scholarly journals GPs’ decisions about prescribing end-of-life anticipatory medications: a qualitative study

2020 ◽  
Vol 70 (699) ◽  
pp. e731-e739 ◽  
Author(s):  
Ben Bowers ◽  
Sam S Barclay ◽  
Kristian Pollock ◽  
Stephen Barclay
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Thematic Analysis ◽  
Symptom Management ◽  
Qualitative Interview ◽  
Structured Interviews ◽  
Clinical Recommendation ◽  
Qualitative Interview Study ◽  
Decision Making Processes ◽  
Purposive Sample

BackgroundGPs have a central role in decisions about prescribing anticipatory medications to help control symptoms at the end of life. Little is known about GPs’ decision-making processes in prescribing anticipatory medications, how they discuss this with patients and families, or the subsequent use of prescribed drugs.AimTo explore GPs’ decision-making processes in the prescribing and use of anticipatory medications for patients at the end of life.Design and settingA qualitative interview study with GPs working in one English county.MethodSemi-structured interviews were conducted with a purposive sample of 13 GPs. Interview transcripts were analysed inductively using thematic analysis.ResultsThree themes were constructed from the data: something we can do, getting the timing right, and delegating care while retaining responsibility. Anticipatory medications were a tangible intervention GPs felt they could offer patients approaching death (something we can do). The prescribing of anticipatory medications was recognised as a harbinger of death for patients and their families. Nevertheless, GPs preferred to discuss and prescribe anticipatory medications weeks before death was expected whenever possible (getting the timing right). After prescribing medications, GPs relied on nurses to assess when to administer drugs and keep them updated about their use (delegating care while retaining responsibility).ConclusionGPs view anticipatory medications as key to symptom management for patients at the end of life. The drugs are often presented as a clinical recommendation to ensure patients and families accept the prescription. GPs need regular access to nurses and rely on their skills to administer drugs appropriately. Patients’ and families’ experiences of anticipatory medications, and their preferences for involvement in decision making, warrant urgent investigation.

scholarly journals GPs’ decisions about prescribing anticipatory medicines at the end of life: a qualitative study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702809
Author(s):  
Ben Bowers ◽  
Kristian Pollock ◽  
Sam Barclay ◽  
Stephen Barclay
Keyword(s):  
Decision Making ◽  
Qualitative Study ◽  
End Of Life ◽  
Thematic Analysis ◽  
Symptom Management ◽  
Symptom Relief ◽  
Structured Interviews ◽  
Family Experiences ◽  
Decision Making Processes ◽  
Purposive Sample

BackgroundGPs have a central role in decisions about prescribing anticipatory medications (AMs) to help control symptoms at the end of life. Little is known about GPs’ decision-making processes in prescribing AMs and the subsequent use of prescribed drugs.AimTo explore GPs’ decision-making processes in the prescribing and use of AMs for patients at the end of life.MethodA qualitative interpretive descriptive enquiry with a purposive sample of 13 GPs working across one English county. Data was collected in 2017 via semi-structured interviews and analysed inductively using Braun and Clarke’s thematic analysis.ResultsThree themes were constructed from the data: 1) ‘Something we can do’: AMs were a tangible intervention GPs felt they could offer to provide symptom relief for patients approaching death. 2) ‘Getting the timing right’: the prescribing of AMs was recognised as a harbinger of death for patients and families. GPs preferred to prescribe drugs weeks before death was expected, while recognising this meant that many prescribed AMs were never used. 3) ‘Delegating care while retaining accountability’: GPs relied on nurse to assess when to administer drugs and keep them updated about their use.ConclusionGPs view AMs as key to symptom management for dying people. AMs are routinely prescribed even though they are often not used. In order to feel comfortable delegating care, GPs need regular access to nurses and trust in their skills to administer drugs appropriately. Patient and family experiences of AMs, and their preference for involvement in decision-making about their use warrant urgent investigation.

scholarly journals Parents and GPs’ understandings and beliefs about food allergy testing in children with eczema: qualitative interview study within the Trial of Eczema allergy Screening Tests (TEST) feasibility trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041229
Author(s):  
Clare Clement ◽  
Matthew J Ridd ◽  
Kirsty Roberts ◽  
Miriam Santer ◽  
Robert Boyle ◽  
...  
Keyword(s):  
Decision Making ◽  
Food Allergy ◽  
Qualitative Interview ◽  
Interview Study ◽  
Screening Tests ◽  
Feasibility Trial ◽  
Structured Interviews ◽  
Allergy Testing ◽  
Qualitative Interview Study ◽  
Severe Eczema

