scholarly journals Recommending Unfunded Innovative Cancer Therapies: Ethical vs. Clinical Perspectives among Oncologists on a Public Healthcare System—A Mixed-Methods Study

2021 ◽  
Vol 28 (4) ◽  
pp. 2902-2913
Author(s):  
Osnat Bashkin ◽  
Keren Dopelt ◽  
Noam Asna ◽  
Nadav Davidovitch
Keyword(s):  
Mixed Methods ◽  
Cancer Treatment ◽  
Psychosocial Support ◽  
Medical Condition ◽  
Mixed Methods Study ◽  
Clinical Aspects ◽  
Public Healthcare ◽  
Cancer Therapies ◽  
New Treatments ◽  
Depth Interviews

Over the past decade, there has been a growing development of innovative technologies to treat cancer. Many of these technologies are expensive and not funded by health funds. The present study examined physicians’ perceptions of the ethical and clinical aspects of the recommendation and use of unfunded technologies for cancer treatment. This mixed-methods study surveyed 127 oncologists regarding their perceptions toward using unfunded innovative cancer treatment technologies, followed by in-depth interviews with 16 oncologists. Most respondents believed that patients should be offered all treatment alternatives, regardless of their financial situation. However, 59% indicated that they often face dilemmas regarding recommending new unfunded treatments to patients with financial difficulties and without private health insurance. Over a third (38%) stated that they felt uncomfortable discussing the cost of treatment with patients. A predictive model found that physicians facing patients whose medical condition worsened due to an inability to access new treatments, and who expressed the opinion that physicians can assist in locating funding for patients who cannot afford treatments, were more likely to recommend unfunded innovative therapies to patients (F = 5.22, R2 = 0.15, p < 0.001). Subsequent in-depth interviews revealed four key themes: economic considerations in choosing therapy, patient–physician communication, the public healthcare fund, and discussion of treatment costs. Physicians feel a professional commitment to offer patients the best medical care and a moral duty to discuss costs and minimize patients’ financial difficulty. There is a need for careful and balanced use of innovative life-prolonging technologies while putting patients at the center of discourse on this complex and controversial issue. It is essential to develop a psychosocial support program for physicians and patients dealing with ethical and psychosocial dilemmas and to set guidelines for oncologists to conduct a comprehensive and collaborative physician–patient discourse regarding all aspects of treatment.

scholarly journals Facing the Unknown: Healthcare Workers’ Concerns, Experiences, and Burnout during the COVID-19 Pandemic—A Mixed-Methods Study in an Israeli Hospital

2021 ◽  
Vol 13 (16) ◽  
pp. 9021
Author(s):  
Keren Dopelt ◽  
Osnat Bashkin ◽  
Nadav Davidovitch ◽  
Noam Asna
Keyword(s):  
Mixed Methods ◽  
Healthcare Workers ◽  
Online Survey ◽  
Psychosocial Support ◽  
Health And Safety ◽  
Hospital Staff ◽  
Study Data ◽  
Mixed Methods Study ◽  
Support Network ◽  
Depth Interviews

The aim of this study was to describe the experiences of healthcare workers during the first wave of the coronavirus crisis. In a mixed-methods study, data were collected through an online survey completed by 263 hospital staff members, as well as 10 semi-structured, in-depth interviews with physicians, nurses, and medical technologists working on coronavirus wards. Respondents expressed extremely high levels of concern for family members, but they were less apprehensive about their own health and safety. Nurses displayed more apprehension and burnout compared to healthcare workers in other professional roles. The in-depth interviews reinforced and supplemented the survey findings and deepened our understanding of the experience of healthcare workers directly involved in the first wave of coronavirus patient care. The findings of this study illuminate the main concerns of hospital staff during the first wave of the COVID-19 pandemic and deepen our understanding of issues that require systemic attention in order to strengthen mental resilience among hospital staff. The steps required to continue fighting the virus include the development of a mental and emotional support network for healthcare workers to safeguard them and their health, as they care for patients, and to provide ongoing psychosocial support. As later waves of COVID-19 continued, these recommendations are even more pertinent.

scholarly journals Facing the Unknown: Healthcare Workers’ Concerns, Attitudes and Burnout During the COVID-19 Pandemic - A Mixed Methods Study

2020 ◽  
Author(s):  
Keren Dopelt ◽  
Osnat Bashkin ◽  
Nadav Davidovitch ◽  
Noam Asna
Keyword(s):  
Mixed Methods ◽  
Medical Staff ◽  
Online Survey ◽  
Psychosocial Support ◽  
National Level ◽  
Health And Safety ◽  
Hospital Staff ◽  
Mixed Methods Study ◽  
Support Network ◽  
Depth Interviews

