The role of communication in breast cancer screening: A qualitative study with Australian experts

Background: One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts’ opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? Methods: We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. Results: Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers’ breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here’s why; Screening is available please consider whether it’s right for you. There was a similar level of support for all three approaches. Experts’ reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. Conclusions: There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims

Framing overdiagnosis in breast screening: a qualitative study with Australian experts

Background: The purpose of this study was to identify how the topic of overdiagnosis in breast cancer screening is framed by experts and to clarify differences and similarities within these frames in terms of problems, causes, values and solutions. Methods: We used a qualitative methodology using interviews with breast screening experts across Australia and applying framing theory to map and analyse their views about overdiagnosis. We interviewed 33 breast screening experts who influence the public and/or policy makers via one or more of: public or academic commentary; senior service management; government advisory bodies; professional committees; non-government/consumer organisations. Experts were currently or previously working in breast screening in a variety of roles including clinical practice, research, service provision and policy, consumer representation and advocacy. Results: Each expert used one or more of six frames to conceptualise overdiagnosis in breast screening. Frames are described as: Overdiagnosis is harming women; Stop squabbling in public; Don’t hide the problem from women; We need to know the overdiagnosis rate; Balancing harms and benefits is a personal matter; and The problem is overtreatment. Each frame contains a different but internally coherent account of what the problem is, the causes and solutions, and a moral evaluation. Some of the frames are at least partly commensurable with each other; others are strongly incommensurable. Conclusions: Experts have very different ways of framing overdiagnosis in breast screening. This variation may contribute to the ongoing controversy in this topic. The concept of experts using different frames when thinking and talking about overdiagnosis might be a useful tool for those who are trying to negotiate the complexity of expert disagreement in order to participate in decisions about screening

Values in breast cancer screening: an empirical study with Australian experts

Objective To explore what Australian experts value in breast screening, how these values are conceptualised and prioritised, and how they inform experts\u27 reasoning and judgement about the Australian breast-screening programme. Design Qualitative study based on interviews with experts. Participants 33 experts, including clinicians, programme managers, policymakers, advocates and researchers selected for their recognisable influence in the Australian breast-screening setting. Setting Australian breast-screening policy, practice and research settings. Results Experts expressed 2 types of values: ethical values (about what was good, important or right) and epistemological values (about how evidence should be created and used). Ethical values included delivering benefit, avoiding harm, promoting autonomy, fairness, cost effectiveness, accountability, professionalism and transparency. Epistemological values informed experts\u27 arguments about prioritising and evaluating evidence methodology, source population and professional interests. Some values were conceptualised differently by experts: for example, delivering benefit could mean reducing breast cancer mortality, reducing all-cause mortality, reducing mortality in younger women, reducing need for aggressive treatment, and/or reassuring women they were cancer free. When values came into conflict, experts prioritised them differently: for example, when experts perceived a conflict between delivering benefits and promoting autonomy, there were differences in which value was prioritised. We explain the complexity of the relationship between held values and experts\u27 overall views on breast cancer screening. Conclusions Experts\u27 positions in breast screening are influenced by evidence and a wide range of ethical and epistemological values. We conclude that discussions about values should be a regular part of breast-screening review in order to build understanding between those who hold different positions, and provide a mechanism for responding to these differences

Climate Change and San Francisco Bay-Delta Tidal Wetlands

Climate change will affect tidal wetlands with higher rates of sea-level rise and higher concentrations of salt in brackish and freshwater tidal systems, in addition to causing increases in atmospheric CO2 concentration, warmer temperatures, and shifts in precipitation. In the San Francisco Bay–Delta, the areas most likely to be affected—brackish and freshwater tidal wetlands—are also the sites with the majority of endemic plant species and the greater biodiversity and productivity. Effects on the San Francisco Bay– Delta estuary are complex and difficult to predict, but a few things are clear. Biodiversity of the tidal wetland system in the San Francisco Bay–Delta region will decline, with subsequent effects on ecosystem functioning and services. Altered plant production, physiological tolerances, and shifts in rates of mortality will modify wetland plant communities in ways not yet predictable. Lower ecosystem productivity from salinity increases will affect both primary and detrital-based food webs. Such changes will cascade via the food webs into invertebrate, bird, and pelagic systems. Tidal wetlands are especially sensitive to processes that climate change will alter. Several of these altered processes are exacerbated by water diversions from the Delta

Patients educating health care providers on Lynch syndrome

Objective: Lynch syndrome (LS) patients are at an elevated risk for early-onset cancers, including endometrial and colorectal (CRC). Prior research has shown a deficit in provider knowledge of LS, which may affect patient satisfaction and adherence to recommended screening and surveillance regimens. Studies suggest patients with LS may educate providers perceived as lacking LS knowledge; however, little is known about these interactions. The goal of this study is to assess patient-reported outcomes from clinical interactions where LS patients educate their providers. Methods: Participants (n=55) were asked to complete an in-depth telephone interview. Results: Out of 55 participants, approximately two-thirds (n=37) reported engaging in educational interactions. Participants reported feeling satisfied with the provider response in over half of the reported educational interactions (n=24). Participants reported changes in their patient-provider relationship ranging from improvements in their relationship to termination of services. Conclusion: Patients with LS report educating providers on their diagnosis as well as their screening and surveillance requirements. Patient-reported outcomes of these educational interactions vary based on the provider’s response to the interaction. Providers should be open and receptive to these educational interactions and follow-up on the discussion to improve patient satisfaction

Role of unfolded proteins in lung disease.