AimTo explore parent and general practitioner (GP) understanding and beliefs about food allergy testing for children with eczema.Design and settingQualitative interview study in UK primary care within the Trial of Eczema allergy Screening Tests feasibility trial.ParticipantsSemi-structured interviews with parents of children with eczema taking part in the feasibility study and GPs at practices hosting the study.Results21 parents and 11 GPs were interviewed. Parents discussed a range of potential causes for eczema, including a role for food allergy. They believed allergy testing to be beneficial as it could potentially identify a cure or help reduce symptoms and they found negative tests reassuring, suggesting to them that no dietary changes were needed. GPs reported limited experience and uncertainty regarding food allergy in children with eczema. While some GPs believed referral for allergy testing could be appropriate, most were unclear about its utility. They thought it should be reserved for children with severe eczema or complex problems but wanted more information to advise parents and help guide decision making.ConclusionsParents’ motivations for allergy testing are driven by the desire to improve their child’s condition and exclude food allergy as a possible cause of symptoms. GPs are uncertain about the role of allergy testing and want more information about its usefulness to support parents and help inform decision making.Trial registration numberISRCTN15397185.

scholarly journals Parental experiences of end of life care decision-making for children with life-limiting conditions in the paediatric intensive care unit: a qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028548 ◽  
Author(s):  
Sarah Mitchell ◽  
Jenna L Spry ◽  
Emma Hill ◽  
Jane Coad ◽  
Jeremy Dale ◽  
...  
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
End Of Life Care ◽  
Healthcare Professionals ◽  
Qualitative Interview ◽  
Life Care ◽  
Parental Experiences ◽  
Qualitative Interview Study ◽  
Life Threatening ◽  
Care Decision

ObjectivesTo provide an in-depth insight into the experience and perceptions of bereaved parents who have experienced end of life care decision-making for children with life-limiting or life-threatening conditions in the paediatric intensive care unit (PICU).DesignAn in-depth qualitative interview study with a sample of parents of children with life-limiting or life-threatening conditions who had died in PICU within the previous 12 months. A thematic analysis was conducted on the interview transcripts.SettingA PICU in a large National Health Service (NHS) tertiary children’s hospital in the West Midlands, UK.Participants17 parents of 11 children who had died in the PICU.ResultsFive interconnected themes were identified related to end of life care decision-making:(1) parents have significant knowledge and experiences that influence the decision-making process.(2) Trusted relationships with healthcare professionals are key to supporting parents making end of life decisions.(3) Verbal and non-verbal communication with healthcare professionals impacts on the family experience.(4) Engaging with end of life care decision-making can be emotionally overwhelming, but becomes possible if parents reach a ‘place of acceptance’.(5) Families perceive benefits to receiving end of life care for their child in a PICU.Conclusions and implicationsThe death of a child is an intensely emotional experience for all involved. This study adds to the limited evidence base related to parental experiences of end of life care decision-making and provides findings that have international relevance, particularly related to place of care and introduction of end of life care discussions. The expertise and previous experience of parents is highly relevant and should be acknowledged. End of life care decision-making is a complex and nuanced process; the information needs and preferences of each family are individual and need to be understood by the professionals involved in their care.

scholarly journals Improving GP communication in consultations on medically unexplained symptoms: a qualitative interview study with patients in primary care

2017 ◽  
Vol 67 (663) ◽  
pp. e716-e723 ◽  
Author(s):  
Juul Houwen ◽  
Peter LBJ Lucassen ◽  
Hugo W Stappers ◽  
Willem JJ Assendelft ◽  
Sandra van Dulmen ◽  
...  
Keyword(s):  
Symptom Management ◽  
Medically Unexplained Symptoms ◽  
Qualitative Interview ◽  
Structured Interview ◽  
Management Plan ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Medically Unexplained ◽  
Unexplained Symptoms ◽  
Specific Management

BackgroundMany GPs find the care of patients with medically unexplained symptoms (MUS) challenging. Patients themselves are often not satisfied with the care they receive.AimTo explore the problems patients with MUS experience in communication during consultations, with the aim of improving such consultationsDesign and settingA qualitative analysis of semi-structured interviews.MethodGP consultations were videorecorded and the GPs were asked immediately afterwards whether MUS were presented. Patients in these MUS consultations were asked to reflect on the consultation in a semi-structured interview while watching a recording of their own consultation.ResultsOf the 393 videorecorded consultations, 43 contained MUS. Patients who did identified six categories of problems. First, they reported a mismatch between the GP’s and their own agenda. Second, patients indicated that the GP evoked an uncomfortable feeling in them during the consultation. Third, they found that GPs did not provide a specific management plan for their symptoms. Fourth, patients indicated that the GP was not well prepared for the consultation. Fifth, they perceived prejudices in the GP during the consultation. Finally, one patient found that the GP did not acknowledge a limited understanding of the origin of the symptoms.ConclusionAccording to patients, GPs can improve their consultations on MUS by making genuine contact with their patients, by paying more attention to the patient’s agenda, and by avoiding evoking uncomfortable feelings and displaying prejudices. They should prepare their consultations and focus on the issues that matter to patients, for example, symptom management. GPs should be honest to patients when they do not understand the origin of symptoms.

scholarly journals Questioning Facilities Management in Higher Education in Egyptian Context for Better Decision-Making Process of Funding Allocation