Abstract Background: Medical staff, who care for patients at their own risk, are on the frontlines of the fight against COVID-19. The aim of this study is to describe the feelings and experiences of medical staff working in hospitals during the coronavirus crisis.Methods: Data were collected as part of a mixed-methods study that included an online survey completed by 263 hospital staff members, as well as 10 semi-structured, in-depth interviews with doctors, nurses and medical technicians working on coronavirus wards.Results: The survey findings revealed that respondents expressed extremely high rates of concern for family members and at a national level, but that they were less apprehensive about their own health and safety. At the same time, burnout was lower than the rates of concern. Nurses displayed more apprehension and burnout compared to medical staff in other professional roles. The in-depth interviews reinforced and supplemented the survey findings and deepened our understanding of the feelings of medical staff directly involved in coronavirus patient care.Conclusions: The study’s findings revealed the main concerns of hospital staff during the coronavirus crisis and deepened our understanding of the issues that require systemic attention in order to strengthen the mental resilience of hospital staff, in particular those working on coronavirus wards. The steps required to continue coping with and fighting the virus include the development of a mental and emotional support network for medical staff, to safeguard them and their health as they care for patients, and to provide ongoing psychosocial support.

scholarly journals Experiences of preparing children for a death of an important adult during the COVID-19 pandemic: a mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e053099
Author(s):  
Elizabeth Rapa ◽  
Jeffrey R Hanna ◽  
Catriona R Mayland ◽  
Stephen Mason ◽  
Bettina Moltrecht ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Social Care ◽  
Psychosocial Support ◽  
Healthcare Team ◽  
Mixed Methods Design ◽  
Significant Relationships ◽  
Health And Social Care ◽  
The Uk ◽  
Parental Belief ◽  
Depth Interviews

ObjectiveThe objectives of this study were to investigate how families prepared children for the death of a significant adult, and how health and social care professionals provided psychosocial support to families about a relative’s death during the COVID-19 pandemic.Design/settingA mixed methods design; an observational survey with health and social care professionals and relatives bereaved during the COVID-19 pandemic in the UK, and in-depth interviews with bereaved relatives and professionals were conducted. Data were analysed thematically.ParticipantsA total of 623 participants completed the survey and interviews were conducted with 19 bereaved relatives and 16 professionals.ResultsMany children were not prepared for a death of an important adult during the pandemic. Obstacles to preparing children included families’ lack of understanding about their relative’s declining health; parental belief that not telling children was protecting them from becoming upset; and parents’ uncertainty about how best to prepare their children for the death. Only 10.2% (n=11) of relatives reported professionals asked them about their deceased relative’s relationships with children. This contrasts with 68.5% (n=72) of professionals who reported that the healthcare team asked about patient’s relationships with children. Professionals did not provide families with psychosocial support to facilitate preparation, and resources were less available or inappropriate for families during the pandemic. Three themes were identified: (1) obstacles to telling children a significant adult is going to die, (2) professionals’ role in helping families to prepare children for the death of a significant adult during the pandemic, and (3) how families prepare children for the death of a significant adult.ConclusionsProfessionals need to: provide clear and honest communication about a poor prognosis; start a conversation with families about the dying patient’s significant relationships with children; and reassure families that telling children someone close to them is dying is beneficial for their longer term psychological adjustment.

scholarly journals Life after prostate cancer treatment: a mixed methods study of the experiences of men with sexual dysfunction and their partners

BMC Urology ◽  
2017 ◽  
Vol 17 (1) ◽  
Author(s):  
Jeffrey A. Albaugh ◽  
Nat Sufrin ◽  
Brittany R. Lapin ◽  
Jacqueline Petkewicz ◽  
Sandi Tenfelde
Keyword(s):  
Prostate Cancer ◽  
Mixed Methods ◽  
Sexual Dysfunction ◽  
Cancer Treatment ◽  
Mixed Methods Study ◽  
Prostate Cancer Treatment

scholarly journals Health-seeking behaviours in a malaria endemic district in Lao People’s Democratic Republic: a mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e055350
Author(s):  
Ken Ing Cherng Ong ◽  
Phonepadith Khattignavong ◽  
Sengdeuane Keomalaphet ◽  
Moritoshi Iwagami ◽  
Paul Brey ◽  
...  
Keyword(s):  
Public Health ◽  
Health Insurance ◽  
Mixed Methods ◽  
Healthcare Workers ◽  
Qualitative Data ◽  
Lao Pdr ◽  
Mixed Methods Study ◽  
Health Seeking ◽  
Endemic District ◽  
Depth Interviews