The lungs are exposed to a range of environmental toxins (including cigarette smoke, air pollution, asbestos) and pathogens (bacterial, viral and fungal), and most respiratory diseases are associated with local or systemic hypoxia. All of these adverse factors can trigger endoplasmic reticulum (ER) stress. The ER is a key intracellular site for synthesis of secretory and membrane proteins, regulating their folding, assembly into complexes, transport and degradation. Accumulation of misfolded proteins within the lumen results in ER stress, which activates the unfolded protein response (UPR). Effectors of the UPR temporarily reduce protein synthesis, while enhancing degradation of misfolded proteins and increasing the folding capacity of the ER. If successful, homeostasis is restored and protein synthesis resumes, but if ER stress persists, cell death pathways are activated. ER stress and the resulting UPR occur in a range of pulmonary insults and the outcome plays an important role in many respiratory diseases. The UPR is triggered in the airway of patients with several respiratory diseases and in corresponding experimental models. ER stress has been implicated in the initiation and progression of pulmonary fibrosis, and evidence is accumulating suggesting that ER stress occurs in obstructive lung diseases (particularly in asthma), in pulmonary infections (some viral infections and in the setting of the cystic fibrosis airway) and in lung cancer. While a number of small molecule inhibitors have been used to interrogate the role of the UPR in disease models, many of these tools have complex and off-target effects, hence additional evidence (eg, from genetic manipulation) may be required to support conclusions based on the impact of such pharmacological agents. Aberrant activation of the UPR may be linked to disease pathogenesis and progression, but at present, our understanding of the context-specific and disease-specific mechanisms linking these processes is incomplete. Despite this, the ability of the UPR to defend against ER stress and influence a range of respiratory diseases is becoming increasingly evident, and the UPR is therefore attracting attention as a prospective target for therapeutic intervention strategies

Linking Abusive Supervision to Employee Engagement and Exhaustion

This research extends the differentiated job demands–resource model by integrating the main propositions of the transactional theory of stress to examine how cognitive appraisal processes link employee perceptions of abusive supervision to engagement and exhaustion. Two studies were conducted using a broad sample of employees. Study 1 developed the abusive supervision demand appraisal measure (ABSDAM). Study 2 examined the role that challenge or hindrance demand appraisals play in employee reactions to perceptions of abusive supervision. Study 1 determined that the ABSDAM was a valid means to measure how employees appraise abusive supervision as a challenge and/or hindrance demand. Study 2 found that hindrance demand appraisals mediate the relationship between perceived abusive supervision and exhaustion, while challenge demand appraisals mediate the relationship between perceived abusive supervision and engagement. This study suggests that accounting for demand appraisal processes provides further insight into how perceptions of abusive supervision may contribute to engagement and exhaustion

“It’s Not Smooth Sailing”: Bridging the Gap Between Methods and Content Expertise in Public Health Guideline Development

Background: The development of reliable, high quality health-related guidelines depends on explicit and transparent processes, methods aimed at minimising risks of bias and the inclusion of all relevant expertise and perspectives. While the methodological aspects of guidelines have been a focus to improve their quality, less is known about the social processes involved, for example, how guideline group members interact and communicate with one another, and how the evidence is considered in informing recommendations. With this in in mind, we aimed to empirically examine the perspectives and experiences of the key participants involved in developing public health guidelines for the Australian National Health and Medical Research Council (NHMRC). Design: This study was conducted using constructivist grounded theory as described by Charmaz, which informed our sampling, data collection, coding and analysis of interviews with key participants involved in developing public health guidelines.Setting: Australian public health guidelines commissioned by the NHMRC.Participants: Twenty experts that were involved in Australian NHMRC public health guideline development, including working committee members with content topic expertise (n = 16) and members of evidence review groups responsible for evaluating the evidence (n = 4).Results: Public health guideline development in Australia is a divided process. The division is driven by 3 related factors: the divergent disciplinary background and expertise that each group brings to the process; the methodological limitations of the framework, inherited from clinical medicine, that is used to assess the evidence; and barriers to communication between content experts and evidence reviewers around respective roles and methodological limitations.Conclusion: Our findings suggest several improvements for a more functional and unified guideline development process: greater education of the working committee on the methodological process employed to evaluate evidence, improved communication on the role of the evidence review groups and better facilitation of the process so that the evidence review groups feel their contribution is valued

Promoting Entrepreneurship amid Youth in Windhoek’s Informal Settlements: A Namibian Case

Considering the high unemployment rate among Namibian youth and a lack of job opportunities, the promotion of entrepreneurship has gained wider attention in the country. A number of initiatives have been started such as entrepreneurship trainings and workshops, business idea competitions, etc. All these aim to inspire young people to think of alternative income sources. As part of a two-year funded community outreach research and development (R&D) project, we have investigated participatory approaches to engage marginalized youth into conceptualizing their own context, imparting skills, and deriving new career paths. This article reports and reflects on one of the interventions we have recently concluded with a group of youth in Havana, an informal settlement in the outskirts of Windhoek. We conducted what we entitled “The Havana Entrepreneur”, a series of interactions inspired upon the model of the American reality game show “The Apprentice”. Over a number of weeks two youth groups were given challenges to tackle by means of competing against one another. After completion of each challenge, groups were rated by a number of judges on skills demonstrated such as marketing, presentation, reflection and creativity among others. We observed an increase in, and improvement of skills revealed along tasks’ completion, besides an openly expressed self-realization and discovery of abilities by participants. Moreover, the youth are currently engaged in the continuation of activities beyond the initial entrepreneurial interactions. Thus we suggest replicating “The Havana Entrepreneur”, including the recording on camera of it by the youth themselves as a new mode to instigating a wider entrepreneurial spirit in informal settlements