Perceptions of social support and relationships while living with a brain tumour: a qualitative study

OBJECTIVE

Having a brain tumour can disrupt social roles and networks. Despite growing evidence on the significance of social support in adjustment to chronic illness, research rarely focuses on the role of relationships when coping with a brain tumour. The current study sought to explore individuals' experiences of social support, and the dynamics within their social relationships, following a diagnosis of a brain tumour.

METHODS

Interpretative Phenomenological Analysis (IPA) was used as a methodological framework. Participants were 12 individuals (83% female) aged 29-54 years diagnosed with primary brain tumour (83% low grade), on average 3.5 years post-diagnosis. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using IPA.

RESULTS

Five themes were identified: Coping together in the family; Being concerned about others; Giving and receiving support; Needing to share the experience; and Negotiating independence. The results highlighted that the illness affected a whole network of closest relationships, and that coping was not an individual task.

CONCLUSION

Coping with the condition was deeply socially embedded. There was a cost associated with seeking support and participants did not always ask for it, in order not to burden the caregivers. Talking to others with similar diagnoses provided a sense of validation and belonging.

'Make Them Wonder How You Are Still Smiling': The Lived Experience of Coping With a Brain Tumour

A brain tumour can be a life-threatening illness and cause unique symptoms compared to other types of cancer, such as cognitive or language deficits, or changes in personality. It is an exceptionally distressing diagnosis which can affect quality of life, even for those with a low-grade tumour or many years after the diagnosis. This study sought to gain an in-depth understanding of the lived experience of adjustment to living with a brain tumour. Twelve individuals (83% female) with a primary brain tumour (83% low-grade) took part in the study. Participants were aged 29-54 years, on average 43 months following the diagnosis, and were recruited through the charitable support organisations in the United Kingdom. In-depth semi-structured interviews were conducted, transcribed verbatim, and analysed using interpretative phenomenological analysis (IPA). Six inter-related themes were identified: making sense of the diagnosis, seeking empowerment, feeling appreciative, taking charge of coping, learning to accept, and negotiating a new normality. Notions of empowerment, gratitude, and acceptance throughout the illness journey were prominent in the participants' narratives. Receiving sufficient information and initiating treatment were important in negotiation of control. The results highlighted what facilitates and hinders adaptive coping. Aspects which facilitated positive coping were as follows: trust in clinician, feeling in control, feeling grateful, or accepting. Participants on a 'watch and wait' approach, while feeling appreciative, perceived the lack of treatment as difficult and frustrating. Implications for patient-clinician communication are discussed, particularly for patients on a 'watch and wait' who might need additional support in adjusting.

Identifying and Responding to Delirium in Acute Stroke: Clinical Team Members' Understandings

Delirium is associated with increased mortality, morbidity, and length of hospital stay. In the acute stroke setting, delirium identification is challenging due to the complexity of cognitive screening in this patient group. The aim of this study was to explore how members of interprofessional stroke-unit teams identified and responded to a potential delirium in a patient. Online focus groups and interviews utilizing case vignettes were conducted with 15 participants: nurses, occupational therapists, speech and language therapists, and physiotherapists working in acute stroke services. Participants' understandings of delirium varied, most participants did not identify the symptoms of a possible hypoactive delirium, and nearly all participants discussed delirium symptoms in tentative terms. Aspects of interprofessional working were discussed through the expression of distinct roles around delirium identification. Although participants demonstrated an ethos of person-focused care, there are ongoing challenges involved in early identification and management of delirium in stroke survivors.

Being conductor of the orchestra: an exploration of district nursing leadership

The purpose of the present study was to gain insight into how district nurses understand their leadership role. Data were generated through interviews and audio-journals and analysed using interpretive phenomenological analysis. Findings suggested that district nurses managing teams and caseloads experienced a burden of responsibility. Being creative problem solvers, they adopted facilitative ways of engaging with patients but directive approaches to team management. District nurses sharing leadership with multidisciplinary colleagues did not appear to experience this burden. Their leadership drew on their facilitative approaches to care-giving. If nurses enabled, rather than directed teams, they could create a context for developing autonomy and growth, easing the burden of responsibility.

The relationship between adult attachment and coping with brain tumour: the mediating role of social support

OBJECTIVE

A primary brain tumour diagnosis is known to elicit higher distress than other forms of cancer and is related to high depressive symptomatology. Using a cross-sectional design, the present study explored how individuals cope with this diagnosis using an attachment theory framework. Attachment anxiety and attachment avoidance were hypothesised to be positively related to helplessness/hopelessness, anxious preoccupation, and cognitive avoidance; and negatively related to fighting spirit and fatalism coping. We proposed perceived social support to play a mediating role in those associations.

METHODS

Four hundred and eighty participants diagnosed with primary brain tumours completed the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the Experiences in Close Relationships Questionnaire-Revised (ECR-R), and the modified Medical Outcomes Study-Social Support Scale (mMOS-SSS) online.

RESULTS

Lower perceived social support mediated the positive associations between both higher attachment anxiety and avoidance and higher helpless/hopeless coping. Attachment anxiety was also positively associated with anxious preoccupation. This relationship was not mediated by perceived social support. Cognitive avoidance was unrelated to both attachment dimensions and social support.

CONCLUSIONS

The findings highlight that the differences in coping repertoire are associated with social relatedness factors, specifically attachment security and its relationship to perceived social support. Implications of the findings are discussed.

A conversation analysis of communicative changes in a time-limited psychotherapy group for mothers with post-natal depression

Objective: To examine qualitatively changes occurring in discussions within a time-limited psychotherapy group for mothers with post-natal depression. Method: Discussions occurring in a group that comprised five mothers and a therapist were recorded over the course of six one-hour therapeutic sessions. Participants had been referred or had self-referred to the group on the basis of having post-natal depression. The recorded discussions were transcribed and then analysed in accordance with principles of conversation analysis. Results: Analysis of early and later group discussions showed changes in group members' alignment with the topics that were introduced, in turn-allocation and turn-taking, and in the co-construction of accounts of experience. In contrast to early discussions, in later discussions participants aligned with topics relating to personal emotions, self-selected as next speakers in the discussions, and collaboratively worked up accounts that made sense of their experiences of childbirth and of being diagnosed as having post-natal depression. Conclusions: Interactional changes over the duration of the group point to the benefits for mothers with post-natal depression of participating in a time-limited psychotherapy group. Fine-grained analysis of group discussions potentially offers a way of examining changes over time in psychotherapeutic groups more generally.

Design Issues for Socially Intelligent User Interfaces

Objectives: This study aims to demonstrate the usability of discourse analyses as a means of evaluating medical informatics systems by examining one particular computer-based data-to-text system for delivering neonatal health care information.

Methods: Six textual summaries of clinical information, three produced by human clinicians and three by the data-to-text system, were subjected to fine-grain discourse analysis. Analysis was performed ‘blind’ on all six textual summaries. Analysis focused on the identification of lexical items and on the potential effects of these items on users of these clinical information summaries.

Results: Results showed that there were clear differences between human- and system-generated clinical summaries, with human clinicians providing better narrative flow and textual detail. The data-to-text system successfully produced textual summaries although it fell short of human abilities.

Conclusions: These results indicate potential future improvements to the system. Discourse analysis as used here may offer significant advantages in evaluating and developing similar medical informatics systems.

'If they have a girlfriend, they have five girlfriends': Accountability and sexism in volunteer workers' talk about HIV/AIDS in a South African health setting

Significant challenges remain in tackling the global HIV/AIDS epidemic. Effective action requires both appropriate policy at a global level and informed practice on the local level. Here, we report how workers in a project in Johannesburg, South Africa, make sense of HIV transmission. Discourse analysis of data from interviews with 63 participants shows that project workers routinely attribute transmission to men's sexual relationships with multiple female partners. This explanation is so pervasive that it renders invisible other routes to transmission. Absence of consideration of other routes to infection potentially restricts front-line practice, so hindering local attempts to tackle HIV/AIDS.

