Is it possible to identify patient's sex when reading blinded illness narratives? An experimental study about gender bias

<p>Abstract</p> <p>Background</p> <p>In many diseases men and women, for no apparent medical reason, are not offered the same investigations and treatment in health care. This may be due to staff's stereotypical preconceptions about men and women, i.e., gender bias. In the clinical situation it is difficult to know whether gender differences in management reflect physicians' gender bias or male and female patients' different needs or different ways of expressing their needs. To shed some light on these possibilities this study investigated to what extent it was possible to identify patients' sex when reading their blinded illness narratives, i.e., do male and female patients express themselves differently enough to be recognised as men and women without being categorised on beforehand?</p> <p>Methods</p> <p>Eighty-one authentic letters about being diseased by cancer were blinded regarding sex and read by 130 students of medicine and psychology. For each letter the participants were asked to give the author's sex and to explain their choice. The success rates were analysed statistically. To illuminate the participants' reasoning the explanations of four letters were analysed qualitatively.</p> <p>Results</p> <p>The patient's sex was correctly identified in 62% of the cases, with significantly higher rates in male narratives. There were no differences between male and female participants. In the qualitative analysis the choice of a male writer was explained by: a short letter; formal language; a focus on facts and a lack of emotions. In contrast the reasons for the choice of a woman were: a long letter; vivid language; mention of emotions and interpersonal relationships. Furthermore, the same expressions were interpreted differently depending on whether the participant believed the writer to be male or female.</p> <p>Conclusion</p> <p>It was possible to detect gender differences in the blinded illness narratives. The students' explanations for their choice of sex agreed with common gender stereotypes implying that such stereotypes correspond, at least on a group level, to differences in male and female patients' illness descriptions. However, it was also obvious that preconceptions about gender obstructed and biased the interpretations, a finding with implications for the understanding of gender bias in clinical practice.</p

Qualities in the short life : psychological studies relevant to patient and spouse in malignant glioma

This thesis deals with psychological issues concerning patients with malignant gliomas, and their spouses. There is no known medical cure, and the patients have a limited survival expectancy. Therefore studies evaluating new treatment modes, an overall supportive atmosphere, and attempts to avoid imposing unnessesary strain are necessary. Thirty consecutive patients with astrocytomas, grade III-IV, were included in a clinical trial with estramustine phosphate in addition to conventional treatment with surgery and radiotherapy. Both the patients and their spouses participated in the present study which aimed at a deeper understanding of the psychological processes relevant to their situation. By means of repeated thematically structured interviews, patients and spouses were followed separately during the entire course of the disease process. In addition to these interviews, all patients were assessed with a mini-mental examination, and five-month survivors were tested with a comprehensive neuropsychological battery. Questionnaires on reaction to the diagnosis and assessing psychosocial well-being were also administered to the patients. The interviews were analysed with grounded theory methodology and the findings were juxtaposed to concepts in psychoanalysis and coping theory. The main finding was that the patients, despite or owing to their severe medical situations, showed a marked capacity to create protection and hope. By means of biased perception they created an 'illusion' that palliated their strain. This finding is related to object-relational psychoanalysis with obvious implications for the crucial discussion on telling bad news. Another finding was that the spouses displayed different crisis trajectories depending on the overall status of their partners. Different senses of the relationship were related to different modes of coping. Especially spouses to patients with personality changes were put under severe strain and ought to be acknowledged by medical staff. Patients with no obvious deficits five months after termination of primary treatment nevertheless evidenced, at neuropsychological testing, a pronounced deficiancy in long-term memory, but no clear impairment in global intellectual capacities. Estramustine phosphate was found to have a negative impact on sexuality and might be one causative agent behind the decline in long-term memory, but these adversive effects did not seem to affect psychosocial well-being. The selective reminding technique proved to be sensitive in detecting deficits and is recommended in future clinical trials affecting the CNS.Diss. (sammanfattning) Umeå : Umeå universitet, 1996, härtill 5 uppsatser.digitalisering@um

Qualities in the short life : psychological studies relevant to patient and spouse in malignant glioma

