Social science & medicine
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Social science & medicine · Jan 1991
ReviewBringing social structure back into clinical decision making.
Although research in the past twenty years has resulted in an increasingly sophisticated understanding of clinical decision making processes, the dominant approach in this area of inquiry remains limited. Most studies emphasize normative models of how decisions ought to be made, others attempt to describe physicians' thinking, but few take the social context of decision making systematically into account. Research models typically assume that physicians are autonomous professionals practicing in socially insular clinical settings--an approach that is consistent with classic formulations of the social structure of medical practice, but they ignore 30 years of sociological research on research on patient-physician relationships and major historical changes in the structure of medical practice. ⋯ Our review of these studies on the social context of clinical decision making, however, reveals major methodological limitations including those inherently imposed by secondary data analysis, normative approaches, written case vignettes, small, non-random samples and the inadequate control of confounding influences. We present a feasible, alternative research strategy, built on a factorial experimental design. Illustrative findings indicate how complex social structural influence on clinical decision making may be disentangled in an unconfounded manner.
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In the early twentieth century in the United States and other Western countries, women were much less likely than men to smoke cigarettes, due in part to widespread social disapproval of women's smoking. During the mid-twentieth century, growing social acceptance of women's smoking contributed to increased smoking adoption by women. Increased social acceptance of women's smoking was part of a general liberalization of norms concerning women's behavior, reflecting increasing equality between the sexes. ⋯ Several other hypotheses concerning the causes of gender differences in smoking are not supported by the available evidence. For example, it appears that women's generally greater concern with health has not contributed significantly to gender differences in the prevalence of smoking. Similarly, it appears that sex differences in physiological responses to smoking have made only minor contributions to gender differences in smoking adoption or cessation.
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Social science & medicine · Jan 1991
Comparative StudyA comparison of hospice and conventional care.
Interviews with relatives and others who knew a group of people dying of cancer in England are reported. The bulk of the paper compares 45 such patients who received hospice care with 126 who received conventional care. The sampling procedure showed that 2.9% of people aged 15 or over at death died in a hospice, and 6.9% received some form of hospice service. ⋯ There were few differences between the two groups in what happened at the time of death, although for in-patient deaths, respondents judged the staff of hospices to be more understanding. The relatives of hospice patients were more likely to be visited by a nurse at home after the death. Few differences in bereavement reaction were found, but those that were suggested that respondents for the hospice group were adjusting better.(ABSTRACT TRUNCATED AT 250 WORDS)
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Social science & medicine · Jan 1991
Comparative StudyPrimary health services in Ecuador: comparative costs, quality, and equity of care in Ministry of Health and rural social security facilities.
This study of costs, quality and financial equity of primary health services in Ecuador, based on 1985 data, examines three assumptions, common in international health, concerning Ministry of Health (MOH) and Social Security (SS) programs. The assumptions are that MOH services are less costly than SS services, that they are of lower quality than SS services, and that MOH programs are more equitable in terms of the distribution of funds available for PHC among different population groups. Full costs of a range of primary health services were estimated by standard accounting techniques for 15 typical health care establishments, 8 operated by the MOH and 7 by the rural SS program (RSSP), serving rural and peri-urban populations in the two major geographical regions of Ecuador. ⋯ Additional evidence of equity, using other indicators, would be helpful in future research. The paper's findings have policy implications not only for Ecuador's health sector but also for policy-makers in other countries at similar levels of socioeconomic development. These implications are spelled out in order to guide officials wrestling with issues of efficiency, quality, and equity as they search for the best use of scarce resources to promote health.
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Social science & medicine · Jan 1991
The impact of family presence on the physician-cancer patient interaction.
Physician behaviors were studied in 473 interactions between oncologists and adult cancer outpatients. Ninety-nine of these interactions occurred when family members were present during the visit. Patients with family members present were likely to be sicker as demonstrated by a poorer performance status. ⋯ The results showed that, in general, physicians provide more information when patients are accompanied by family members, or if no family are present, when the patient has a worse performance status. Patient satisfaction and quality of life were rated lower for patients with a worse performance status and were not impacted by physician behaviors. Physicians' behavior was affected by both the presence of a family member, and the patient's performance status.