What Lies behind the Wish to Hasten Death? A Systematic Review and Meta-Ethnography from the Perspective of Patients

BACKGROUND: There is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish. METHODS AND FINDINGS: Systematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life ('having an ace up one's sleeve just in case'). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation. CONCLUSIONS: The expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans

Effective curricula for at-risk students in vocational education:a study of teachers’ practice

Abstract Background This study focused upon a curriculum for at-risk students in vocational education aimed at enhancing students’ motivation and engagement for learning. The study explored teachers’ view on effective curricular characteristics and teachers’ strategies to create positive learning experiences for students. Methods Qualitative research has been conducted regarding four curricula for at-risk students; data were collected and examined by means of 16 focus group interviews with teachers and analysis of relevant documents. Results Teachers pointed out the central position of the student, resulting in individual trajectories. Teachers used peer group dynamics, job orientation and sports as tool for student development. Teachers regarded themselves as coaches, as experts in sport activities and as group managers. For positive learning experiences two key curricular characteristics have been identified: (1) equality in the relationship between student and teacher, (2) a positive fit between the curriculum and the students

Workplace support after breast cancer treatment: recognition of vulnerability

Background: Support from the workplace seems to be a key element in addressing the poor return-to-work (RTW) rate of employees with breast cancer. We aim to acquire an in-depth understanding of how Flemish employees experience their RTW after breast cancer and the support from the workplace. Method: Fourteen in-depth interviews of women who experienced breast cancer and returned to work (high school graduates, age range 42-55 years, mean age 48 at time of surgery) were analysed using the Qualitative Analysis Guide of Leuven (QUAGOL), based on a Grounded Theory approach. Results: The key experiences were feeling vulnerable, feeling able to work and need for support. Although little diversity in RTW experiences was found, the background of the vulnerability varied. Women experienced support (which could be emotional or practical) only as adequate if it addressed their specific vulnerability. Conclusions: Employees felt particularly vulnerable. Vulnerability is not the same as low-work ability and as such it should be added as theoretical concept in RTW research. Adequate workplace support addresses the specific vulnerability of an individual woman. Our study offers a nuanced insight into the RTW process of breast cancer survivors

Return to Work Following Breast Cancer Treatment: The Employers' Side

Purpose Research on employers' experiences with return to work (RTW) of employees with breast cancer is lacking. Employers seem to be the key people to create good working conditions. Our aim is to explore how Belgian employers experience their role and responsibility in RTW of employees with breast cancer. Methods Using a qualitative design (Grounded Theory) 17 employers from the public (7), private (5) and non-profit (5) sector, directly involved in the RTW process, were interviewed. The analysis was based on the Qualitative Analysis Guide of Leuven (QUAGOL) with constant data comparison and interactive team dialogue as important guiding characteristics. Results RTW of employees with breast cancer is experienced by employers as an intangible process that is difficult to manage. This was expressed in (1) concern, referring to the employer's personal and emotional involvement, (2) uncertainty about the course of illness and the guidance needed by the employee and (3) specific dilemmas in the RTW process (when does one infringe on employee privacy; employee vs. organization interest; employers' personal vs. professional role). The degree to which this was experienced related to variety in organizational, employer, and employee factors. Conclusions The findings of this study confirm the importance of the employer's involvement in RTW of employees with breast cancer and contribute to a better understanding of its complexity. The employers did their best to grasp the intangibility of the RTW process. Further research is needed to refine these findings and to discover the specific needs of employers regarding supporting RTW of breast cancer patients