Recommendations for Hospice Care to Terminally Ill Cancer Patients: A Phenomenological Study of Oncologists' Experiences

The aim of this exploratory study was to better understand oncologists' experiences and their perceptions of hospice care as an end-of-life treatment choice for terminally ill cancer patients. To describe this experience, semi-structured qualitative interviews were conducted using phenomenological methods with nine oncologists. Four themes emerged from the data analysis: (a) feelings of discomfort and relief, (b) being different from others, (c) experience with nonhospice patients, and (d) factors influencing the decision to recommend hospice. Future research and a flexible interdisciplinary practice model are suggested to better assist with end-of-life care decision making and recommendations for hospice care with oncologists and their terminally ill cancer patients are presented.     

The Staff-Designed Medical Audit

Abstract

The presentation describes a cyclic process of patient-care evaluation especially suited for use in ambulatory care settings. The cycle is discussed in detail, beginning with topic selection and moving through all steps to the final activity, reevaluation. Rather than assessment of a single individual's competence, the development of a composite profile of performance for the group is made possible through examination of the four perspectives of prevention, investigation, management, and outcome. The standards, or criteria, are developed by those whose performance is to be evaluated, thus assuring a high degree of commitment to the process.

In the 2 1/2 years' experience with the use of such staff-designed audit at one health service, 10 of 11 re-audits, performed after intervals of 6 to 12 months, have demonstrated improvement in performance when measured against the same criteria. Each of 13 new topics considered during this period has provided subject matter for staff meetings, either through general discussions, review of pertinent literature, or presentations by invited speakers. Such data provide supporting evidence for the concept that a nonpersonalized, internally-developed assessment process can elicit significant commitment to improved patient care and to ongoing education.     

Return to work: A comparison of two cognitive behavioural interventions in cases of work-related psychological complaints among the self-employed

We investigated the effectiveness of cognitive behavioural therapy (CBT) and a combined intervention of workplace- and individual-focused techniques among self-employed people on sick leave owing to work-related psychological complaints (such as anxiety, depression, and burnout). Both interventions were based on CBT; however, one was conducted by psychotherapists and involved extensive CBT, while the other was delivered by “labour experts” and consisted of a brief CBT-derived intervention combined with both individual-focused and workplace interventions. One hundred and twenty-two self-employed people who had applied for sickness benefit from an insurance company enrolled in a randomized controlled design. These individuals were assessed before the intervention and then at 4 months and 10 months after the onset of the intervention. The outcome was assessed based on duration of sick leave until partial and full return to work and on psychological complaints. Significant effects on partial and full return were found in favour of the combined intervention: partial return occurred 17 and 30 days earlier in this group than in the CBT group and the control group, respectively. For full return to work, the difference was approximately 200 days. A decrease in psychological complaints was present in each condition but we found no significant interaction effects. The results suggest that work resumption should be addressed earlier in individuals receiving CBT. This insight is of value for the (scarce) literature concerning interventions for individuals who are on sick leave owing to work-related psychological complaints.     

How listeners shape what tellers tell: Patterns of interaction in lifestory interviews and their impact on reminiscence by elderly interviewees

How older adults reminisce about their lives to others depends in part on who is listening, and on the relationship that they and their listeners establish. To support this hypothesis, findings are presented from a narrative analysis of 12 lifestory interviews done by 3 interviewers (4 interviews each: 2 with males; 2 with females) with people 80 and older living in a largely rural area of Eastern Canada. The interviewers have distinctive listening styles and come from significantly different backgrounds. One is a man, and former minister, from the immediate region; another, a woman from a large European city; the third, a younger woman from an urban centre in Western Canada. The paper takes advantage of the opportunity inherent in having 3 interviewers rather than only 1 and compares patterns that characterized the various interviewer–interviewee interactions and the impact of such patterns on how interviewees talked about their lives. Speculations are offered concerning how different listeners might have elicited reminiscences on different themes or of different types from the same tellers.     

Conclusions: Adolescents' Preparation for the Future

The future of societies depends on their success in providing pathways whereby young people develop and prepare themselves to be contributing adults to their communities. When these pathways are well marked, stable, supported by the community, and inviting to adolescents, a society can be confident that new generations will join the ranks of adulthood well prepared. When these paths are hazardous, unpredictable, uninviting, or ill fitted to the demands of adulthood in that society, the future is insecure, both for adolescents and for society. This volume and the additional two volumes of this study group (Brown, Larson, && Saraswathi, 2002; Mortimer && Brown, 2002) suggest the following observations about the experiences of youth and how well they are being prepared for adulthood in the 21st century.     

Why is the potential of augmentative and alternative communication not being realized? Exploring the experiences of people who use communication aids

Augmentative and alternative communication (AAC) holds the potential to enable people with severe oral communication impairments to participate more fully in society. However, despite the development of increasingly sophisticated communication aids, as well as recent UK policy initiatives aimed at improving access to them, some major obstacles stand in the way of the inclusory potential of AAC being realized to any significant degree. Drawing on findings of a research study that explored the experiences of people who use AAC, this paper looks at the various problems that people encounter in using communication aids. It identifies the lack of consistent, structured support as a key overarching issue. The author goes on to argue that for the potential of AAC to be realized attention needs to be given to the development of coordinated systems of support within the policy domains of education, health and social services.     

A Serpent in the Garden: Implications of Highway Development in Canada's Niagara Fruit Belt

This paper examines how long–term residents of the Niagara Fruit Belt of Ontario, Canada interpret the disappearance of prime farming land. The Queen Elizabeth Way, a highway development, is identified as one major initiative which has deeply affected the characteristics of the region and, importantly, has overshadowed perspectives of development and growth. An historical account of the development of the highway is presented to show how the event has become symbolic of urbanization and government interference. Participants in the study expressed little hope for the continuation of fruit farming in the region.