The micro and the macro: How discourse of control maintains HIV-related stigma

In this article, we examine how HIV/AIDS caregivers negotiate stigma in their discourse of providing care to HIV-positive individuals. Using interview data, we demonstrate how participants employed discourse of control in attempting to avoid and counter HIV-related stigma: participants rejected fear of associating with HIV-positive individuals by drawing on their knowledge of HIV transmission and their ability to control and avoid infection. Such discourses backfire, however, as the concept of HIV infection being controllable and thus avoidable maintains accountability for the disease. Thus, participants' micro discourse of control can maintain the macro discourse that produces HIV-related stigma.

Negotiating parental accountability in the face of uncertainty for attention-deficit hyperactivity disorder

Despite extensive research into attention-deficit hyperactivity disorder (ADHD), parents' constructions of their children's behaviors have received limited attention. This is particularly true outside North American contexts, where ADHD is less established historically. Our research demonstrates how United Kingdom parents made sense of ADHD and their own identities postdiagnosis. Using discourse analysis from interviews with 12 parents, we show that they drew from biological and social environmental repertoires when talking about their child's condition, paralleling repertoires found circulating in the United Kingdom media. However, in the context of parental narratives, both these repertoires were difficult for parents to support and involved problematic subject positions for parental accountability in the child's behavior. In this article we focus on the strategies parents used to negotiate these troublesome identities and construct accounts of moral and legitimate parenting in a context in which uncertainties surrounding ADHD existed and parenting was scrutinized.

'They're more than animals': refugees' accounts of racially motivated violence

Previous discursive research has found that minority group members may deny or downplay the existence of discrimination. However, to date, little research has addressed the issue of violence against minority group members. This study therefore draws on interviews with asylum seekers and refugees in a Scottish city to analyse their reports of violence committed against them. One form of reporting violence was by way of a complaint available to any speaker, in making no reference to attributes of attackers or victim. When racism was alleged, it was presented as a tentative, reluctant or 'last resort' explanation. The descriptions offered by interviewees reflected the contributions made by the interviewer, highlighting the ways in which these reports are interactional co-productions. The results suggest that accounts from victims of seemingly racially motivated violence may function in similar ways to 'new racism' in making racism seem to 'disappear'. These findings point to the potential difficulties that arise in identifying and looking to challenge instances of 'new racism'.

Living with falls: house-bound older people's experiences of health and community care

Despite world-wide emphasis on falls prevention, falls and their consequences remain a major health issue for older people, and their health care providers. Many systematic reviews have been undertaken to evaluate the impact of intervention programmes on falls reduction, however, relatively little research provides a voice for older people's own perceptions of such programmes. To readdress this imbalance the current research utilized a purposive sampling method to recruit a hard to reach group of older people who had received a post-fall health and social-care programme to investigate their experiences of the programme. Semi-structured interviews with eight housebound people aged over 65 who had fallen were undertaken, and data analysed using interpretative phenomenological analysis. Four themes were identified: losing independence; losing confidence; losing social identity; managing a changed self. Despite a tailored intervention programme minimal improvement in participants' psychological adjustment to falls was noted. Outcomes from this study are of interest to health and social-care staff who deliver falls prevention programmes. Staff need to enhance constructive adjustment to the older person's altered circumstances and ensure behaviours do not exacerbate their clients' loss of independence. This should assist older people's ability to positively manage their sense of self, allowing them to find continuing meaning in their daily lives.

Locals, incomers and intra-national migration: Place-identities and a Scottish island

In a trans-national context, immigrants are often described as essentially different from existing residents. However these descriptions of group differences are occasioned constructions of immigrants, and talk about nations provides frameworks of history and space within which immigration is understood. Claimed group differences and the proposed commonality of nation together present a challenging context for immigrants to negotiate identities and to gain acceptance. Drawing on the concept of place-identity, we examined here whether similar issues arise in intra-national migration to a remote Scottish island. We conducted semi-structured interviews with individuals who had lived on the island for periods ranging from 14 months to 20 years. The interviewees described island residents as comprising different groups, in terms such as residence, motivation, place of birth, and connections to other locations. The interviewees negotiated place-identities that compared favourably with others with more transitory connections but unfavourably with residents of longer-standing. Findings show that spatial connections can be used to account for varying degrees of social status in such locations. But some issues relevant to trans-national immigration still arise in intra-national migration, even in the absence of racial, ethnic, religious, or language differences. In short, 'incomers' cannot readily do 'being local'.

