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Hodgson S, Noack K, Griffiths A, Hodgins M. Between equilibrium and chaos, with little restitution: a narrative analysis of qualitative interviews with clinicians and parent carers of children with medical complexity. BMC Health Serv Res 2024; 24:504. [PMID: 38654202 DOI: 10.1186/s12913-024-10973-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) comprise 1% of the paediatric population, but account for over 30% of health service costs. Lack of healthcare integration and coordination for CMC is well-documented. To address this, a deep understanding of local contextual factors, experiences, and family-identified needs is crucial. The aim of this research was to investigate the lived experiences of CMC, their families, and healthcare staff, focusing on understanding the dynamics of care coordination and the challenges faced in providing integrated care, in order to inform the development of effective, family-centred models of care. METHODS In April to July 2022, 31 semi-structured interviews were conducted with parents/guardians of CMC and healthcare professionals who care for CMC. Interviews explored complex paediatric care and care coordination barriers. An inductive thematic analysis was undertaken. Themes were then further explored using Frank's narrative approach. RESULTS Through analysis, we identified that the restitution typology was absent from both staff and parent/guardian narratives. However, we uncovered narratives reflective of the chaos and quest typologies, depicting overwhelming challenges in managing complex medical needs, and proactive efforts to overcome barriers. Importantly, a novel typology termed 'equilibrium' was uncovered. Narratives aligning with this typology described medical complexity as a balance of power and a negotiation of roles. Within the equilibrium typology, illness trajectory was described as a series of negotiations or balancing acts between healthcare stakeholders, before finally reaching equilibrium. Participants described seeking a balance, where their expertise is respected, whilst maintaining the ability to rely on professional guidance and support. These insights provide a nuanced understanding of the multifaceted narratives shaping care experiences for CMC and their families. CONCLUSIONS Our research delineates multifaceted challenges within the care landscape for CMC, their families, and healthcare staff. Embracing the equilibrium narrative typology highlights the criticality of tailored, integrated care models. This necessitates prioritising clear role delineation and communication among caregivers, implementing support systems addressing the challenges of continuous caregiving, and integrating parents/guardians as essential members of the care team. These insights advocate for pragmatic and sustainable strategies to address the unique needs of CMC and their families within healthcare systems.
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Affiliation(s)
| | - Kirsten Noack
- Hunter New England Local Health District, Newcastle, Australia
| | | | - Michael Hodgins
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv 2023:10.1007/s11764-023-01373-6. [PMID: 37040001 DOI: 10.1007/s11764-023-01373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. METHODS A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. RESULTS Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. CONCLUSIONS The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
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Affiliation(s)
- Jill M Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA.
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA.
| | - Sheryl Gabram
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Janae Finley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
| | | | - Lisa VanHoose
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- College of Saint Mary, Omaha, NE, USA
- The Ujima Center, Monroe, LA, USA
| | - Lauren E McCullough
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Cole L, Easley J, Grightmire L, Lakshmanan EM, Matthias SJ, McBoyle K, Piercell E, Purdy A, Schneider N, Wassersug RJ, Martino R, Fitch MI. Every Story Is Different: Experiences With Body Changes Related to Cancer. Front Psychol 2022; 13:831811. [PMID: 35677121 PMCID: PMC9169964 DOI: 10.3389/fpsyg.2022.831811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/05/2022] [Indexed: 11/16/2022] Open
Abstract
One of the important aspects of stakeholder engagement in cancer care and system planning is hearing from individuals who have been diagnosed with cancer about the impact of the diagnosis and treatment on their lives. Hearing stories from the perspectives of cancer survivors offers opportunity to gain new insight and understanding about experiences of being diagnosed and treated for cancer. This article presents ten short narratives about survivors' perspectives on body image and cancer. Each story is unique but, taken together, the picture they create is one of facing challenges, discovering personal resilience, and moving forward to engage in living. The stories emphasize the importance of communication and support from healthcare providers and understanding needs for a person-centered cancer care system.
