Existential communication in maternity care - Mixed method evaluation of a postgraduate short course

OBJECTIVE

The birth of a child is a significant life event, possibly accompanied by thoughts and feelings of existential turmoil, which some parents need to share. Maternity care professionals may be unprepared for this, as very few educational initiatives exist with a focus on existential communication. We evaluated the curriculum and delivery of a course in existential communication for midwives. The evaluation was based on participants' experiences of self-reported self-efficacy and self-reflection before and after participation.

METHODS

A parallel mixed methods design with pre- and post-course questionnaires and field observations. Quantitative data were evaluated using Mann-Whitney analyses, and open-ended questions and field observations were thematised for further analysis.

RESULTS

Seventy-three maternity care professionals participated in the course. Of these, 69 (95%) completed a pre-course questionnaire, and 71 (97%) a post-course questionnaire. The quantitative data found a significant difference in various participant measures such as increase in self-efficacy in existential communication and understanding of existential communication. Qualitative data from the questionnaires and field observations led to six different themes including topics such as the need for reflection with peers and the presence of existential within maternity care.

CONCLUSIONS

The course evaluation suggested an increase in participants' awareness of existential aspects of maternity care and improved self-reflection and existential awareness.

Designing and Developing an eHealth Program for Patients With Persistent Physical Symptoms: Usability Study

BACKGROUND

Patients with persistent physical symptoms presenting in primary care are often affected by multiple symptoms and reduced functioning. The medical and societal costs of these patients are high, and there is a need for new interventions tailored to both the patients and health care system.

OBJECTIVE

This study aimed to examine the usability of an unguided, self-help treatment program, "My Symptoms," developed to assist patients and general practitioners in symptom management.

METHODS

In all, 11 users (4 patients with persistent physical symptoms and 7 laypeople) participated in web-based thinking-aloud interviews involving the performance of predefined tasks in the program. Thematic analysis was used to categorize the severity of usability issues. General usability heuristics were cross-referenced with the usability issues.

RESULTS

The analysis identified important usability issues related to functionality, navigation, and content. The study shows how therapeutic knowledge in some cases was lost in the translation of face-to-face therapy to a digital format. The user testing helped uncover how the functionality of the digital elements and general navigation of the program played a huge part in locating and accessing the needed treatment. Examples of redesign to mediate the therapeutic value in the digital format involving health care professionals, web developers, and users are provided. The study also highlights the differences of involving patients and laypeople in the interviews.

CONCLUSIONS

Taking the experience of common symptoms as a point of departure, patients and laypeople contributed to finding usability issues on program functionality, navigation, and content to improve the program and make the treatment more accessible to users.

Narrative recognition and identification: a qualitative pilot study into reading literary texts with advanced cancer patients

Purpose

Patients with advanced cancer can experience their disease as a contingent life event. The sudden interruption of their life stories can obscure life goals and disrupt meaning making. In the context of the research project “In search of stories,” we aim to investigate the reading and discussion of selected stories which present ways of dealing with a contingent life event. In addition, we examine the use of a newly developed guide for reading these exemplary texts together with advanced cancer patients.

Methods

This qualitative study describes the experiences of five patients with advanced cancer who participated in a guided reading and discussion about selected literary texts. The intervention consisted of reading a selected story, after which each patient was interviewed, using the reading guide as a conversation template. The interviews were then thematically analyzed for their conceptual content using a template analysis.

Results

All five conversations showed some form of recognition in reaction to the chosen text, which led to personal identification of experiences of contingency, such as loss of life goals, impending death, or feelings of uncertainty. Besides the important role of identification, revealed by the responses to the questions in the reading guide, the discussion of the text helped them articulate their own experience and sources of meaning. Diverse worldviews came to the fore and concepts of meaning such as fate, life goals, quality of life, and death.

Conclusions

First experiences with our newly developed reading guide designed to support a structured reading of stories containing experiences of contingency suggest that it may help patients to express their own experiences of contingency and to reflect on these experiences.

Implications for Cancer Survivors

The intervention tested in this study may contribute to supportive care for survivors with advanced cancer, but further research is needed to evaluate its effect on quality of life.