Learning from the lifeworld: Introducing alternative approaches to phenomenology in psychology

In this multi authored article, Dr Brooks introduces phenomenological psychology before leading UK psychologists explain some of the ways in which they draw upon phenomenological principles in their own work

The Pictor Technique: Exploring Collaborative Working in Nursing

Pictor is a graphical visual technique with its origins in personal construct psychology and phenomenology. It was developed to explore experiences of collaborative working in health and social care contexts, but may be used in any setting where people with different backgrounds or perspectives need to interact around a specific task or goal. In this case study, we outline the principles behind the method and describe how it is used to collect data, and how such data may be analysed. We present a case example from a recent study of collaborative working among nurses and other professionals in relation to the care of people with cancer and long-term conditions. We conclude by reflecting on the strengths and weaknesses of the technique

Attributions, distress and behavioural responses in the significant others of people with Chronic Fatigue Syndrome

To test an attribution-emotion model of reactions to chronic fatigue syndrome (CFS/ME), 30 significant others of 30 adult patients with CFS/ME were administered a semi-structured interview about their beliefs regarding the patient’s illness, and completed questionnaire measures of distress and behavioural responses to the patient. Spontaneous causal explanations (attributions) for illness events, symptom exacerbation and negative patient mood were extracted and coded. Significant other distress and negative behavioural responses towards the CFS/ME patient were associated with attributing illness events to causes personal and internal to the patient. Our findings may inform future family–based interventions for CFS/ME

Supporting people with active and advanced disease: a rapid review of the evidence

1.1 Background: the NCSI AAD group The National Cancer Survivorship Initiative (NCSI, 2010) was set up in response to the NHS Cancer Reform Strategy (Department of Health, 2007) as a collaboration between Macmillan Cancer Support, the Department of Health and NHS Improvement, with the goal to achieve a better understanding of the experiences of cancer survivors and to advocate for the provision of services to support them. Within this broad remit, it was recognised that there was a particular group of patients whose needs were commonly neglected; people who were experiencing the ongoing effects of cancer beyond first-line treatment but who were not at end of life. The Active and Advanced Disease (AAD) working group was created to consider issues of relevance to such people. 1.2 Aims of this review This project set out to meet the following aim: To review the literature on selected cancers in order to identify implications for the development of services to support patients experiencing difficulties associated with active and advanced disease

Valuing Family Medicine: Historical Journey, Institutional Hostility, and Individual Narratives

For over 80 years, concern has persisted in the United States about medicine\u27s trajectory toward specialization and the resulting shortage of generalist physicians, who have long been considered the cornerstone of the health care system. This perpetual problem is investigated at three levels: historical, institutional, and individual. I find that the profession of medicine fails to embrace Family Medicine as an equal--a reality even when Family Medicine first became a specialty in 1969. I show that the struggle for workers is closely joined to a struggle for prestige, which points to a deeper conflict between the values of Family Medicine\u27s holistic philosophy and the medical profession\u27s dominant biomedical model. I argue that the medical profession withholds prestige because Family Medicine\u27s holistic approach enlarges the boundaries of medicine in directions that threaten to undermine the purity and control of the profession\u27s domain of expertise. I argue that this broad devaluing is an underappreciated factor in the generalist shortage, and that this disparagement operates at an institutional level through obstacles embedded in the content, culture, and structure of medical education. Of particular importance, analysis of oral histories reveals an inherent mismatch between the reported rewards of primary care, such as building relationships with patients over time, and the structure of medical training itself. Analysis of medical school mission statements examine the relationship between medical schools\u27 unhidden curriculum and primary care, which yields a moderate correlation between the inclusion of primary care and related words and the production of primary care physicians. However, few schools (14%) of the 141 schools examined publicly value primary care in their mission statements. In light of pervasive disparagement, analysis of Family Medicine resident biosketches asks (1) why individuals commit to a specialty with such low status and (2) how these individuals construct value and appeal in their work. The presence of a social justice schema emerges, that, when embraced, renders Family Medicine as a desirable specialty and diminishes the power of the dominant narratives of disparagement

