The consent process: enabling or disabling patients’ active participation?

Standards expected by doctors’ regulatory bodies in respect of the process of consent to treatment have arguably sought to restructure the nature of the doctor-patient relationship from one of paternalism to that of shared decision-making. Yet, few studies have explored empirically, from patients’ perspectives, the extent to which the process of consent to treatment enables or disables patients’ participation in medical decision-making. Our paper examines patients’ attitudes towards the consent process, exploring how and why these attitudes influence patients’ active participation in decision-making and considering possible consequent medico-legal issues. Data were collected longitudinally using semi-structured interviews and field observations involving 35 patients and 19 of their caregivers, in an English hospital between February and November 2014. These indicate that generally patients defer to the doctor in respect of treatment decision-making. Although most patients and their caregivers wanted detailed information and discussion, they did not necessarily expect that this would be provided. Further, patients perceived that signing the consent form was an obligatory routine principally to protect doctors from legal action should something go wrong. Our study suggests that patients’ predominantly paternalistic perceptions of the consent process can not only undermine attempts by doctors to involve them in decision-making but, as patients are now considered in law as informed actors, their perceptions of the consent form as not being in their interests could be a self-fulfilling prophecy if signing is undertaken without due consideration to the content

Depressed mood in pregnancy: Prevalence and correlates in two Cape Town peri-urban settlements

<p>Abstract</p> <p>Background</p> <p>The disability associated with depression and its impact on maternal and child health has important implications for public health policy. While the prevalence of postnatal depression is high, there are no prevalence data on antenatal depression in South Africa. The purpose of this study was to determine the prevalence and correlates of depressed mood in pregnancy in Cape Town peri-urban settlements.</p> <p>Methods</p> <p>This study reports on baseline data collected from the Philani Mentor Mothers Project (PMMP), a community-based, cluster-randomized controlled trial on the outskirts of Cape Town, South Africa. The PMMP aims to evaluate the effectiveness of a home-based intervention for preventing and managing illnesses related to HIV, TB, alcohol use and malnutrition in pregnant mothers and their infants. Participants were 1062 pregnant women from Khayelitsha and Mfuleni, Cape Town. Measures included the Edinburgh Postnatal Depression Scale (EPDS), the Derived AUDIT-C, indices for social support with regards to partner and parents, and questions concerning socio-demographics, intimate partner violence, and the current pregnancy. Data were analysed using bivariate analyses followed by logistic regression.</p> <p>Results</p> <p>Depressed mood in pregnancy was reported by 39% of mothers. The strongest predictors of depressed mood were lack of partner support, intimate partner violence, having a household income below R2000 per month, and younger age.</p> <p>Conclusions</p> <p>The high prevalence of depressed mood in pregnancy necessitates early screening and intervention in primary health care and antenatal settings for depression. The effectiveness and scalability of community-based interventions for maternal depression must be developed for pregnant women in peri-urban settlements.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00972699">NCT00972699</a>.</p

The Management Researcher as Practitioner –Issues from the Interface

This chapter focuses upon the issues and associated opportunities and constraints faced by academic management researchers undertaking research that is immediately useful and relevant to practitioners. It takes as its starting point the emphasis given to the academic-practitioner interface by the relevance debates of the past decade and government policy initiatives to support knowledge transfer from academia to practice. As previous chapters have revealed, a substantial body of literature arguing the need for relevance in management research now exists (for example Huff and Huff, 2001; Starkey and Maddon, 2001; Rousseau, 2006; Van Aken, 2005). Although this highlights possible reasons for management academics deciding whether or not to undertake research at the interface and issues associated with such working (for example Bartunek, et al. 2006; Pollit, 2006; Macbeth, 2002), the actual realities have been discussed less widely. When discussions occur, they highlight differences between management researchers and practitioners in their orientations. Here the focus tends to be on potential tensions and constraints management researchers may face (for example, Buchanan et al., 1988; Learmonth, 2008; Macbeth, 2002), rather than also considering potential opportunities such interface research may offer along with issues that might need to be addressed (for example, Cornelissen, 2002; Maclean and Macintosh, 2002). This chapter is written with the belief that, while not all management research can or should be of direct relevance to practitioners or have commercial value, management researchers can address the needs of practitioners, delivering practical, relevant and useful research grounded in practice. This adoption of a practitioner orientation in research I refer to as ‘management researcher as practitioner’. I begin the chapter with a consideration of differences between management researchers and practitioners derived from the literature, which highlights possible tensions and the potential issues these create. This is followed by two case studies based on my own and colleagues’ experiences, offered as inside accounts of such research. These are used to explore and discuss the tensions and issues, highlighting associated opportunities and constraints. I conclude with a discussion of how the differences outlined can offer the management researcher as practitioner additional research opportunities at the interface, albeit constrained by practitioners’ requirements.</p

The Management Researcher as Practitioner –Issues from the Interface

This chapter focuses upon the issues and associated opportunities and constraints faced by academic management researchers undertaking research that is immediately useful and relevant to practitioners. It takes as its starting point the emphasis given to the academic-practitioner interface by the relevance debates of the past decade and government policy initiatives to support knowledge transfer from academia to practice. As previous chapters have revealed, a substantial body of literature arguing the need for relevance in management research now exists (for example Huff and Huff, 2001; Starkey and Maddon, 2001; Rousseau, 2006; Van Aken, 2005). Although this highlights possible reasons for management academics deciding whether or not to undertake research at the interface and issues associated with such working (for example Bartunek, et al. 2006; Pollit, 2006; Macbeth, 2002), the actual realities have been discussed less widely. When discussions occur, they highlight differences between management researchers and practitioners in their orientations. Here the focus tends to be on potential tensions and constraints management researchers may face (for example, Buchanan et al., 1988; Learmonth, 2008; Macbeth, 2002), rather than also considering potential opportunities such interface research may offer along with issues that might need to be addressed (for example, Cornelissen, 2002; Maclean and Macintosh, 2002). This chapter is written with the belief that, while not all management research can or should be of direct relevance to practitioners or have commercial value, management researchers can address the needs of practitioners, delivering practical, relevant and useful research grounded in practice. This adoption of a practitioner orientation in research I refer to as ‘management researcher as practitioner’. I begin the chapter with a consideration of differences between management researchers and practitioners derived from the literature, which highlights possible tensions and the potential issues these create. This is followed by two case studies based on my own and colleagues’ experiences, offered as inside accounts of such research. These are used to explore and discuss the tensions and issues, highlighting associated opportunities and constraints. I conclude with a discussion of how the differences outlined can offer the management researcher as practitioner additional research opportunities at the interface, albeit constrained by practitioners’ requirements.</p

Understanding research philosophy and approaches to theory development

By the end of this chapter you will be able to: • explain the relevance of ontology, epistemology and axiology to business research; • describe the main research paradigms that are significant for business research; • explain the relevance for business research of philosophical positions such as positivism, critical realism, interpretivism, postmodernism and pragmatism; • reflect on your own epistemological, ontological and axiological stance; • reflect on and articulate your own philosophical position in relation to your research; • distinguish between deductive, inductive, abductive and retroductive approaches to theory development