Qualitative health research
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Negative beliefs and a lack of clarity surrounding the meaning of palliative care have been widely reported as obstacles to its uptake. Information available to the public possibly contributes to this. A descriptive and discourse-theoretical analysis was conducted of information spread online by palliative care policy, advocacy, and practice organizations. ⋯ Tensions arose around the concepts of autonomy, a natural death, and an emphasis on the quality of life away from death and dying. Overall, this study showed that the online information of palliative care is a potential source of confusion and might even contribute to its stigmatization. Insights are provided that may help improve clarity toward the public.
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Medication-assisted treatment (MAT) for opioid use disorder (OUD) is accessed half as often in rural versus urban areas in the United States. To better understand this disparity, we used a qualitative descriptive approach to explore the experiences of individuals with OUD seeking MAT in rural New Mexico. ⋯ Thematic content analysis derived five major themes which identified novel barriers and facilitators to MAT success, including a perceived gender disparity in obtaining MAT, challenges in building a recovery-oriented support system, and the importance of navigating a new normal social identity. This deeper knowledge of the experiences and perspectives of rural individuals with OUD could serve to address the rural-urban MAT disparity, leading to enhanced recovery capacity and transformative policies.
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Observational Study
The Patient's Situation During Interhospital Intensive Care Unit-to-Unit Transfers: A Hermeneutical Observational Study.
Interhospital intensive care unit-to-unit transfers are an increasing phenomenon, earlier mainly studied from a patient safety perspective. Using data from video recordings and participant observations, the aim was to explore and interpret the observed nature of the patient's situation during interhospital intensive care unit-to-unit transfers. ⋯ The patient's situation can be viewed as an involuntary journey, one where the patient exists in a constantly changing space drifting in and out of the health personnel's attention and where movements from the journey become part of the patient's body. Interhospital transfers of vulnerable patients emerge as a complex task, challenging the health personnel's ability to maintain a caring atmosphere around these patients.
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Lynn conceptualized end-of-life (EoL) care for patients with advanced chronic-progressive illnesses as a combination of life-preserving/palliative care, the palliative aspect gradually becoming the main focus as death approaches. We checked this concept by exploring the advanced-terminal illness trajectories of 50 patients. Strategies heralding active therapy exhaustion were the catalyst for a participant's awareness of terminality, but were not a decisive factor in the divergent EoL care pathways we detected. ⋯ Conversely, the concept of EoL care encompassing three palliative care modalities ( life-prolonging palliative therapy, restorative palliative care, and symptom-oriented [only] palliative care), each harboring a different blend of life-preserving and symptom-comforting aspects, proved adequate. These modalities could run serially, oscillatorily, or parallelly, explaining the divergent EoL care pathways. We suggest an adjustment of the model of Lynn and reconsider the traditional palliative care concept.
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In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. ⋯ Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and "outing," which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives.