Experiences of Iranian women with prenatal diagnosis of fetal abnormalities: A qualitative study

Abstract Background: Women are more likely to be diagnosed with congenital anomalies. Following prenatal diagnosis of fetal abnormalities, women may be forced to make decisions about whether to continue a pregnancy with fetal abnormalities. This can be a dilemma for the women. The aim of the study was to explore women’s experiences of prenatal diagnosis of fetal abnormalities. Methods: A qualitative study was conducted in a referral women’s hospital in Tehran, Iran in 2018. Participants were a purposeful sample of 15 women with prenatal diagnosis of fetal abnormalities. Data were collected by individual, in-depth interviews. The conventional content analysis approach was used to analyze the data. Results: Two main themes “emotional suffering” and “decision-making challenge” were extracted from the participants’ experiences. Emotional suffering consisted of subthemes “sense of guilt”, “self-blame”, “questioning of God”, “commiseration” and “projection”. Decision making challenge included subthemes “distrust”, “possible cure”, “dark future”, “economic problems”, “stereotypical beliefs”, “coercion” and “lack of support”. Conclusions: The experience of prenatal diagnosis of fetal abnormalities was associated with emotional suffering and challenges in decision-making to continue or terminate the pregnancy. Strategies need to be employed to improve women’s autonomy in decision-making. Healthcare professionals should be trained in communication skills to provide appropriate counseling to support women with diagnosis of fetal anomalies.

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Experiences of Iranian Women with Prenatal Diagnosis of Fetal Abnormalities: A Qualitative Study

The Qualitative Report ◽

10.46743/2160-3715/2021.4688 ◽

2021 ◽

Author(s):

Fahimeh Ranjbar ◽

Fatemeh Oskouie ◽

Shahrzad Hashemi Dizaji ◽

Maryam Gharacheh

Keyword(s):

Decision Making ◽

Prenatal Diagnosis ◽

Qualitative Study ◽

New Technologies ◽

Medical Science ◽

Fetal Abnormalities ◽

Women’S Experiences ◽

Self Blame ◽

Emotional Suffering ◽

Women's Experiences

Women are more likely to be diagnosed with congenital anomalies due to advances in new technologies in medical science. Following prenatal diagnosis of fetal abnormalities, women may be forced to make decisions about whether to continue a pregnancy with fetal abnormalities. This can be a dilemma for the women. The aim of the study was to explore women’s experiences of prenatal diagnosis of fetal abnormalities. A qualitative study was conducted in a referral women’s hospital in Tehran, Iran in 2018. Participants were a purposeful sample of 15 women with prenatal diagnosis of fetal abnormalities. Data were collected by individual, in-depth interviews. The conventional content analysis approach was used to analyze the data. Two main themes “emotional suffering” and “decision-making challenge” were extracted from the participants’ experiences. Emotional suffering consisted of subthemes “commiseration,” “self-blame,” “sense of guilt,” and “projection.” Decision-making challenge included subthemes “lack of support,” “stereotypical beliefs,” and “uncertainty.” The women’s experiences of prenatal diagnosis of fetal abnormalities were associated with emotional suffering and challenges in decision-making to continue or terminate the pregnancy. Strategies need to be employed to improve women’s autonomy in decision-making. Healthcare professionals should be trained in communication skills to provide appropriate counseling to support women with diagnosis of fetal anomalies.

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Termination of pregnancy following a prenatal diagnosis of Down syndrome: A qualitative study of the decision-making process of pregnant couples

Acta Obstetricia Et Gynecologica Scandinavica ◽

10.1111/aogs.13386 ◽

2018 ◽

Vol 97 (10) ◽

pp. 1228-1236 ◽

Cited By ~ 8

Author(s):

Stina Lou ◽

Kathrine Carstensen ◽

Olav Bjørn Petersen ◽

Camilla Palmhøj Nielsen ◽

Lone Hvidman ◽

...

