Challenges of Dealing with Financial Concerns during Life-Threatening Illness: Perspectives of Health Care Practitioners

ABSTRACT

The costs of serious medical illness and end of life care are often a heavy burden for patients and families (Collins, Stepanczuk, Williams, & Rich, 2016 Collins, A., Stepanczuk, C., Williams, N., & Rich, E. (2016). Supporting better patient decisions at the point of care: What payers and delivery systems can do (Mathematica Policy Research Issue Brief). Retrieved from http://econpapers.repec.org/paper/mprmprres/6c6a86e28d7149c993713352eeceaa18.htm [Google Scholar]; Kim, 2007 Kim, P. (2007). Cost of cancer care: The patient perspective. Journal of Clinical Oncology, 25(2), 228–232. doi:10.1200/JCO.2006.07.9111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]; May et al., 2014 May, C. R., Eton, D. T., Boehmer, K., Gallacher, K., Hunt, K., MacDonald, S.,?… &?Rogers, A. E. (2014). Rethinking the patient: Using burden of treatment theory to understand the changing dynamics of illness. BMC health services research, 14(1), 1–11. doi:10.1186/1472-6963-14-281[Crossref], [PubMed] , [Google Scholar]; Zarit, 2004 Zarit, S. H. (2004). Family care and burden at the end of life. Canadian Medical Association Journal, 170(12), 1811–1812. doi:10.1503/cmaj.1040196[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]). Twenty-six practitioners, including social workers, managers/administrators, supervisors, and case managers from five health care settings, participated in qualitative semistructured interviews about financial challenges patients encountered. Seven practitioners took part in a focus group. Practitioners were recruited from hospice (n?=?5), long-term care (n?=?5), intensive care (n?=?5), dialysis (n?=?6), and oncology (n?=?5). Interview and focus group questions focused on financial challenges patients encountered when facing life-threatening illness. Interview data were transcribed and thematically coded and trustworthiness of data was established with peer debriefing, member checking, and agreement on themes among the authors. Practitioners described interacting micro, meso, and macroinfluences on the financial well-being and challenges patients encountered. Microlevel influences involved patient characteristics, such as their demographic profile and/or health status that set them up for financial aptitude or challenges. Macrolevel influences involved the larger health care/safety net system, which provided valuable resources for some patients but not others. Practitioners also discussed the mesolevel of influence, the local setting where they worked to match available resources with patients’ individual needs given the constraints emerging from the micro and macrolevels. Practitioners described how they navigated the interplay of these three areas to meet patients’ needs and cope with financial challenges. Implications for practice point to directly addressing the kind of financial concerns that patients and families facing financial burden from serious medical illness have, and identifying ways to bridge knowledge and resource access gaps at the individual, organizational, and societal levels.     

Contemporary Political Communications: Audiences, Politicians and the Media in International Research

Research into political communication has grown rapidly in the past three decades, shifting from specific, quantitative and utilitarian studies to include a broad variety of research questions, methods and theoretical frameworks. Interdisciplinary work in political communication takes audiences, political actors (such as governments and politicians), and media content and media institutions as central foci. Research has traditionally focused on election campaign-specific studies within national contexts. Emerging research, however, is now addressing broader questions about media texts and organisations and also about representations and power. This research is working to trace technological changes and developments in an era of globalised media and political communication and developing new, complex conceptions of audience agency and reception.     

A framework for providing telecommuting as a reasonable accommodation: some considerations on a comparative case study

Telecommuting, whether full time, part time, or over short periods when the need arises, can be an important accommodation for employees with disabilities. Indeed, telecommuting may be the only form of accommodation that offers employees whose disabilities fluctuate a means to stay consistently and gainfully employed. This article describes one employer's experience in considering a request for telecommuting as a reasonable accommodation for a particular employee. Drawing on real-life examples, both positive and negative, this article provides a win/win framework for decision-making that can help employers evaluate the use of telecommuting as a possible accommodation and facilitates open and ongoing communication between employer and employee.     