Young people with diabetes and their peers

Aims Peer influences can impact across a range of adolescent behaviours. Type 1 diabetes (T1D) is amongst the most common forms of chronic illness to affect young people in the UK. Self-management is crucial, but managing their T1D is often very difficult for adolescents. It has been suggested that interventions to support young people with T1D could usefully include their friends and peers, but little is known about how peers think about and respond to T1D. This research explored T1D from the perspective of adolescent patients, friends, and peers. Methods We conducted dyadic interviews with adolescent diabetes patients aged 13-15 years and a nominated close friend (n=20). We then carried out three focus groups sessions with participants without any necessary prior knowledge of diabetes in a high school setting. Data were thematically coded and final data interpretations were subject to independent scrutiny from young people the same age as our research participants who assessed the findings in terms of relevance and usefulness from their own perspective. Results Limited awareness of T1D amongst their peer group generally and school teaching staff was reported by interview participants. Close friends play a valuable role in recognising the importance of T1D management, whilst also accepting and normalising the condition. Considerable variations in experiences of support provided in relation to T1D in the school environment were reported by all participants, including the extent to which peers were encouraged or even permitted to support patients. Educational materials designed in response to issues raised in the interviews were piloted in classroom settings. Realistic vignettes developed from the interviews were used to facilitate group discussion. The simple materials were well-received and positively evaluated. Conclusions This research highlights the need for greater awareness of T1D in schools amongst teachers and peers, but encouragingly suggests that simple educational sessions can be easily implemented and are well received. There is a lack of standardised school policies in relation to management of T1D. This important aspect of the care pathway should be addressed to ensure there are no barriers to optimal self-management for adolescents in their school environment

"It's not just about the patient, it's the families too.": End of life care in the home environment

Introduction: Most people when asked say they would prefer to die at home. However, ‘Death in Usual Place of Residence’ (DiUPR) does not give any real insight into the quality and experiences of care received. Additionally, DiUPR involves other family members resident in the home environment and their needs, preferences and experiences also need consideration. Aim(s) and Method(s): The aim of this work was to explore the experiences of patients and informal caregivers receiving at-home care from a specialist palliative care service. We undertook individual interviews with 11 patients and 10 significant others. We used the Pictor technique, a novel interview tool used to sensitively explore networks of support and experiences of palliative care. Interviews were analysed thematically. Results: Caring for a loved one at home was acknowledged as draining, but participants were effusive about the excellent at-home professional support they received from the specialist service. The care provided evidently recognised the needs of both patients and their families. Effective co-ordination of care, including liaison with other services was especially appreciated. Conclusion(s): With increasing trends towards DiUPR, it is vital that there are sufficient well-resourced palliative care services available in the community to support both patients and their families at the end of life. Pictor is a useful means to obtain detailed insight into individual experiences of end of life care. Care co-ordination emerged as key concern for patients receiving End of Life Care and their families

'I think positivity breeds positivity': a qualitative exploration of the role of family members in supporting those with chronic musculoskeletal pain to stay at work

Background: It is proposed that family members are important sources of support in helping those with chronic musculoskeletal pain to remain at work, but the phenomenon remains largely unexplored. The aim of this study was to examine the extent and nature of support provided by family members in this respect. Methods: Qualitative data were collected from workers and their ‘significant others’ spouses/partners/close family members) in two un-related studies focused on working with pain; one conducted in the United Kingdom (n = 10 dyads) and one in the Netherlands (n = 21 dyads). Thematic analysis techniques were applied to both sets of data independently, and findings were then assimilated to establish common themes. Results: Findings were broadly similar in both studies. Workers acknowledged significant other support in helping them to manage their pain and remain at work, and their descriptions of the type of support provided and required were echoed by their significant others. Three common themes were identified - ‘connectivity’, ‘activity’ and ‘positivity’. Worker and significant other responses were largely congruent, but significant others provided more in-depth information on the nature of their support, their concerns and the impact on their relationship. Conclusions: This research presents novel insights about the specific contribution made by significant others in helping their relatives with chronic musculoskeletal pain to stay at work. These findings add to the under-represented ‘social’ dimension of the biopsychosocial model currently applied to our understanding and treatment of pain, and point to harnessing support from significant others as a potentially effective management strategy