Social science & medicine
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Social science & medicine · Jun 2004
The medical practice of patient autonomy and cancer treatment refusals: a patients' and physicians' perspective.
The idea that patients should take up an autonomous position in the decision-making process is generally appreciated. However, what patient autonomy means in the case of patients who refuse a recommended oncological treatment has not been investigated. This study aims to clarify how the concept of patient autonomy can be applied to patients who refuse a recommended oncological treatment. ⋯ The results show that the extent of pressure physicians will exert to persuade the patient to be treated as recommended depends on the medical distinction between a curative and a non-curative treatment goal. It seems that there exists a shift in respecting patient autonomy, which depends on factors like treatment goal. Discussing the respect shift may serve to clarify underlying thoughts and principles in the decision-making process for both physicians and patients.
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Social science & medicine · Jun 2004
Review Comparative StudyIsumagijaksaq: mindful of the state: social constructions of Inuit suicide.
Inuit suicide is the most significant mental health issue in the newly created Nunavut Territory of Canada's eastern Arctic. Suicide rates in Nunavut are 6 times those of Canada's southern provinces. Consistent with other Canadian populations, males aged 15-29 years of age are most at risk. ⋯ Attempts to complete the picture by identifying risk factors have produced contradictory and unsatisfactory results. We conclude that the impact of colonial relations of ruling has much to do with the current problem and advocate an approach that combines narrative research and intergenerational communication with community action to address the problem. Low Inuit inuusittiaqarniq (self-esteem) is an important factor in Inuit suicide, but rather than a psychological problem, has its roots in a history of colonialism, paternalism and historical events.
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Social science & medicine · Jun 2004
Comparative StudySeeking informed consent to cancer clinical trials: describing current practice.
Clinical trials have come to be regarded as the gold standard for treatment evaluation. However, many doctors and their patients experience difficulties when discussing trials, leading to poor accrual to trials and questionable quality of informed consent. We have previously developed a typology for ethical communication about Phase II and III clinical trials within four domains: (a) shared decision making, (b) sequencing information, (c) type and clarity of information, and (d) disclosure/coercion. ⋯ In almost one third of the consultations (28.8%) doctors made implicit statements favouring one option over another, either standard or clinical trial treatment. Doctors complied with some but not other aspects of a standard procedure for discussing clinical trials. This reflects the difficulty inherent in seeking ethical informed consent and the need for communication skills training for oncologists.
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Social science & medicine · Jun 2004
Comparative StudyPlace of death: preferences among cancer patients and their carers.
The place of death of cancer patients has become an important theme in UK cancer and palliative care policy. This paper examines the place of death preferences of 41 terminally ill cancer patients and 18 of their informal carers, living in the Morecambe Bay area of north-west England. We interviewed cancer patients referred to the research team by 13 specialist palliative care professionals; patients had an estimated 3 months of life remaining. ⋯ Palliative Med. 3 (2000) 287). More importantly, it uncovers some of the reasons that underpin these preferences. Our research revealed a much stronger preference for deaths in a hospice than had been anticipated, leading us to take a qualified stance on the current policy drive in favour of home deaths by those charged with delivering UK cancer and palliative care services.
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Social science & medicine · Jun 2004
Comparative StudyRegulation of junior doctors' work hours: an analysis of British and American doctors' experiences and attitudes.
Regulations of junior doctors' work hours were first enacted in the United States (US) and United Kingdom (UK) over a decade ago, with the goals of improving patient care and doctors' well-being while maintaining a high quality of medical training. This study examines experiences and attitudes regarding the implementation of these regulations among physicians and surgeons at two teaching hospitals, one in South-East England, and the other in New England, US. This paper presents the findings of a survey questionnaire and a series of in-depth interviews administered to a sample of junior doctors and the consultants responsible for their supervision. ⋯ A number of barriers to the success of the regulations in achieving their objectives are identified, and the relative merits of political action and professional self-regulation are discussed. This research suggests that recently enacted policies requiring further reductions in junior doctors' hours in both the US and UK may face similar barriers when implemented. Understanding the lessons that emerge from implementation of the original regulations is essential if future reforms are to succeed and a high-quality system of health care is to be sustained.