitioner trainer?
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BACKGROUND: Increasing attention is being given to the training of doctors to become teachers. This does not apply only to the schooling of teachers in undergraduate medical education: at the postgraduate level, general practitioner trainers (GP-trainers) receive special schooling to prepare them for their role. Yet the skills, knowledge and traits that should be expected in the competent GP-trainer have not been elucidated precisely. OBJECTIVES: The aim of this research project is to determine the traits, knowledge and skills required for a competent GP-trainer. METHOD: We used a qualitative method to answer the question. Ten focus-group meetings were held involving three Departments of Vocational Training in The Netherlands. Each group consisted of GP-trainers, GP-trainees or staff members. The transcriptions of these meetings were analysed, resulting in a description of what makes a competent GP-trainer. RESULTS: Five hundred items were obtained from the focus-group meetings, each of which was formulated in the form "A good GP-trainer is/can/knows. ", etc. These items were divided into the following categories: teaching knowledge, teaching skills, teaching attitude and personality traits of the GP-trainer. A competent GP-trainer must understand basic teaching methods and be able to apply this knowledge. The skill to give good feedback was seen as an important asset for a competent GP-trainer, as were observation skills, the skill to analyse and the skill to foster reflection in the trainee. The teaching attitude of a competent GP-trainer is characterized by giving latitude to and having respect for and interest in the trainee, and being available for consultation, while the teaching approach should be individualized. Enthusiasm, flexibility, patience and self-insight were some of the personality traits identified. CONCLUSION: Many characteristics were identified as a result of this research. The next logical step will involve a Delphi consensus procedure to obtain a profile of the competent GP-trainer. This profile will then be suitable in setting the standards for curricula for future GP-trainers. (+info)
Confidentiality within physiotherapy: perceptions and attitudes of clinical practitioners.
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OBJECTIVES: This study examined the issue of confidentiality in relation to i) undergraduate curriculum content in physiotherapy, and ii) the awareness, experiences and attitudes of clinical physiotherapists. DESIGN: Postal survey of universities and focus group interviews with physiotherapists. SETTING: Twenty-five universities in the UK and Ireland and 44 therapists in five hospitals in southern England. RESULTS: The survey of universities indicated that legal and ethical aspects of confidentiality featured in virtually all preregistration courses that responded. However, whereas its inclusion was rated as extremely important, the degree of coverage of confidentiality varied considerably between courses. Within the focus groups, 35 informants recollected coverage of confidentiality in their preregistration education, and 12 in postregistration in-service training; in neither case was this coverage in great detail. Informants identified environmental factors and working practices as barriers to preserving confidentiality. Disclosure to others also gave rise to difficulties. Informants were only aware in general terms of the relevant sections of the Chartered Society of Physiotherapy's Rules of Professional Conduct. CONCLUSIONS: Aspects of hospital-based physiotherapy practice were seen to create specific problems in relation to confidentiality. More detailed sources of education and guidance on this issue appear to be required. (+info)
Living with treatment decisions: regrets and quality of life among men treated for metastatic prostate cancer.
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PURPOSE: To examine variation in men's long-term regret of treatment decisions, ie, surgical versus chemical castration, for metastatic prostate cancer and its associations with quality of life. METHODS: Survey of previously treated patients to assess treatment decisions and quality of life, supplemented with focus groups. Two items addressing whether a patient wished he could change his mind and the belief that he would have been better off with the treatment not chosen were combined in classifying survey respondents as either satisfied or regretful. Chi(2) and t tests were used to test associations between regret and treatment history, complications, and quality of life. RESULTS: Survey respondents included 201 men aged 45 to 93 years (median, 71 years), who had begun treatment (71% chemical castration, 29% orchiectomy) a median of 2 years previously. Most reported complications: hot flashes (70%), nausea (34%), and erectile dysfunction (81%). Most were satisfied with the treatment decision, but 23% expressed regret. Regretful men more frequently reported surgical (43%) versus chemical (36%) castration (P: = .030) and nausea in the past week (54% v 32%; P: = .010) but less frequently reported erectile dysfunction (56% v 72%; P: = .048). Regretful men indicated poorer scores on every measure of generic and prostate cancer-related quality of life. Qualitative analyses revealed substantial uncertainty about the progress of their disease and the quality of the decisions in which patients participated. CONCLUSION: Regret was substantial and associated with treatment choice and quality of life. It may derive from underlying psychosocial distress and problematic communication with physicians when decisions are being reached and over subsequent years. (+info)
Loyalty to the regular care provider: patients' and physicians' views.
