Social science & medicine
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Social science & medicine · Mar 2000
Doctor-patient communication about drugs: the evidence for shared decision making.
The traditional paternalistic model of medical decision-making, in which doctors make decisions on behalf of their patients, has increasingly come to be seen as outdated. Moreover, the role of the patient in the consultation has been emphasised, notably through the adoption of 'patient-centred' strategies. Models that promote patients' active involvement in the decision-making process about treatment have been developed. ⋯ As a consequence there was no basis upon which to build a consensus about the preferred treatment and reach an agreement on which treatment to implement. Thus even the first two of the four conditions said to be necessary for shared decision making were not generally present in the consultations we studied. These findings were presented in feedback sessions with participating GPs, who identified a number of barriers to shared decision making, as well as expressing an interest in developing strategies to overcome these barriers.
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Social science & medicine · Feb 2000
Cadaveric donotransplantation: nurses' attitudes, knowledge and behaviour.
Human organ transplantation is an important treatment for certain medical conditions, and for irreversible organ failure. There is a shortfall in the number of organs required for transplantation. The close and continuous proximity of nurses to potential donors and their families make them critical links in the organ donation process. ⋯ Comparisons were made between certain of nurses' specialist groups and significant differences were found. Comparisons of factor scores between certain specialist groups or other strata were assessed by analysis of variance. Nurses working in renal units were significantly more in favour of donotransplantation than any other group of nurses.
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The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. ⋯ The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.
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The medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). ⋯ The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.
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Social science & medicine · Jan 2000
'In the safety of your own home': results from a national survey on gun use at home.
In the US, guns, particularly handguns, are typically brought into the home for protection. The wisdom of having a firearm in the home, however, is disputed. While guns appear to be a risk factor for family homicide, suicide and unintentional firearm fatality, no evidence has been available about gun use at home to intimidate family members and little about gun use to thwart crimes by intruders, or about the use of other weapons in home self-defense. ⋯ While we do not always know whose weapon was used in these incidents, most gun brandishings were by male intimates against women. A gun in the home can be used against family members or intruders and can be used not only to kill and wound, but to intimidate and frighten. This small study provides some evidence that guns may be used at least as often by family members to frighten intimates as to thwart crime, and that other weapons are far more commonly used against intruders than are guns.