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Affiliation(s)
- Linda Cole
- Independent Scholar, Toronto, ON, Canada
| | | | | | | | - Sharon J. Matthias
- Matthias Inc: Connecting for Innovation and Advancing Societies, Edmonton, AB, Canada
| | | | | | | | | | | | - Rosemary Martino
- Department of Speech Language Pathology, Rehabilitation Science Institute, University of Toronto, Toronto, ON, Canada
| | - Margaret I. Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Bonnamy J. Holding Multiple Identities: a Personal Narrative of Young Onset Colorectal Cancer. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1261-1266. [PMID: 32270373 DOI: 10.1007/s13187-020-01740-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This is a personal narrative of my experience as a young man diagnosed with colorectal cancer. It is an exploration of the tension between multiple identities, including a clinical nurse specialist, academic and oncology patient. Young patients with colorectal cancer face particular challenges. They are often diagnosed with more advanced and poorly differentiated cancers. Research around young onset colorectal cancer is controversial, with some studies suggesting poorer survival. Although there is research in this area, there are few qualitative accounts that describe raw, honest and diverse narratives of colorectal cancer experiences, especially in young people. Writing personal narratives is a powerful experience, it has allowed me to tell my story to the world and given me time to reflect and make sense of my new reality. Although this journey has forced me to let go of my old identity, and embrace a new and challenging existence, the truth is that being diagnosed with cancer stinks. Writing this narrative is an uncomfortable process, punctuated with truths that are difficult to speak. However, sharing my story has provided a platform for self-exploration, a safe space to narrate my experience with cancer in the hope that it helps other clinicians, researchers and patients.
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Affiliation(s)
- James Bonnamy
- School of Nursing and Midwifery, Monash University, 47-49 Moorooduc Highway, Frankston, Victoria, 3199, Australia.
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Byrne C, Soundy A. The effects of storytelling in the promotion of physical activity for chronically ill patients: an integrative review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Physical activity is regarded as an essential component of self-management for people with chronic illness. Storytelling is an approach that successfully uses a group environment to influence change in physical activity intentions and behaviours. The aim of this study was to develop an understanding of what a storytelling intervention entails, its main effects and how this leads to the promotion of physical activity in chronically ill patients. Methods An integrative review was undertaken in three stages: search, appraisal and synthesis. Studies were included if they represented participants with a chronic illness, used a storytelling approach for the intervention and had physical activity as a component of the intervention. Results A total of 14 articles were identified that included a total of 818 participants (191 male, 348 female, 279 unknown). No articles were identified as flawed and all were included in the synthesis. Four themes were identified: ideal processes within interventions; psychosocial factors that influenced storytelling; perceived outcomes relating to storytelling; and perceived benefits of physical activity. Conclusions This review develops a deeper understanding of the required processes, associated factors and outcomes of storytelling interventions for people with chronic illness. It provides evidence of how storytelling can be used to promote physical activity. Further research into storytelling interventions is required.
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Affiliation(s)
- Charlotte Byrne
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
| | - Andy Soundy
- School of Sport, Exercise and Rehabilitation, University of Birmingham, Birmingham, UK
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Fiddian-Green A, Kim S, Gubrium AC, Larkey LK, Peterson JC. Restor(y)ing Health: A Conceptual Model of the Effects of Digital Storytelling. Health Promot Pract 2019; 20:502-512. [PMID: 30736703 DOI: 10.1177/1524839918825130] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We currently see an interdisciplinary shift toward a "participatory turn" in health research and promotion under which community engagement, shared decision making and planning, and the use of visual and digital methods have become paramount. Digital storytelling (DST) is one such innovative and engaging method increasingly used in applied health interventions, with a growing body of research identifying its value. Despite its increasing use, a standard approach to empirically assess the impacts on individuals participating in DST interventions does not currently exist. In this article, we define DST as a distinct narrative intervention, illustrate key elements that inform the methodology, and present a conceptual model to examine how DST may contribute to increased socioemotional well-being and bolster positive health outcomes. Our proposed model is informed by elements of narrative theory, Freirian conscientization, multimodality, and social cognitive theory and can serve as a guide for public health practitioners and researchers interested in assessing the potential benefits of DST as an applied health intervention. Recommendations for practice call for a rigorous methodological approach to apply and test this model across a range of health contexts and populations.