ObjectivesThis mixed methods study was conducted to explore the barriers and facilitators for health-seeking behaviours in a malaria endemic district in Lao PDR.DesignA convergent mixed methods design.SettingTwo malaria endemic villages in Thapangthong district, Savannakhet Province, Lao PDR.ParticipantsVillagers and healthcare workers in the two villages in Thapangthong district.MethodsIn the quantitative part, a pretested questionnaire was used to identify the health-seeking behaviours of the villagers. In the qualitative part, focus group discussions were employed to explore health-seeking behaviours of the villagers and in-depth interviews were used to explore the perceptions of the healthcare workers. Descriptive statistics were computed and multiple logistic regressions were used to identify the factors associated with perceived severity and perceived susceptibility. Thematic analysis was used to analyse the qualitative data. Quantitative and qualitative results were integrated in joint displays.ResultsIn the quantitative part, data were collected from 313 villagers from both villages. For malaria, 96.0% and 98.2% of villagers from villages A and B, respectively, would first seek treatment at public health facilities. Villagers who have not experienced malaria before were more likely to perceive that the consequences of malaria were serious compared with those who have experienced malaria before (adjusted OR=1.69, 95% CI: 1.03 to 2.75). However, qualitative data showed that villagers faced problems such as lack of medicines and medical equipment. Healthcare workers also mentioned the lack of manpower and equipment in the in-depth interviews. Nevertheless, villagers still preferred to seek treatment at the health center as the National Health Insurance was introduced.ConclusionsPublic health facility usage was high but barriers existed. Effective policy and enabling environment such as the introduction of the National Health Insurance could help accelerate the progress towards the malaria elimination goal. Moreover, the benefits could go beyond the context of malaria.

scholarly journals Unmet needs in occupational health: prevention and management of viral hepatitis in healthcare workers in Ho Chi Minh City, Vietnam: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e052668
Author(s):  
Tran Nguyen ◽  
Trang Pham ◽  
Hong K Tang ◽  
Loc Phan ◽  
Gary Mize ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Hepatitis C ◽  
Hepatitis B ◽  
Viral Hepatitis ◽  
Healthcare Workers ◽  
Hepatitis B Surface Antigen ◽  
Mixed Methods Study ◽  
Ho Chi Minh City ◽  
Clinical Activity ◽  
Depth Interviews

ObjectivesVietnam is an endemic area for hepatitis B virus and hepatitis C virus infection (HBV-HCV), yet its largest city, Ho Chi Minh City (HCMC), has no comprehensive policy to educate, screen, treat and protect healthcare workers (HCWs) from viral hepatitis. We conducted a mixed-methods study to document HBV-HCV infection rates, risk factors, local barriers and opportunities for providing education, screening and medical care for HCWs.DesignThis mixed-methods study involved an HBV and HCV serological evaluation, knowledge, attitude and practice survey about viral hepatitis and many in-depth interviews. Descriptive statistics and thematic content analysis using inductive and deductive approaches were used.SettingHCMC, Vietnam.ParticipantsHCWs at risk of viral hepatitis exposure at three hospitals in HCMC.ResultsOf the 210 invited HCWs, 203 were enrolled. Of the 203 HCWs enrolled, 20 were hepatitis B surface antigen-positive, 1 was anti-hepatitis C antibody (anti-HCV Ab)-positive, 57 were anti-hepatitis B core Ab-positive and 152 had adequate anti-hepatitis B surface Ab (anti-HBs Ab) titre (≥10IU/mL). Only 50% of the infected HCWs reported always using gloves during a clinical activity involving handling of blood or bodily fluid. Approximately 50% of HCWs were still not vaccinated against HBV following 1 year of employment. In-depth interviews revealed two major concerns for most interviewees: the need for financial support for HBV-HCV screening and treatment in HCWs and the need for specific HBV-HCV guidelines to be independently developed.ConclusionsThe high HBV infection rate in HCWs coupled with inadequate preventive occupational practices among the population in HCMC highlight the urgent needs to establish formal policy and rigorous education, screening, vaccination and treatment programmes to protect HCWs from HBV acquisition or to manage those living with chronic HBV in Vietnam.

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