Keyword(s):

Decision Making ◽

Down Syndrome ◽

Prenatal Diagnosis ◽

Qualitative Study ◽

Termination Of Pregnancy ◽

Decision Making Process

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Professional decision making with digitalisation of patient contacts in a medical advice setting: a qualitative study of a pilot project with a chat programme in Sweden

BMJ Open ◽

10.1136/bmjopen-2021-054103 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054103

Author(s):

Åsa Cajander ◽

Gustaf Hedström ◽

Sofia Leijon ◽

Marta Larusdottir

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Healthcare Professionals ◽

Professional Knowledge ◽

Pilot Project ◽

Medical Advice ◽

Patient Contact ◽

Clinical Patient ◽

Nurses And Physicians ◽

Professional Judgement

ObjectivesPatient e-services are increasingly launched globally to make healthcare more efficient and digitalised. One area that is digitalised is medical advice, where patients asynchronously chat with nurses and physicians, with patients having filled in a form with predefined questions before the chat. This study aimed to explore how occupational professionalism and the possibility of professional judgement are affected when clinical patient contact is digitalised. The study’s overall question concerns whether and how the scope of the healthcare staff’s professional judgement and occupational professionalism are affected by digitalisation.Design and settingA qualitative study of healthcare professionals working in a pilot project with a chat programme for patients in a medical advice setting in Sweden.Participants and analysisContextual inquiries and 17 interviews with nurses (n=9) and physicians (n=8). The interviews were thematically analysed. The analysis was inductive and based on theories of decision making.ResultsThree themes emerged: (1) Predefined questions to patients not tailored for healthcare professionals’ work, (2) reduced trust in written communication and (3) reduced opportunity to obtain information through chat communication.ConclusionsThe results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system’s design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

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Understanding the low take-up of home-based dialysis through a shared decision-making lens: a qualitative study

BMJ Open ◽

10.1136/bmjopen-2021-053937 ◽

2021 ◽

Vol 11 (11) ◽

pp. e053937

Author(s):

Jane Noyes ◽

Gareth Roberts ◽

Gail Williams ◽

James Chess ◽

Leah Mc Laughlin

Keyword(s):

Decision Making ◽

Qualitative Study ◽

Shared Decision Making ◽

Healthcare Professionals ◽

Family Members ◽

Shared Decision ◽

Framework Analysis ◽

Future Treatment ◽

Modifiable Factors ◽

Decision Making Processes

ObjectivesTo explore how people with chronic kidney disease who are pre-dialysis, family members and healthcare professionals together navigate common shared decision-making processes and to assess how this impacts future treatment choice.DesignCoproductive qualitative study, underpinned by the Making Good Decisions in Collaboration shared decision-model. Semistructured interviews with a purposive sample from February 2019 - January 2020. Interview data were analysed using framework analysis. Coproduction of logic models/roadmaps and recommendations.SettingFive Welsh kidney services.Participants95 participants (37 patients, 19 family members and 39 professionals); 44 people supported coproduction (18 patients, 8 family members and 18 professionals).FindingsShared decision-making was too generic and clinically focused and had little impact on people getting onto home dialysis. Preferences of where, when and how to implement shared decision-making varied widely. Apathy experienced by patients, caused by lack of symptoms, denial, social circumstances and health systems issues made future treatment discussions difficult. Families had unmet and unrecognised needs, which significantly influenced patient decisions. Protocols containing treatment hierarchies and standards were understood by professionals but not translated for patients and families. Variation in dialysis treatment was discussed to match individual lifestyles. Patients and professionals were, however, defaulting to the perceived simplest option. It was easy for patients to opt for hospital-based treatments by listing important but easily modifiable factors.ConclusionsShared decision-making processes need to be individually tailored with more attention on patients who could choose a home therapy but select a different option. There are critical points in the decision-making process where changes could benefit patients. Patients need to be better educated and their preconceived ideas and misconceptions gently challenged. Healthcare professionals need to update their knowledge in order to provide the best advice and guidance. There needs to be more awareness of the costs and benefits of the various treatment options when making decisions.

