Tailoring communications to the evolving needs of patients throughout the cancer care trajectory: a qualitative exploration with breast cancer patients

Background: Doctor-patient communication is a crucial aspect of patient care. This study explored the communication experience of patients in a cancer consultation over the course of the cancer continuum. Methods: In-depth interviews with seven breast cancer patients were carried out. Results: Themes related to communication experiences across the five phases of cancer consultation, from diagnosis to recurrence, were identified. The most salient issue is that patients also perceived cancer as 'a disease of the mind', which is not adequately cared for in consultation. This highlights the notion that cancer care providers should provide appropriate care for the psychological dimensions of the cancer experience with an empathic and sincere attitude during consultations. To this end, non-verbal aspects of communication that convey caring, support, and respect seem important. Furthermore, patients perceived that the consultation time was far shorter then they needed and reported that they felt pressured for time. Moreover, the stance taken by patients and the needs and preferences of patients varied across the phases of the cancer trajectory. As patients progressed through the phases of their treatment, they assumed more active roles in the course of their care and the need for more detailed information and questioning increased. Thus, ensuring that patients have opportunities to ask questions in the consultation is important. Conclusion: Current findings suggest that the efficacy of communication varies depending on which phase patients are in and that effective communication should be tailored to these evolving needs and preferences of breast cancer patients. Also, patients perceived that the consultation did not adequately address their need for information related to their care or their emotional issues associated with the cancer experience. It is therefore important to address their needs by paying particular attention to non-verbal aspects of communication that convey empathy and respect toward patients, as well as allowing patients to ask questionsope

The European Code Against Injuries (ECAI)

No abstract available

Understanding reasons for non-compliance in motorcycle helmet use among adolescents in Greece

Objective: To explore attitudes towards two-wheel motorized vehicle (TWMV) helmet use among adolescents in a country with poor legal compliance. Design: Self-administered questionnaires were completed by 523 high school students to define the sample of a qualitative study; thereafter, the Health Belief Model (HBM) was applied in 12 focus groups comprising 70 students. Setting: Three randomly selected public secondary schools in middle-income areas of Athens, Greece. Results: Students reporting frequent helmet use were characterized by a high perceived threat of a TWMV-related injury, which seemed to be associated with both prior experience of an injury and receiving information on helmet wearing from "significant others." Students reporting helmet non-use were characterized by a low threat perception, possibly attributable to adolescent egocentrism and accompanying feelings of invulnerability or to lack of knowledge and experience in risk identification. A sharp contrast was noted regarding the most important perceived benefit of helmet use, expressed among users as "protection in the case of a road crash" and among non-users as "avoiding tickets from traffic police". Main barriers to helmet use, as identified by non-users, included: low perceived efficacy of helmets; peer pressure; lack of appropriate information on helmet use; high helmet cost; lack of convenience; vision and hearing disturbance; and style reasons. Conclusions: When social norms of low compliance to safety laws prevail, qualitative research can assist in developing tailored educational interventions targeting behavior modification among adolescents

Understanding reasons for non-compliance in motorcycle helmet use among adolescents in Greece

Objective: To explore attitudes towards two-wheel motorized vehicle (TWMV) helmet use among adolescents in a country with poor legal compliance. Design: Self-administered questionnaires were completed by 523 high school students to define the sample of a qualitative study; thereafter, the Health Belief Model (HBM) was applied in 12 focus groups comprising 70 students. Setting: Three randomly selected public secondary schools in middle-income areas of Athens, Greece. Results: Students reporting frequent helmet use were characterized by a high perceived threat of a TWMV-related injury, which seemed to be associated with both prior experience of an injury and receiving information on helmet wearing from “significant others.” Students reporting helmet non-use were characterized by a low threat perception, possibly attributable to adolescent egocentrism and accompanying feelings of invulnerability or to lack of knowledge and experience in risk identification. A sharp contrast was noted regarding the most important perceived benefit of helmet use, expressed among users as “protection in the case of a road crash” and among non-users as “avoiding tickets from traffic police”. Main barriers to helmet use, as identified by non-users, included: low perceived efficacy of helmets; peer pressure; lack of appropriate information on helmet use; high helmet cost; lack of convenience; vision and hearing disturbance; and style reasons. Conclusions: When social norms of low compliance to safety laws prevail, qualitative research can assist in developing tailored educational interventions targeting behavior modification among adolescents

Evaluating the impact of a school-based helmet promotion program on eligible adolescent drivers: Different audiences, different needs?

The school environment has been often identified as a prosperous venue for public health improvement. This study is a cluster randomized controlled trial evaluating the impact of a school-based helmet promotion program on knowledge, attitudes and practices of eligible adolescent drivers. Four public, four private and four vocational high schools situated in Attica, Greece, were sorted by type and randomly assigned to receive a 1-month intervention, based on the concepts of the Health Belief Model, or serve as controls. Self-report data were collected at baseline from 741 second grade students (∼16 years) and immediately after program completion. Linear mixed models with random student effects were used to estimate mean changes in scores for each treatment group and corresponding between groups differences of changes. Likelihood-based analysis showed that the intervention yielded a significant improvement in knowledge about helmet use. Yet, its impact on attitudes and practices appeared to vary across different school types. With current research offering ambiguous results on the appropriate timing of injury prevention efforts, this study suggests that educational programs targeting road safety can lead to positive changes if tailored to the needs of specific population groups and implemented during critical life periods, such as the transition to driving status. © The Author 2010. Published by Oxford University Press. All rights reserved

Antibiotic prescribing for acute respiratory tract infections in primary care: an updated and expanded meta-ethnography.

This is the author accepted manuscript. The final version is available from Royal College of General Practitioners via the DOI in this record.BACKGROUND: Reducing unnecessary prescribing remains a key priority for tackling the global rise of antibiotic-resistant infections. AIM: The authors sought to update a 2011 qualitative synthesis of GPs' experiences of antibiotic prescribing for acute respiratory tract infections (ARTIs), including their views of interventions aimed at more prudent prescribing. They expanded the original scope to encompass all primary care professionals (PCPs) who can prescribe or dispense antibiotics for ARTIs (for example, nurses and pharmacists). DESIGN AND SETTING: Systematic review and meta-ethnography of qualitative studies. METHOD: A systematic search was conducted on MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, and Web of Science. No date or language restrictions were used. Identified studies were grouped according to their thematic focus (usual care versus intervention), and two separate syntheses were performed. RESULTS: In all, 53 articles reporting the experiences of >1200 PCPs were included. Analysis of usual-care studies showed that PCPs tend to assume multiple roles in the context of ARTI consultations (the expert self, the benevolent self, the practical self), depending on the range of intrapersonal, interpersonal, and contextual situations in which they find themselves. Analysis of intervention studies identified four possible ways in which PCPs may experience quality improvement interventions (compromise, 'supportive aids', source of distress, and unnecessary). CONCLUSION: Contrary to the original review, these results suggest that the use of the same intervention is experienced in a totally different way by different PCPs, and that the same elements that are perceived as benefits by some could be viewed as drawbacks by others. Acceptability of interventions is likely to increase if these are context sensitive and take into account PCPs' varying roles and changing priorities.Evi Germeni was supported by an Advanced Postdoc Mobility grant from the Swiss National Science Foundation (P300P1_164574). Ruth Garside, Morwenna Rogers, and Nicky Britten were partially supported by the UK National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The content is solely the responsibility of the authors and does not necessarily represent the views of the Swiss National Science Foundation, the UK NIHR, the UK NHS, or the UK Department of Health