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Affiliation(s)
| | - Sunny Kim
- 2 Arizona State University, Phoenix, AZ, USA
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Crangle CE, Bradley C, Carlin PF, Esterhay RJ, Harper R, Kearney PM, McCarthy VJC, McTear MF, Savage E, Tuttle MS, Wallace JG. Exploring patient information needs in type 2 diabetes: A cross sectional study of questions. PLoS One 2018; 13:e0203429. [PMID: 30444868 PMCID: PMC6239280 DOI: 10.1371/journal.pone.0203429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/21/2018] [Indexed: 01/02/2023] Open
Abstract
This study set out to analyze questions about type 2 diabetes mellitus (T2DM) from patients and the public. The aim was to better understand people's information needs by starting with what they do not know, discovered through their own questions, rather than starting with what we know about T2DM and subsequently finding ways to communicate that information to people affected by or at risk of the disease. One hundred and sixty-four questions were collected from 120 patients attending outpatient diabetes clinics and 300 questions from 100 members of the public through the Amazon Mechanical Turk crowdsourcing platform. Twenty-three general and diabetes-specific topics and five phases of disease progression were identified; these were used to manually categorize the questions. Analyses were performed to determine which topics, if any, were significant predictors of a question's being asked by a patient or the public, and similarly for questions from a woman or a man. Further analysis identified the individual topics that were assigned significantly more often to the crowdsourced or clinic questions. These were Causes (CI: [-0.07, -0.03], p < .001), Risk Factors ([-0.08, -0.03], p < .001), Prevention ([-0.06, -0.02], p < .001), Diagnosis ([-0.05, -0.02], p < .001), and Distribution of a Disease in a Population ([-0.05,-0.01], p = .0016) for the crowdsourced questions and Treatment ([0.03, 0.01], p = .0019), Disease Complications ([0.02, 0.07], p < .001), and Psychosocial ([0.05, 0.1], p < .001) for the clinic questions. No highly significant gender-specific topics emerged in our study, but questions about Weight were more likely to come from women and Psychosocial questions from men. There were significantly more crowdsourced questions about the time Prior to any Diagnosis ([(-0.11, -0.04], p = .0013) and significantly more clinic questions about Health Maintenance and Prevention after diagnosis ([0.07. 0.17], p < .001). A descriptive analysis pointed to the value provided by the specificity of questions, their potential to disclose emotions behind questions, and the as-yet unrecognized information needs they can reveal. Large-scale collection of questions from patients across the spectrum of T2DM progression and from the public-a significant percentage of whom are likely to be as yet undiagnosed-is expected to yield further valuable insights.
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Affiliation(s)
- Colleen E. Crangle
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Paul F. Carlin
- South Eastern Health and Social Care Trust, Research Office, Dundonald, Northern Ireland, United Kingdom
| | - Robert J. Esterhay
- Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, United States of America
| | - Roy Harper
- Department of Endocrinology & Diabetes, The Ulster Hospital, South Eastern Health and Social Care Trust, Dundonald, Northern Ireland, United Kingdom
| | - Patricia M. Kearney
- Department of Epidemiology & Public Health, University College Cork, Cork, Ireland
| | | | - Michael F. McTear
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Mark S. Tuttle
- Board of Directors, Apelon Inc., Hartford, Connecticut, United States of America
| | - Jonathan G. Wallace
- School of Computing and Mathematics, University of Ulster at Jordanstown, Jordanstown, Northern Ireland, United Kingdom
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Narrative analysis of written accounts about living with epileptic or psychogenic nonepileptic seizures. Seizure 2018; 62:59-65. [DOI: 10.1016/j.seizure.2018.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/05/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
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Coyle LA, Atkinson S. Imagined futures in living with multiple conditions: Positivity, relationality and hopelessness. Soc Sci Med 2018; 198:53-60. [PMID: 29276986 PMCID: PMC5884318 DOI: 10.1016/j.socscimed.2017.12.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 11/28/2022]
Abstract
Hope serves as an overarching concept for a range of engagements that demonstrate the benefits of a positive outlook for coping with chronic conditions of ill-health and disability. A dominant engagement through medicine has positioned hope as a desirable attribute and its opposite, hopelessness, as pathological. In this engagement hope is individual, internally located and largely cognitive and able to be learned. Attaining hope reflects a process of coming to terms with the losses associated with long-term conditions and of imagining new meanings and purposes for the future ahead. This process is characterised by a set of linear temporal stages, from loss and denial to acceptance and reappraising the life-course, by an emphasis on the morally desirable exercise of self-care and by a desired outcome that, in the absence of cure, is hope. Through interviews, we aim to unsettle the privileged status given to a positive outlook through examining the expressions, contexts and negotiations of hopelessness of people living with multiple conditions of ill-health and/or disability. These narratives of hopelessness disclose the ways in which realistic imagined possibilities for the future are constrained by external structures of time and function that demand complex negotiations with places, bodies and other people. As a situated and relational narrative, hopelessness draws our attention to the need to rebalance the exclusive attention to individual, internal resources with a renewed attention to contexts and settings. Moreover, hopelessness can be generative for those living with multiple conditions in shaping alternatively framed priorities with respect to their temporal and interpersonal relations.