Inflammatory effects and immune system correlates of rape

The purpose of this study was to evaluate the feasibility of measuring stress hormones and immunity following rape. The long-term goal is to evaluate the predictive value of stress-immune-inflammatory responses to later health outcomes. Fifteen women reporting rape were compared with 16 control participants. Serum stress hormones, proinflammatory cytokines, acute phase proteins, functional assays, and lymphocyte subsets were measured in blood samples. Women reporting rape had higher cytotoxic cells, lower B lymphocyte counts, higher proinflammatory biomarkers, and decreased lymphocyte proliferation compared to the control group. This finding suggests that rape produces activation of the innate immunity and suppression of some aspects of adaptive immunity. If these immune changes persist, they may contribute to the pathophysiology of long-term health sequelae by provoking chronic inflammation and decreased cellular immunocompetence.     

Integrating the older/special needs adoptive child into the family

This qualitative, grounded theory study investigated 11 families who reported having successfully integrated into their family unit at least one older/special needs adoptee. The theory that emerged through the constant comparative methodology consisted of two categories (Decision to Adopt and Adjustment) and a core category (Developing a Sense of Family). The two categories and core category comprised a process that was informed by the Family Narrative Paradigm and culminated in the successful integration of the child or children into the existing family unit. Parental perceptions that appeared to facilitate this process included: (a) finding strengths in the children overlooked by previous caregivers, (b) viewing behavior in context, (c) reframing negative behavior, and (d) attributing improvement in behavior to parenting efforts.     

Voices from Segregated Schooling: towards an inclusive education system

Romantown LEA, like other authorities in England and Wales, is adopting a policy of 'inclusion' in providing education for young disabled people. The reorganisation has involved the closure of Adamston, an all-age school for pupils with physical disabilities. This article addresses the meaning of 'inclusion' from the viewpoint of disabled people who have experienced segregated education. We draw first on the literature to offer an analysis of the documented views of survivors of special schools. Secondly, we explore the views and experiences of Adamston pupils prior to the closure of the school. In presenting what clearly represents a wide range of experiences we seek to take the debate beyond the sterile analysis of 'pros and cons' of special schools. We argue that voices from experiences of segregation are central in constructing 'inclusion' and essential in any process of change towards an education system which is truly inclusive.     

A Case of Mistaken Identity? A Comparison of Professional and Amateur Problem Gamblers

Professional gamblers are more likely than amateur gamblers to meet criteria for problem gambling but minimal research has examined their gambling behavior and its consequences. This study compared gambling behavior, problem gambling symptoms, related harms, recognition, and help-seeking among problem semi/professional gamblers (PPGs/PSPGs) and problem amateur gamblers (PAGs). Surveys completed by 57 self-identified professional gamblers, 311 semi-professional gamblers and 4226 amateur gamblers were analysed. PPGs/PSPGs were significantly more likely than PAGs to be male, younger, never married, speak a language other than English at home, and have higher psychological distress, compared to PAGs. PPGs/PSPGs were more likely to gamble more frequently on many skills-based forms, but most also participated in several chance-based forms. PPGs’/PSPGs’ most common problematic gambling form was electronic gaming machines and they were more likely to have problems with sports betting than PAGs. Most PPGs/PSPGs reported coming out behind on all gambling forms over the previous year. PPGs/PSPGs were more likely than PAGs to report chasing losses and numerous detrimental financial gambling consequences. This group’s self-identification as PPGs/PSPGs is clearly inaccurate and perhaps a means to avoid stigma, elevate status and support problem denial. PPGs/PSPGs may represent an extreme example of gamblers with erroneous cognitions and beliefs who lack the required discipline and skill to be successful professional gamblers. The findings identify a group of problem gamblers who may benefit from interventions to dispel their mistaken self-identity, and emphasize the need for more rigorous confirmation of professional gambler status in future research.     

Sleepless in school? The social dimensions of young people’s bedtime rest and routines

There are increasing concerns that social pressures, such as family changes and social media, are ‘invading’ the sanctuary of the bedroom with the result that students arrive at school tired and stressed. This paper seeks to examine whether these concerns are justified and contribute to the growing literature on the social dimensions of sleep through examining the rest and routines of two cohorts of young people aged 12–13 and 14–15 years old. Our research indicates that, in general, most young people have ‘reasonable’ amounts of sleep and routines. But, a significant proportion does go to school tired, with apparent negative consequences for their well-being. The paper examines some of the within-cohort variations, in particular, the significance of volume of sleep, routines and engagement with social media and how these may reflect the material and cultural circumstances of the young people. The paper concludes by arguing for more research on the complex social causes and consequences of sleep deprivation among today’s youth.