Healthcare professionals’ assertions and women's responses during labour: A conversation analytic study of data from One born every minute

© 2016 Elsevier Ireland Ltd Objective Communication during labour is consequential for women's experience yet analyses of situated labour-ward interaction are rare. This study demonstrates the value of explicating the interactional practices used to initiate ‘decisions’ during labour. Methods Interactions between 26 labouring women, their birth partners and HCPs were transcribed from the British television programme, One Born Every Minute. Conversation analysis was used to examine how decisions were initiated and accomplished in interaction. Findings HCPs initiate decision-making using interactional practices that vary the ‘optionality’ afforded labouring women in the responsive turn. Our focus here is on the minimisation of optionality through ‘assertions’. An ‘assertive’ turn-design (e.g. ‘we need to…’) conveys strong expectation of agreement. HCPs assert decisions in contexts of risk but also in contexts of routine activities. Labouring women tend to acquiesce to assertions. Conclusion The expectation of agreement set up by an assertive initiating turn can reduce women's opportunities to participate in shared decision-making (SDM). Practice implications When decisions are asserted by HCPs there is a possible dissonance between the tenets of SDM in British health policy and what occurs in situ. This highlights an educational need for HCPs in how best to afford labouring women more optionality, particularly in low-risk contexts

Consent revisited: The impact of return of results on participants’ views and expectations about trial participation.

Background Increasingly, the sharing of study results with participants is advocated as an element of good research practice. Yet little is known about how receiving the results of trials may impact on participants’ perceptions of their original decision to consent. Objective We explored participants’ views of their decision to consent in a clinical trial after they received results showing adverse outcomes in some arms of the trial. Method Semi-structured interviews were conducted with a purposive sample of 38 women in the UK who participated in a trial of antibiotics in pregnancy. All had received results from a follow-up study that reported increased risk of adverse outcomes for children of participants in some intervention arms. Data analysis was based on the constant comparative method. Results Participants’ original decisions to consent to the trial had been based on hope of personal benefit and assumptions of safety. On receiving the results, most made sense of their experience in ways that enabled them to remain content with their decision to take part. But for some, the results provoked recognition that their original expectations might have been mistaken or that they had not understood the implications of their decision to participate. These participants experienced guilt, a sense of betrayal by the maternity staff and researchers involved in the trial, and damage to trust. Conclusions Sharing of study results is not a wholly benign practice, and requires careful development of suitable approaches for further evaluation before widespread adoption

Factors influencing participation in randomised clinical trials among patients with Barrett’s early neoplasia: A multi-centre interview study

Objectives Strong recruitment and retention into randomised controlled trials involving invasive therapies is a matter of priority to ensure better achievement of trial aims. The BRIDE (Barrett’s Randomised Intervention for Dysplasia by Endoscopy) Study investigated the feasibility of undertaking a multicentre randomised controlled trial comparing argon plasma coagulation and radiofrequency ablation, following endoscopic resection, for the management of early Barrett’s neoplasia. This paper aims to identify factors influencing patients’ participation in the BRIDE Study and determine their views regarding acceptability of a potential future trial comparing surgery with endotherapy. Design A semistructured telephone interview study was performed, including both patients who accepted and declined to participate in the BRIDE trial. Interview data were analysed using the constant comparison approach to identify recurring themes. Setting Interview participants were recruited from across six UK tertiary centres where the BRIDE trial was conducted. Participants We interviewed 18 participants, including 11 participants in the BRIDE trial and 7 who declined. Results Four themes were identified centred around interviewees’ decision to accept or decline participation in the BRIDE trial and a potential future trial comparing endotherapy with surgery: (1) influence of the recruitment process and participant–recruiter relationship; (2) participants’ views of the design and aim of the study; (3) conditional altruism as a determining factor and (4) participants’ perceptions of surgical risks versus less invasive treatments. Conclusion We identified four main influences to optimising recruitment and retention to a randomised controlled trial comparing endotherapies in patients with early Barrett’s-related neoplasia. These findings highlight the importance of qualitative research to inform the design of larger randomised controlled trials.</p

Principles of Authorship and Good Practice Tips

As researchers in all fields are well aware, authoring academic papers is a vital part of our academic currency. Authorship is often used as an indication of academic ‘worth’, and thus allocation of authorship is often a contentious issue, particularly on collaborative projects. In SAPPHIRE, most of our papers arise from large research projects which often involve multiple researchers (academic staff and contracted research associates and assistants) in different roles – as principal investigators, co-investigators, data collectors, data analysts and project managers, not to mention all the other tasks involved in the actual drafting and re-drafting of reports and academic papers. Almost every paper we produce has, quite rightly, multiple authors. Keen to avoid the anxieties and potential for discord disagreements over authorship could generate, we recognised the need, as a research group, to have a more transparent and consistent approach to reaching these decisions. While a number of relevant authorship codes of conduct exist, including our own University’s Research Code of Conduct, we felt that as a group we would benefit from developing more detailed guidance for operationalizing such codes in a transparent, robust and ethically defensible way. So, we have embarked on a process of developing a set of ‘Authorship Principles’ and accompanying ‘Good Practice Tips’