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Understanding perceptions and factors involved in do not resuscitate (DNR) decision making in the emergency department of a low-resource country: a mixed-methods study protocol

BMJ Open ◽

10.1136/bmjopen-2020-038915 ◽

2020 ◽

Vol 10 (9) ◽

pp. e038915

Author(s):

Kiran Azizi ◽

Shahan Waheed ◽

Rubina Barolia ◽

Naveed Ahmed ◽

Madiha Ismail

Keyword(s):

Decision Making ◽

Emergency Department ◽

Healthcare Professionals ◽

Group Discussion ◽

Cross Sectional Study ◽

Do Not Resuscitate ◽

Eligibility Criteria ◽

Cross Sectional ◽

Depth Interviews ◽

Low Resource Country

IntroductionDo not resuscitate (DNR) decision making is an integral component of emergency medicine practice. There is a paucity of data, protocols and guidelines regarding the perceptions and barriers that are involved in the interactions among healthcare professionals, patients and their caregivers regarding DNR decision making. The aim of this study is, therefore, to explore the perceptions and factors influencing DNR decision making in the emergency department and to evaluate the use of a context-based protocol for DNR decision making.Methods and analysisThis will be a sequential mixed method study beginning with qualitative research involving in-depth interviews (IDIs) with patient family members and focus group discussion with healthcare professionals. The consensual qualitative approach will be used to perform a thematic analysis to the point of saturation. The expected outcome will be to identify key themes that suggest perceptions and factors involved in DNR decision making. After piloting, the derived protocol will then be used with a different group of individuals (150 healthcare professionals) who meet the eligibility criteria in a quantitative cross-sectional study with universal sampling. Data will be analysed using NVIVO in the qualitative phase and SPSS V.19 in the quantitative phase. The study findings will support the development of a standardised protocol for DNR decision making for healthcare professionals in the emergency department.Ethics and disseminationThe proposal was reviewed by the ethics review committee (ERC) of the institution (ERC # 2020-1551-7193). The project is an institution SEED grant recipient PF139/0719. The results will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations, brochures and emails. The findings will be published in a highly accessed peer-reviewed medical journal and will be presented at international conferences.

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Exploring nurse navigators' contribution to integrated care: a qualitative study

Australian Journal of Primary Health ◽

10.1071/py19042 ◽

2019 ◽

Vol 25 (4) ◽

pp. 339

Author(s):

Clare Hannan-Jones ◽

Charlotte Young ◽

Geoffrey Mitchell ◽

Allyson Mutch

Keyword(s):

Qualitative Study ◽

Integrated Care ◽

Healthcare Professionals ◽

Interdisciplinary Collaboration ◽

Clinical Integration ◽

Two Phase ◽

Professional Integration ◽

Healthcare Settings ◽

Care Practices ◽

Depth Interviews

This paper examines nurse navigation as a model of integrated care operating across primary and secondary healthcare settings. A two-phase qualitative study involving a focus group with seven nurse navigators (NNs) to explore their understandings and perceptions of the role, followed by in-depth interviews with three NNs to examine current practice, was undertaken in Queensland, Australia. NNs’ role spanned a continuum of patient and population care, and involved engagement in clinical integration, coordinating patient care and providing education and points-of-contact for healthcare professionals. NNs also engaged in professional integration, fostering interdisciplinary collaboration, education and connections between healthcare professionals, while promoting integrated care across care settings. NNs were enabled through the establishment of relationships, trust and shared communication between stakeholders. NNs’ work transcended traditional clinical boundaries, operating horizontally across silos and specialties, which allowed them to avoid (some) system shortfalls. By contributing to a culture of integration, NNs can potentially support more sustainable integrated care practices that extend relationships between healthcare professionals and beyond individual patients. Increasing our understanding of nurse navigation as a model of integrated care, this study illustrates the complexity, diversity and breadth of the role and its ability to contribute to broader, system-wide integration.

