Parents' responses to prognostic disclosure at diagnosis of a child with a high-risk brain tumor:Analysis of clinician-parent interactions and implications for clinical practice

BackgroundPrevious studies have found that parents of children with cancer desire more prognostic information than is often given even when prognosis is poor. We explored in audio‐recorded consultations the kinds of information they seek.MethodsEthnographic study including observation and audio recording of consultations at diagnosis. Consultations were transcribed and analyzed using an interactionist perspective including tools drawn from conversation and discourse analysis.ResultsEnrolled 21 parents and 12 clinicians in 13 cases of children diagnosed with a high‐risk brain tumor (HRBT) over 20 months at a tertiary pediatric oncology center. Clinicians presented prognostic information in all cases. Through their questions, parents revealed what further information they desired. Clinicians made clear that no one could be absolutely certain what the future held for an individual child. Explicit communication about prognosis did not satisfy parents’ desire for information about their own child. Parents tried to personalize prognostic information and to apply it to their own situation. Parents moved beyond prognostic information presented and drew conclusions, which could change over time. Parents who were present in the same consultations could form different views of their child's prognosis.ConclusionPopulation level prognostic information left parents uncertain about their child's future. The need parents revealed was not for more such information but rather how to use the information given and how to apply it to their child in the face of such uncertainty. Further research is needed on how best to help parents deal with uncertainty and make prognostic information actionable

Young people’s experiences of social recovery cognitive behavioural therapy and treatment as usual in the PRODIGY trial

Aim: The PRODIGY trial is an ongoing randomised controlled trial of Social Recovery Cognitive Behavioural Therapy (SRCBT), a new intervention designed to improve social functioning in young people at risk of long-term social disability due to severe and complex mental health problems. The aim of this qualitative sub-study was to understand trial participants’ experiences of SRCBT and the control condition, treatment as usual (TAU). Method: Trial participants were aged 16 – 25 with socially disabling severe and complex mental health problems. A purposive sample of trial participants took part in in-depth qualitative interviews which were transcribed verbatim and analysed thematically. Results: Participants from the SRCBT arm valued the relationship with their therapist, the flexibility of intervention delivery and the cognitive and behavioural techniques taught. They viewed SRCBT as challenging but worthwhile. Participants from the TAU arm reported receiving little support, both prior to and during their participation in the trial. Participants from both arms valued opportunities to talk about their difficulties during trial participation. Increased activity was an important goal of participants from both arms and most expressed high motivation and little hopelessness. Conclusions: Currently available services do not meet the needs of some young people with socially disabling mental health problems. Motivation to change appears high at this early stage of disorder, supporting the potential value of intervening early to prevent longer-term social disability. SRCBT was well accepted by participants and so is a promising intervention to meet this objective

A triangulation of relationships: Godfrey Wilson, Zacharia Mawere and their Bemba informants in Broken Hill, Northern Rhodesia, 1938–1941

Magister Artium - MAThe rich corpus of postcolonial scholarly engagement on indigenous intermediaries, interpreters, clerks and assistants has a made a strong argument for the active participation of African agents in social scientific knowledge production on Africa. This literature has highlighted the complex and negotiated nature of fieldwork in African anthropology. While this literature has begun to deepen our understanding of the knowledge work of anthropologists and their research assistants, it has not adequately explored the relationship between anthropologists and informants in what one scholar has recently called ‘a triangulation of relationships’ between the anthropologist, the assistant and the informant. This research project proposes to explore these relationships in a detailed case study: that of the British anthropologist Godfrey Wilson (1908–1944), his interpreter Zachariah Mawere, and three primary informants, during three years of pioneering research into the effects of migrant labour at Broken Hill, Northern Rhodesia (Zambia) between 1938 and 1941. Using a close textual reading and detailed analysis of Wilsons Bemba and English fieldnotes held in the Godfrey and Monica Wilson collection at the University of Cape Town’s African Studies Library, the study will apply a micro-historical and biographical approach. It will seek to reconstruct the biographies and anthropological contributions of one interpreter and three central Bemba informants in order to explore the micro-politics of knowledge production in African anthropology