Social Contexts of Infant Feeding and Infant Feeding Decisions

Background: Infant feeding takes place within a network of social relationships. However, the social context in which infant feeding advice is received remains underresearched. Objective: The objective of this study was to evaluate the social contexts of infant feeding by examining individual and relationship characteristics of mothers and network members associated with advice to exclusively breastfeed, exclusively formula feed, or use a combination of breast milk and formula. Methods: Information about 287 network members was reported by 80 low-income mothers during a one-time survey. Characteristics of relationships associated with mothers receiving advice (exclusively breastfeed/formula feed, combination feed) from each network member were identified using 2-level logistic regression analyses. Results: Mothers had greater odds of receiving advice to exclusively breastfeed from network members who help make feeding decisions (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.35-4.42), exclusively breastfed their own child or children (OR, 6.99; 95% CI, 2.96-16.51), and were health care providers (OR, 4.82; 95% CI, 1.70-13.67). Mothers had greater odds of receiving advice to breastfeed in combination with formula from network members who provided emotional support (OR, 2.45; 95% CI, 1.31-4.55), combination fed their own child or children (OR, 4.85; 95% CI, 1.80-13.05), and had an opinion that was important to the mother (OR, 2.67; 95% CI, 1.13-6.33). Mothers had greater odds of receiving advice to exclusively formula feed from network members who exclusively formula fed their own child or children (OR, 2.23; 95% CI, 1.07-4.66) than those who did not. Conclusion: Social relationship characteristics and network members’ infant feeding experiences may have implications for the advice new mothers receive. Future research should investigate social contexts of infant feeding longitudinally to inform interventions

Qualitative assessment of organizational barriers to optimal lung cancer care in a community hospital setting in the United States

Background Lung cancer is a major public health challenge in the United States with a complicated process of care delivery. In addition, it is a challenge for many lung cancer patients and their caregivers to navigate health care systems while coping with the disease. Objective To explore the organizational barriers to receiving quality health care from the perspective of lung cancer patients and their caregivers. Methods In a qualitative study involving 10 focus groups of patients and their caregivers, we recorded and transcribed guided discussions for analysis by using Dedoose software to investigate recurrent themes. Results Analysis of the transcriptions revealed 4 recurring themes related to organizational barriers to quality care: Insurance, scheduling, communication, and knowledge. The participants perceived support with navigating the health care system, either through their own social network or from within the health care systems, as beneficial in coping with the lung cancer, seeking information, expediting appointments, connecting patients to physicians, and receiving timely care. Limitations Institutional and geographic differences in the experience of lung cancer care may limit the generalizability of the results of this study. Conclusions This study offers insights into the perspectives of lung cancer patients and caregivers on the organizational barriers to receiving quality care. Targeting barriers related to insurance coverage, appointment scheduling, provider-patient communication, and patient or family education about lung cancer and its treatment process will likely improve patient and caregiver experience of care

\u27One-stop shop\u27: Lung cancer patients\u27 and caregivers\u27 perceptions of multidisciplinary care in a community healthcare setting

Background: Multidisciplinary care is rarely practiced in community healthcare settings where the majority of patients receive lung cancer care in the US. We sought direct input from patients and their informal caregivers on their experience of lung cancer care delivery. Methods: We conducted focus groups of patient and caregiver dyads. Patients had received care for lung cancer in or out of a multidisciplinary thoracic oncology clinic coordinated by a nurse navigator. Focus groups were audiotaped, transcribed, and analyzed using Creswell\u27s 7-step process. Recurring overlapping themes were developed using constant comparative methods within the Grounded Theory framework. Results: A total of 46 participants were interviewed in focus groups of 5 patient-caregiver dyads. Overlapping themes were a perception that multidisciplinary care improved physician collaboration, patientphysician communication, and patient convenience, while reducing redundancy in testing. Improved coordination decreased confusion, stress, and anxiety. Negative experience of serial care included poor communication among physicians, insensitive communication about illness, delays in diagnosis and treatment, misdiagnosis, and mistreatment. Physician-to-physician communication and patient education were suggested areas for improvement in the multidisciplinary model. Conclusions: Multidisciplinary care was perceived as more patient-centered, effective, safe, and efficient than standard serial care. It was also believed to improve the timeliness of care and equitable access to high quality care. Additional studies to compare these perspectives to those of other key stakeholders, including clinicians, hospital administrators and representatives of third party payers, will facilitate better understanding of the role of multidisciplinary care programs in lung cancer care delivery