This thesis deals with psychological issues concerning patients with malignant gliomas, and their spouses. There is no known medical cure, and the patients have a limited survival expectancy. Therefore studies evaluating new treatment modes, an overall supportive atmosphere, and attempts to avoid imposing unnessesary strain are necessary. Thirty consecutive patients with astrocytomas, grade III-IV, were included in a clinical trial with estramustine phosphate in addition to conventional treatment with surgery and radiotherapy. Both the patients and their spouses participated in the present study which aimed at a deeper understanding of the psychological processes relevant to their situation. By means of repeated thematically structured interviews, patients and spouses were followed separately during the entire course of the disease process. In addition to these interviews, all patients were assessed with a mini-mental examination, and five-month survivors were tested with a comprehensive neuropsychological battery. Questionnaires on reaction to the diagnosis and assessing psychosocial well-being were also administered to the patients. The interviews were analysed with grounded theory methodology and the findings were juxtaposed to concepts in psychoanalysis and coping theory. The main finding was that the patients, despite or owing to their severe medical situations, showed a marked capacity to create protection and hope. By means of biased perception they created an 'illusion' that palliated their strain. This finding is related to object-relational psychoanalysis with obvious implications for the crucial discussion on telling bad news. Another finding was that the spouses displayed different crisis trajectories depending on the overall status of their partners. Different senses of the relationship were related to different modes of coping. Especially spouses to patients with personality changes were put under severe strain and ought to be acknowledged by medical staff. Patients with no obvious deficits five months after termination of primary treatment nevertheless evidenced, at neuropsychological testing, a pronounced deficiancy in long-term memory, but no clear impairment in global intellectual capacities. Estramustine phosphate was found to have a negative impact on sexuality and might be one causative agent behind the decline in long-term memory, but these adversive effects did not seem to affect psychosocial well-being. The selective reminding technique proved to be sensitive in detecting deficits and is recommended in future clinical trials affecting the CNS.Diss. (sammanfattning) Umeå : Umeå universitet, 1996, härtill 5 uppsatser.digitalisering@um

Bad news from the patient's perspective: an analysis of the written narratives of newly diagnosed cancer patients

Papers in clinical journals dealing with how to tell cancer patients bad news rely mostly on the opinion of the physician. The purpose of the present study was to contribute with knowledge from the patient's perspective by analysing how patients with recently diagnosed cancer narrate the manner in which they received their diagnosis. A consecutive series of 187 patients who had received their cancer diagnosis 2-8 months prior to the outset of this study were asked to describe the manner in which they learned of their diagnosis in writing. A crucial finding from the submitted 138 written narratives was that the participants often described experiences from the first contact with hospital staff to the end of their treatment, rather than as a single instance of diagnosis communication. The relational meaning of these experiences was obvious. Information on treatment was of the utmost significance. No one required more prognostic information. From the perspective of the physicians, "bad news" focuses on how to provide information about diagnosis and prognosis in the course of a single diagnostic consultation. From the patient's perspective, "bad news" reflects the process of being diseased by cancer, and how medical services are available when one is in need of establishing a helpful relationship. In this relationship information about diagnosis and treatment is more a means than an end.Bad news Cancer Communication Patient-physician relationship Narrative analysis

Why 'spirituality' instead of 'the humanistic side of medicine'?

To the Editor: In a recent commentary, Puchalski et al1 describe the developing field of "spirituality” and its expansion into health professions education. However, we question whether this promotion really reflects an improvement. 1 Puchalski CM, Blatt B, Kogan M, Butler A. Spirituality and health: The development of a field. Acad Med. 2014;89:10–16

What does an oncology social worker deal with in patient consultations? : An empirical study

The oncology social worker is a core profession in the psycho- social care of cancer patients, and has been scrutinised accord- ing to its role, function, and delivery of care, primarily from an Anglo-Saxon perspective. There is, however, a lack of studies outside this context, and empirical studies based on individual data. This study is a contribution by exploring the variability in clinical practice from a Swedish perspective. It is based on documentation from one oncology social worker’s (OSW’s) patient contacts over the course of one year. The essence of the majority of contacts was counseling and the patients dis- played a wide variety of motives for seeing an OSW. The function of the OSW is thus multifaceted, and the findings suggest that the OSW, in addition to guiding patients in social legislation issues, also should be prepared to act as an anchor in an acute crisis, contain despair in different phases of the trajectory, and facilitate the ‘carrying on as before’ or finding a ‘new normal’. The paper discusses the importance of the OSW being acquainted with different counseling/psychother- apy perspectives in the illness context, but primarily the impor- tance of having the ability to establish a ‘working alliance’ with their patients

Two sides of the same coin : Oncology social workers’ experiences of their working life and its pros and cons

From the literature we learn that social workers in health care are exposed to different stressors connected to the risk for the development of burnout or traumatization. However, there is a lack of studies that focuses on the social workers’ own narratives on the burdensome, but also the rewarding aspects, of social work in health care. This study focuses on social work in oncology. Thematically structured qualitative interviews were conducted in a narrative form with 20 oncology social workers, half of whom were less experienced and half of whom were more experienced and with additional training in psychotherapy. The interviews focused on ‘pros and cons of practicing social work’ and the results were categorized by means of the similarities-differences technique. The burdensome cons concerned ‘Organizational and professional barriers’ and ‘Demanding cases’, with the latter divided into ‘Impasse because of hopelessness’ and ‘Impasse because of helplessness’. The rewarding pros categories all concerned meaningfulness including ‘Organizational meaningfulness’, ‘Meaningfulness from giving’, ‘Meaningfulness from receiving’, and ‘Meaningfulness from personal development’. Our findings indicate that the burdensome and rewarding aspects are two sides of the same coin. They are interconnected in the sense that the strain and challenge of being in situations of psychological despair also imply emotional satisfaction due to an experience of meaningfulness