Bangen und Hoffen: Erfahrungen von Frauen mit vulvären intraepithelialen Neoplasien während des Krankheitsverlaufs – Eine qualitative Studie

The vulvar intraepithelial neoplasia (VIN) is a rare chronic skin condition that may progress to an invasive carcinoma of the vulva. Major issues affecting women's health were occurring symptoms, negative influences on sexuality, uncertainty concerning the illness progression and changes in the body image. Despite this, there is little known about the lived experiences of the illness trajectory. Therefore, the aim of this study was to describe the experiences of women with VIN during the illness trajectory. In a secondary data analysis of the foregoing qualitative study we analysed eight narrative interviews with women with VIN by using thematic analysis in combination with critical hermeneutics. Central for these women during their course of illness was a sense of "Hope and Fear". This constitutive pattern reflects the fear of recurrence but also the trust in healing. The eight narratives showed women's experiences during their course of illness occurred in five phases: "there is something unknown"; "one knows, what IT is"; "IT is treated and should heal"; "IT has effects on daily life"; "meanwhile it works". Women's experiences were particularly influenced by the feeling of "embarrassment" and by "dealing with professionals". Current care seems to lack adequate support for women with VIN to manage these phases. We suggest, based on our study and the international literature, that new models of counselling and providing information need to be developed and evaluated.Die vulväre intraepitheliale Neoplasie (VIN) ist eine seltene chronische Krankheit, die zu einem invasiven Karzinom der Vulva fortschreiten kann. Symptome von VIN, negative Auswirkungen auf die Sexualität, die Ungewissheit der Krankheitsentwicklung und Körperbildveränderungen wurden von betroffenen Frauen als die schlimmsten Begleiterscheinungen benannt. Zum Erleben des Krankheitsverlaufs bei VIN ist jedoch wenig bekannt. Ziel dieser qualitativen Studie ist es, das Erleben von Frauen mit VIN während des Krankheitsverlaufs darzustellen. Dabei wurde in einer Sekundäranalyse der qualitativen Daten der WOMAN-PRO-Studie acht Interviews mit Frauen nach chirurgischen Eingriffen bei VIN mittels thematischer Analyse und in Kombination mit kritisch hermeneutischer Reflexion ausgewertet. «Bangen und Hoffen» stellt ein grundlegendes Muster dar und beinhaltet die stets vorhandene Angst vor Rezidiven sowie die Hoffnung, dass die Therapie wirkt. Aufgrund der Analyse zeigte sich eine Darstellung des Krankheitsverlaufs in fünf Phasen: «da ist etwas Unbekanntes», «man weiß, was ES ist», «ES wird behandelt und soll heilen», «ES hat Auswirkungen» und «mittlerweile geht es». Der Krankheitsverlauf wurde durch das Gefühl der Frauen «sich dafür schämen» beeinflusst, auch das Thema «mit Fachpersonen umgehen» spielte eine maßgebende Rolle. Die gegenwärtige Behandlung und Pflege scheint Frauen mit VIN nicht ausreichend zu unterstützen, um diese Phasen adäquat zu bewältigen. Wir empfehlen daher, neue Modelle der Beratung und Information zu entwickeln und zu evaluieren

Parental and provider vaccine hesitancy and non-timely childhood vaccination in Switzerland

OBJECTIVE: Although medical providers are a trusted vaccination information source for parents, they do not universally support vaccination. Complementary medicine (CM) providers are particularly likely to hold vaccine hesitant (VH) views, and VH parents often consult with them. Little research compares VH of parents and providers, and if and how each is associated with uptake of recommended childhood vaccines. METHODS: We defined non-timely receipt as recommended vaccines given > 1 month later than officially recommended, based on vaccination records. We administered versions of the Parent Attitudes about Childhood Vaccines (PACV) 5-item survey instrument to 1256 parents and their children's pediatricians (N = 112, 40 CM-oriented, 72 biomedical [not CM-oriented]) to identify moderately (PACV-score 5-6) and highly (PACV-score 7+) hesitant providers/parents. We obtained multivariable adjusted odds ratios to test relationships between parental VH and provider type/VH, and between non-timely receipt of selected childhood vaccines and parental VH and provider type/VH. RESULTS: No biomedical providers were VH, 9 CM providers were moderately VH, and 17 were highly VH. Parents seeing moderately and highly hesitant providers had adjusted odds ratio (AOR) for being VH = 6.6 (95% confidence interval (CI), 3.1-14.0) and AOR = 31.3 (95% CI 16.8-58.3), respectively. Across all vaccine uptake endpoints, children of moderately and highly hesitant parents had 1.9-3.8 and 7.1-12.3 higher odds of non-timely vaccination, and children seeing highly hesitant CM providers had 4.9-9.4 higher odds. Children seeing moderately hesitant CM providers had 3.3 higher odds of non-timely vaccination for the 1st dose of measles and 3.5 higher odds for 1st dose of polio/pertussis/tetanus. CONCLUSION: VH by both parents and providers each is associated with non-timely childhood vaccination. As VH parents are more likely to consult with VH providers, interventions aimed at increasing timely vaccination need to primarily target VH providers and their clients

Parental and provider vaccine hesitancy and non-timely childhood vaccination in Switzerland

Objective Although medical providers are a trusted vaccination information source for parents, they do not universally support vaccination. Complementary medicine (CM) providers are particularly likely to hold vaccine hesitant (VH) views, and VH parents often consult with them. Little research compares VH of parents and providers, and if and how each is associated with uptake of recommended childhood vaccines. Methods We defined non-timely receipt as recommended vaccines given > 1 month later than officially recommended, based on vaccination records. We administered versions of the Parent Attitudes about Childhood Vaccines (PACV) 5-item survey instrument to 1256 parents and their children’s pediatricians (N = 112, 40 CM-oriented, 72 biomedical [not CM-oriented]) to identify moderately (PACV-score 5–6) and highly (PACV-score 7+) hesitant providers/parents. We obtained multivariable adjusted odds ratios to test relationships between parental VH and provider type/VH, and between non-timely receipt of selected childhood vaccines and parental VH and provider type/VH. Results No biomedical providers were VH, 9 CM providers were moderately VH, and 17 were highly VH. Parents seeing moderately and highly hesitant providers had adjusted odds ratio (AOR) for being VH = 6.6 (95% confidence interval (CI), 3.1–14.0) and AOR = 31.3 (95% CI 16.8–58.3), respectively. Across all vaccine uptake endpoints, children of moderately and highly hesitant parents had 1.9–3.8 and 7.1–12.3 higher odds of non-timely vaccination, and children seeing highly hesitant CM providers had 4.9–9.4 higher odds. Children seeing moderately hesitant CM providers had 3.3 higher odds of non-timely vaccination for the 1st dose of measles and 3.5 higher odds for 1st dose of polio/pertussis/tetanus. Conclusion VH by both parents and providers each is associated with non-timely childhood vaccination. As VH parents are more likely to consult with VH providers, interventions aimed at increasing timely vaccination need to primarily target VH providers and their clients