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Affiliation(s)
- Lindsay-Ann Coyle
- Durham University, Department of Geography and the Centre for Medical Humanities, Lower Mountjoy, DH1 3LE, United Kingdom
| | - Sarah Atkinson
- Durham University, Department of Geography and the Centre for Medical Humanities, Lower Mountjoy, DH1 3LE, United Kingdom.
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De Clercq E, Elger B, Wangmo T. Missing life stories. The narratives of palliative patients, parents and physicians in paediatric oncology. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12651] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Affiliation(s)
- E. De Clercq
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
| | - B.S. Elger
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
| | - T. Wangmo
- Institute for Biomedical Ethics; University of Basel; Basel Switzerland
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Coll-Planas G, Visa M. The wounded blogger: analysis of narratives by women with breast cancer. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:884-898. [PMID: 26893129 DOI: 10.1111/1467-9566.12405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this article is to analyse the representation of the body in seven blogs by Spanish women with breast cancer. Using both texts and images, we analyse how they reproduce modern and postmodern logic to represent the wounded body. Based on Frank's proposals, this article draws the conclusion that the women bloggers mainly reproduce the modern logic (characterised by the restitution narrative and a predictable, disassociated and monadic body), but there are elements which break with this logic (the quest narrative, the body presented as associated, dyadic and full of desire, and the acceptance of contingency). After applying Frank's categories, we suggest that the contemporary way of experiencing illness may question the clarity of the modern/postmodern divide.
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Affiliation(s)
- Gerard Coll-Planas
- Department of Communication, University of Vic - Central University of Catalonia, Spain
| | - Mariona Visa
- Department of Philology and Communication, University of Lleida, Spain
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12
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Fioretti C, Smorti A. Narrating positive versus negative memories of illness: does narrating influence the emotional tone of memories? Eur J Cancer Care (Engl) 2016; 26. [PMID: 27271542 DOI: 10.1111/ecc.12524] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2016] [Indexed: 11/26/2022]
Abstract
Psychoncological studies have recognised a reduced autobiographical memory in cancer patients, furthermore cognitive studies have found that narrative is an effective instrument to re-elaborate memories. However, it is still unclear whether narrating positive versus negative events can have a different impact on autobiographical memory. The present study aims to explore the emotional experience of autobiographical memory before and after having narrated negative or positive events related to the illness. Of 63 oncological patients, 35 were selected for the present study. Participants completed a Memory Fluency Task twice, before and after having selected and narrated a positive (PN group) or a negative (NN group) memory of illness. They also had to attribute one or more emotions to each memory and to the narrative. The number of emotions and the percentage of emotional tones in both narrated and non-narrated memories were assessed. Narrated memories were more emotionally re-elaborated than non-narrated ones. Negative group participants, more than positive group ones, decreased negative emotions and increased complex ones. Authors discuss these results claiming that narrating works as a rehearsal of autobiographical memories in oncological patients and narrating negative memories eases the emotional re-elaboration of illness.