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A Qualitative Study of Factors Influencing Decision-Making after Prenatal Diagnosis of down Syndrome

Journal of Genetic Counseling ◽

10.1007/s10897-016-0061-8 ◽

2016 ◽

Vol 26 (4) ◽

pp. 814-828 ◽

Cited By ~ 8

Author(s):

Amy R. Reed ◽

Kathryn L. Berrier

Keyword(s):

Decision Making ◽

Down Syndrome ◽

Prenatal Diagnosis ◽

Qualitative Study ◽

Factors Influencing

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Switching antipsychotics to support the physical health of people with severe mental illness: a qualitative study of healthcare professionals’ perspectives

BMJ Open ◽

10.1136/bmjopen-2020-042497 ◽

2021 ◽

Vol 11 (2) ◽

pp. e042497

Author(s):

Annabel Nash ◽

Tom Kingstone ◽

Saeed Farooq ◽

Jessica Tunmore ◽

Carolyn A Chew-Graham

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Illness ◽

Side Effects ◽

Qualitative Study ◽

Physical Health ◽

Severe Mental Illness ◽

Secondary Care ◽

Healthcare Professionals ◽

Mental Health Nurses

ObjectivesThe side effects of antipsychotic medications (APs) can increase the risk of developing physical health conditions. Some APs pose a higher risk than others. Evidence suggests switching to lower risk APs can support physical health outcomes. We sought to explore the views of healthcare professionals about switching antipsychotics to support physical health in people with severe mental illness (SMI).DesignA qualitative study with semi-structured interviews conducted with general practitioners (GPs), psychiatrists and mental health nurses. The main focus was to explore participants’ views on the physical health of people with SMI, the impact of APs and decision-making about switching medication to support physical health. Data were analysed thematically using principles of constant comparison.SettingsParticipants recruited through primary care and one mental health trust in the West Midlands.ParticipantsInterviews were conducted with 9 GPs, 10 psychiatrists and 4 mental health nurses.ResultsAwareness and knowledge of AP side-effects and risk profiles varied considerably between primary and secondary care clinicians. GPs reported limited awareness, while psychiatrists and nurses demonstrated a comprehensive understanding of AP risk profiles and side-effects. Mental health and control of symptoms were prioritised. Switching to promote physical health was considered as a reactive intervention, once side-effects or complications developed. There were a range of views over where responsibility lay for monitoring physical health and consideration of switching. Collaboration between primary and secondary care was identified as a way to address this.ConclusionsThis study presents multidisciplinary perspectives on awareness, decision making, perceived responsibility and barriers to switching APs to support physical health. Collaborative approaches that involve liaison between primary and secondary care, but tailored to the individual patient, may support switching, and present an opportunity to intervene to address the physical health inequalities experienced by individuals with SMI.

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Reflecting on the Challenges encountered by nurses at the great Kermanshah Earthquake: A qualitative study

10.21203/rs.3.rs-38281/v4 ◽

2020 ◽

Author(s):

Alireza Abdi ◽

Aliakbar Vaisi -Raygani ◽

Bahareh Najafi ◽

Hamid saidi ◽

khalil moradi

Keyword(s):

Content Analysis ◽

Data Analysis ◽

Qualitative Study ◽

Human Resources ◽

Healthcare Providers ◽

Educational Management ◽

National Team ◽

The Past ◽

Conventional Content Analysis ◽

Depth Interviews

Abstract Background: Iran has experienced an increasing number of earthquake disasters in the past three decades. Nurses are the largest group of healthcare providers that play an important role in responding to disasters. Therefore, this study aimed to explore the nursing challenges to provide care to the injured in the Kermanshah earthquake, Iran. Methods: The present study was conducted as a qualitative conventional content analysis, and data collection was carried out through 16 semi‑structured and in‑depth interviews with the nurses involved in providing care to the injured in the Kermanshah earthquake. The data were analyzed following Graneheim and Lundman’s approach.Results: Data analysis led to the emergence of 453 primary codes, 14 subcategories, and 5 categories. The five categories were as follows: (a) organizational and managerial challenges; (b) human resources; (c) infrastructure; (d) educational system; (e) and ethical.Conclusion: The results of this study showed that nurses faced several challenges in providing care to earthquake victims. Based on these findings, better educational management and planning, infrastructure reform, and establishment of a crisis nursing national team seem necessary.

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