Committed to (un)equal opportunities?: ‘New ageism’ and the older worker

In recent years the principle of equality of opportunity in employment has been widely promoted as a means of addressing the marginalization of various groups of workers, including older workers. Evidence suggests, however, that equal opportunities have not improved prospects for older workers. The present study employs discourse analysis to examine a variety of accounts of those responsible for employment within a number of organizations. Analysis shows that these accounts are rhetorically oriented towards potential attributions of age discrimination. As evidence of a non-discriminatory stance, participants attend to possible shortcomings in written policies by making explicit their organizations' equal opportunity practices. In describing their workforces as comprising predominantly younger employees, however, they make only implicit reference to practices involving older workers. When they account for the apparent age imbalances in their workforces, they attribute these imbalances to factors outwith their control so that the organization's practices become completely 'invisible'. The contrast between this 'invisibility' and explicit claims to be committed to equal opportunities allows participants to position themselves as non-discriminating employers and at the same time justifies the marginalization of older workers.

Cancer-related psychosocial research: what are the perspectives of cancer care centre users on participation?

PURPOSE

To explore the perspectives of cancer care centre users on participation in psychosocial research to inform research design and ethics.

METHODS

The study is based on a qualitative research design. Fourteen semistructured interviews were carried in people diagnosed with cancer and carers. The interview included four main questions about practical barriers to participation, types of research design, motivating factors and the conduct of research in a cancer care support setting. The data were analysed using qualitative content analysis.

RESULTS

Interviewees demonstrated a willingness to participate in psychosocial research within certain circumstances. There were no practical barriers identified, although they considered payment for research-related travel important. The most acceptable research design was the face-to-face interview and the least preferred was the randomised control trial. The factors that motivated participation were altruism, valuing research, and making a contribution to the centre. Interviewees supported the conduct of research in cancer care support centres conditional upon delaying recruitment during the initial months of users' visits and its need to be discreet to avoid deterring visitors from accessing the centre.

CONCLUSIONS

The study concludes that the personal interaction between participants and researchers is the most important feature of decision-making by patients/carers to join studies. Taking into account the perspectives of people affected by cancer during the early stages of research design may enhance recruitment and retention and can contribute to the development of research protocols and ethics.

A discourse analytic study of ME/CFS (Chronic Fatigue Syndrome) sufferers’ experiences of interactions with doctors

The aetiology, symptoms, diagnosis and treatment of ME/CFS are controversial. Doctors and sufferers often have opposing perspectives, leading to problematic clinical interactions. We use discourse analysis to explore ME/CFS sufferers’ descriptions of interactions with medical professionals taken from an asynchronous, online sufferers’ support group. Participants described themselves as experiencing limited medical care and attention but restricted criticisms to ‘legitimate’, pragmatic or ancillary matters such as a clinicians’ unwillingness to prescribe untested treatments. Participants also described themselves as active in seeking a resolution to their problems. They thus attended to possible negative attributions of being ‘complaining’ or unmotivated to seek recovery.

Harry, Paul and the Filipino Maid: Racial and Sexual Abuse in Local Contexts

Estacio argues for critical health psychology to take action to address three issues raised (unintentionally) in the `Harry and Paul' sketch broadcast on British television. It is suggested that, although attempting humour, the sketch offensively reflected and reproduced patterns of social injustice that are far from funny. We argue here that micro-level analysis of the interactional elements of the sketch provides an understanding of how in everyday contexts Filipino workers are constructed in socially unjust terms and of how abuse can be justified. Such an understanding can allow critical health psychology to make a distinctive contribution to these topics.