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Affiliation(s)
- C Fioretti
- Department of Educational Science and Psychology (SCIFOPSI), University of Florence, Florence, Italy
| | - A Smorti
- Department of Educational Science and Psychology (SCIFOPSI), University of Florence, Florence, Italy
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Atkinson S, Evans B, Woods A, Kearns R. 'The medical' and 'health' in a critical medical humanities. THE JOURNAL OF MEDICAL HUMANITIES 2015; 36:71-81. [PMID: 25502919 PMCID: PMC4352602 DOI: 10.1007/s10912-014-9314-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, 'medical humanities' and 'health humanities,' and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between 'the medical' and 'health' by looking at the history of an analogous debate between 'medical geography' and 'the geographies of health' that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities.
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Affiliation(s)
- Sarah Atkinson
- Department of Geography and the Centre for Medical Humanities, Durham University, Durham, DH1 3LE, UK,
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ASH JS, COTTRELL E, SAXTON L, NEWMAN L, GEBHARDT E, HELFAND M. Patient narratives representing patient voices to inform research: a pilot qualitative study. Stud Health Technol Inform 2015; 208:55-60. [PMID: 25676947 PMCID: PMC4390498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We are investigating the feasibility and effectiveness of establishing a library of patient narratives to inform patient-centered research in the U.S. Veterans Affairs organization. Using qualitative methods, we conducted a needs assessment of 15 researchers and then interviewed and videotaped 11 veterans with traumatic brain injury or diabetes. We developed a method for displaying the narratives to researchers modeled after a UK initiative called DIPEx and then performed preliminary usability testing. We found that it is not only feasible to provide researchers with patient narratives that could help guide their research, but that similar narratives might be useful to practitioners, health system decision makers, and other patients as well.
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Affiliation(s)
- Joan S ASH
- Oregon Health & Science University, Portland, OR, USA
| | | | - Lauren SAXTON
- Oregon Health & Science University, Portland, OR, USA
| | - Lucas NEWMAN
- Oregon Health & Science University, Portland, OR, USA
| | - Eric GEBHARDT
- Oregon Health & Science University, Portland, OR, USA
| | - Mark HELFAND
- Oregon Health & Science University, Portland, OR, USA
- Portland VA Medical Center, Portland, OR, USA
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An interpretative phenomenological analysis exploring the lived experience of individuals dying from terminal cancer in Ireland. Palliat Support Care 2014; 13:641-51. [DOI: 10.1017/s1478951514000285] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The experience of living with dying has attracted limited research. We utilized interpretive phenomenological analysis to explore the lived experience of individuals with terminal cancer receiving palliative care in Ireland.Method:Participants were purposely selected from public interviews that had been conducted between 2006 and 2011. The study included the accounts of eight participants (N = 8; six females and two males) with a diagnosis of terminal cancer. Participant ages ranged from 36 to 68 years.Results:Three master themes emerged from the analysis: the personal impact of diagnosis, the struggle in adjusting to change, and dying in context. The results revealed that participants were still living while simultaneously dying. Interestingly, participants did not ascribe new meaning to their lives. The terminal illness was understood within the framework of the life that had existed before diagnosis. They strove to maintain their normal routines and continued to undertake meaningful activities. Management of unfinished business and creation of a legacy were salient tasks. Social withdrawal was not present; rather, participants engaged in emotional labor to sustain valued roles. However, we found that within the public domain there is a paucity of education and discourse supporting individuals at the end of life. The hospice was noted as an important external resource. Each participant experienced a unique dying process that reflected their context.Significance of Results:Healthcare professionals need to recognize the subjectivity of the dying process. Dying individuals require support and options to maintain their personhood.
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Grassi L. Quam bene vivas referre
: curing and caring in psycho-oncology. Psychooncology 2013; 22:1679-87. [PMID: 23825038 DOI: 10.1002/pon.3333] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 12/26/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences; University of Ferrara; Ferrara Italy
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Woods A. Rethinking "Patient Testimony" in the Medical Humanities: The Case of Schizophrenia Bulletin's First Person Accounts. JOURNAL OF LITERATURE AND SCIENCE 2012; 6:38-54. [PMID: 24563663 PMCID: PMC3928561 DOI: 10.12929/jls.06.1.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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