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BACKGROUND: Changes in the organization of primary care practices are likely to have repercussions on the manner in which patients and physicians perceive loyalty to a regular source of care. A better understanding of their views will contribute to conceptual reflections on this poorly documented topic and, where needed, will reinforce efforts to adapt services to patient expectations. OBJECTIVES: The aims of this study are to document and compare the views that patients and GPs have of loyalty to the regular care provider. METHODS: This exploratory study uses the focus group technique. In 1997, we set up three groups of patients and three groups of physicians practising in Montreal. A total of 23 patients and 14 physicians participated in the study. The meetings investigated the participants' points of view on various aspects of the notion of loyalty. Analysis was based on transcripts of the meetings. The emerging themes were identified and the viewpoints were coded independently and then revised (when necessary) in order to obtain a consensus. RESULTS: Patients and physicians have a relatively congruent vision of the notion of loyalty. This tendency to use the regular source of care over time appears to be rooted in a formal or informal contract between patients and their physicians and implies a sustained partnership and a strong interpersonal relationship. The relationship established is neither exclusive nor permanent. Patients periodically reconsider it by evaluating their physician's technical and interpersonal skills. CONCLUSIONS: This study highlights the dynamic and multidimensional nature of the notion of loyalty. It shows that patients clearly identify with a particular physician rather than a clinic. The results challenge the prevailing methods of assessing longitudinality of care. (+info)
An exploration of the influence of family on cigarette smoking among American Indian adolescents.
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American Indians have the highest smoking rate of all major racial/ethnic groups in the US, despite significant variation across tribes and regions of the country. Yet, little research has been conducted on smoking initiation among American Indian adolescents. In an effort to identify the mechanisms through which families influence teen smoking, both positively and negatively, 20 focus groups were conducted with 144 non-reservation American Indian teens in Oklahoma. Findings indicated that most of the antismoking messages from family members were given by parents and grandparents, and focused on the long-term health consequences of smoking and addiction. Parental responses to teen smoking varied widely, with some responses sending mixed messages to the teens. Many teens discussed obtaining their first cigarette in a family setting and the teens felt that having smokers in their families influenced them to try smoking. Teens were able to discuss the traditional role of tobacco in their culture and were aware of its presence at Indian events, but felt ceremonial and traditional use was distinct from recreational use. Additional research is necessary to assess whether these results are generalizable to other tribes and regions, and to other racial/ethnic groups. (+info)
Social-environmental influences on children's diets: results from focus groups with African-, Euro- and Mexican-American children and their parents.
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Children's fruit, juice and vegetable (FJV) and fat intakes do not meet recommended guidelines. Since personal factors account for only a small percentage of the variability in children's FJV consumption, social and environmental influences were explored via focus group discussions with Grade 4-6 African-, Euro- and Mexican-American students and parents. Questions included the effects of social influences, availability and accessibility on children's FJV and low-fat food choices. Few ethnic differences were noted. A variety of low-fat items and fresh FJV (not cut-up) were available at home; older children were expected to prepare their own. Eating out occurred at least twice a week; FJV were not usual restaurant choices. Students reported some modeling by parents (more mothers) and friends (usually at lunch). Negative peer responses for eating vegetables were reported. Parents were concerned with children eating too much junk food and not enough FJV, recognized the outside influences their children received about food, and reported several methods to encourage children to eat FJV. Recommendations for future interventions are proposed. (+info)
Knowledge of the Tuskegee study and its impact on the willingness to participate in medical research studies.
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The under-representation of racial/ethnic minorities among medical research participants has recently resulted in mandates for their inclusion by the National Institutes of Health (NIH). Therefore, there is a need to determine how history, attitudes, cultural beliefs, social issues, and investigator behavior affect minority enrollment in medical research studies. From January 1998 to March 1999, 179 African-American and white residents of the Detroit Primary Metropolitan Statistical Area (PMSA) participated in a mail and telephone survey designed to examine impediments to African-American participation in medical research studies. Chi-square tests were performed to assess differences between the study groups using the Survey Data Analysis Program (SUDAAN). Eighty-one percent of African Americans and 28% of whites had knowledge of the Tuskegee Study (p = <0.001). Knowledge of the Tuskegee Study resulted in less trust of researchers for 51% of African-Americans and 17% of whites (p = 0.02). Forty-six percent of African-Americans and 34% of whites indicated that their knowledge of the study would affect future research participation decisions (p = 0.25). Of these, 49% of African-Americans and 17% of whites would not be willing to participate in future medical research studies (p = 0.05). This study confirms the need for medical researchers to confront the issue of the Tuskegee Study and its continuing impact on African-Americans' trust of medical research studies. (+info)