"You can't fight windmills": how older men do health, ill health, and masculinities

Many health researchers have reported higher mortality and morbidity rates for men than for women. Various writers have argued that such differences reflect men's delay in seeking help when required and that reluctance to seek help reflects prevailing constructions of hegemonic masculinity. The authors report findings from an interview study of 12 older men's understandings of health and ill health. In describing health, participants constructed identities consistent with prevailing notions of hegemonic masculinity. When discussing ill health, they aligned themselves with less powerful identities that were inconsistent with the "ideal" hegemonic masculinity. Participants used a "time will tell" discursive formulation to negotiate transitions between hegemonic and subordinate identities. Delay in seeking help, accordingly, can be viewed as reflecting transitions in identity rather than hegemonic masculinity itself. These constructions are consistent with those found in other contexts and act to disadvantage men both in health terms and in identity terms.

Critical health psychology, pluralism and dilemmas: the importance of being critical

Hepworth argues for critical health psychology (CHP) to move on from binary opposition to mainstream health psychology (MHP) and to engage with other researchers in projects of common interest. In doing so, CHP can take up Murray and Campbell's earlier 'call to action' and avoid the risk of isolation. However neither action nor cross-subject collaboration are necessarily appropriate strategies for all elements of a pluralistic CHP that encompasses a diversity of epistemological positions. Conducting research on others' terms also holds risks for the development of work that remains critical. The potential contributions of a pluralistic CHP, by way of action or otherwise, might usefully be judged in relation to both the distal and proximate contexts of health issues.

"I intend to donate but …": Non-donors' views of blood donation in the UK

Although only 6% of the eligible United Kingdom population regularly donate blood, reasons for low donation rates remain poorly understood. In a grounded theory investigation, blood donors (n = 23) and non-donors (n = 27) completed a questionnaire that included 15 open-ended items. Semi-structured interviews were conducted with sub-samples of donors (n = 5) and non-donors (n = 7). Analysis of open-ended responses and interview transcripts identified five themes. Three themes, namely pro-social views, helping behaviour and awareness had similar relevance for donors and non-donors. Two themes, anxiety and practical difficulties, were used by non-donors to account for non-donation despite intentions to donate. Although non-donors' anxieties may be difficult to overcome, perceived practical difficulties provide scope for intervention. The removal of perceived barriers to donation offers one way of increasing donation rates.

Predicting parents' decisions on MMR immunisation: a mixed method investigation

BACKGROUND

Increasing uptake rates for MMR vaccination requires an understanding of factors leading parents to decide for and against vaccination, particularly in the light of recent developments.

OBJECTIVE

We investigated factors relevant to immunising and non-immunising parents and the extent to which these factors predicted their decisions.

METHODS

The study was conducted in Edinburgh, UK. A two-stage mixed method design was used. Delphi technique elicited parents' views of factors relevant to MMR immunisation. Twenty-six factors identified as relevant were incorporated into a final questionnaire. Using cluster sampling, the final questionnaire was distributed to parents recruited through a group of local nurseries. 110 parents participated: eighty (72.7%) had had their child MMR vaccinated, thirty (27.3%) had refused the vaccine. The factors in the final questionnaire were analysed against vaccination status using a direct binary logistic regression model.

RESULTS

Four factors significantly predicted vaccination status, (prediction toward 'yes vaccination'). These were the influence of current research (OR=0.18, 95% CI=0.07-0.51), the helpfulness of leaflets and information packs (OR=3.27, 95% CI=1.38-7.75), the importance of eradication of rubella (OR=2.42, 95% CI=1.01-5.78), and the importance attached to the risk of adverse reactions (OR=0.65, 95% CI=0.48-0.87).

CONCLUSIONS

Differences between immunising and non-immunising parents lie in the importance attached to four relevant factors. Excluding risk of adverse reactions, these factors have not been previously identified as salient and require to be explored further. Health advice to parents should highlight the identified importance attached to eradicating rubella and explicitly reflect research findings.

Is quality of life a healthy concept? Measuring and understanding life experiences of older people

The concept of quality of life has received considerable attention as an inclusive notion of health and as a basis for health interventions. The authors' argument in this article is that notwithstanding this attention, little consensus exists as to definition of the term. In addition, a focus on measurement has led to the neglect of wider aspects of quality of life. Such difficulties are particularly relevant to the study of quality of life of older people. Analysis of interview data suggests that older people's understandings of quality of life are not readily measurable and should be viewed in terms of phenomenological experience. The authors discuss the implications for studying quality of life of this group and difficulties for the concept itself.