2017 ◽  
Vol 12 (7) ◽  
pp. 129
Author(s):  
Mona Mohamed Abd Elghany ◽  
Reem Aly Elharakany
Keyword(s):  
Higher Education ◽  
Decision Making ◽  
Public Universities ◽  
Quality Of Education ◽  
Decision Making Process ◽  
Facilities Management ◽  
Structured Interviews ◽  
Decision Making Processes ◽  
Strategic Relationships

The quality of education is influenced by the managerialization of the universities, which refers to the introduction of substantial changes in the decision-making processes of the academic institutions, and the application of renewed information systems along with new managerial methodologies to restructure the organisational strategic relationships with stakeholders. This paper proposes a questionnaire to assess the importance of facilities in universities according to their financial budget consumed value. Semi Structured Interviews were conducted with the heads of logistic and financial departments in Egyptian universities, twenty public universities and twenty-three private universities, in order to identify criteria for the most significant university's facilities and appealing infrastructure that contributes to the quality of education.

The importance of relationships in treatment for chronic leg ulceration

2017 ◽  
Vol 24 (13) ◽  
pp. 1839-1849 ◽  
Author(s):  
Philippa Tollow ◽  
Jane Ogden
Keyword(s):  
Surgical Treatment ◽  
Patient Experience ◽  
Thematic Analysis ◽  
Qualitative Interview ◽  
Interview Study ◽  
Leg Ulcers ◽  
Profound Impact ◽  
Patient Centred Care ◽  
Qualitative Interview Study ◽  
Non Surgical Treatment

Leg ulcers are a hard-to-heal wound that can have a profound impact on the lives of those that they affect. While a significant body of evidence has explored the efficacy of various treatments for leg ulcers, little research has addressed the patient experience of such treatment. A total of 21 participants were recruited for this qualitative interview study, exploring patient’s experiences of non-surgical treatment for leg ulcers. Thematic analysis identified two major themes, ‘Failure’ and ‘Powerlessness’, as well as the overarching theme of ‘Relationships’. These findings are discussed in relation to concepts of acceptance and in the broader context of patient-centred care.

scholarly journals Understanding Relationship between Milestone and Decision-Making in Project Management: A Qualitative Study among Project Managers in Saudi Arabia

2018 ◽  
Vol 13 (8) ◽  
pp. 184 ◽  
Author(s):  
Umar Altahtooh ◽  
Thamir Alaskar
Keyword(s):  
Decision Making ◽  
Saudi Arabia ◽  
Project Management ◽  
Qualitative Study ◽  
Thematic Analysis ◽  
Project Managers ◽  
Structured Interviews ◽  
Pragmatic Research ◽  
The Impact ◽  
The Relationship

Despite the importance of milestone as a key knowledge in project management, there has been lack of research to understand the relationship between milestones and decision-making. This paper presents a pragmatic research context that aims understanding the nature of milestones and their relationship with different decision-making structures and responsibilities across projects. Data were collected through 14 semi-structured interviews with project managers and analyzed using thematic analysis. The findings explore the concepts of project milestones among project managers in Saudi Arabia. The paper finds that there is a relationship between milestones and the impact on decision-making.

Grief and Best Friendship Among Adolescent Girls

2019 ◽  
pp. 003022281985614
Author(s):  
Ditte A. Winther-Lindqvist ◽  
Ida O. Larsen
Keyword(s):  
Adolescent Girls ◽  
Thematic Analysis ◽  
Friendship Quality ◽  
Qualitative Interview ◽  
Interview Study ◽  
Qualitative Interview Study ◽  
Best Friendship ◽  
The Relationship ◽  
Case Stories

This article explores the relationship between grief and best friendship (BF) dynamics among adolescent girls. Based on a qualitative interview study with 10 Danish girls, findings suggest that bereavement affects friendship dynamics in ways that challenge the by-standing friend in succeeding with being and staying supportive. Through a thematic analysis, we identify 12 themes that cut across the case stories, all of which testify to the difficulties bereavement represent to friendship quality and maintenance. Among other issues, it seems like grief is contagious and the bereaved friend changes her way of responding to the by-standing friend in ways that disturb expectations, values, and virtues of BF among girls in adolescence. The general categories found to be characteristic for long-term BFs, that is, positivity, supportiveness, openness, and interaction are all affected by bereavement in adolescent BFs among girls.

Dentists' Perspectives on Infection Control in Relation to Blood-borne Viruses

2008 ◽  
Vol 14 (1) ◽  
pp. 82
Author(s):  
K. M. Jenkinson ◽  
M. Temple-Smith ◽  
J. Lavery ◽  
S. M. Gifford ◽  
M. Morgan
Keyword(s):  
Infection Control ◽  
Thematic Analysis ◽  
Poor Compliance ◽  
Dental Practice ◽  
Structured Interviews ◽  
Standard Precautions ◽  
Australian Health ◽  
Health Practitioners ◽  
Infection Control Guidelines ◽  
Purposive Sample

The prevalence of blood-borne viruses (BBV) continues to increase in Australia, as does the need for vigilant infection control. Despite this, some Australian health practitioners demonstrate poor compliance with recommended infection control practices. The aim of this study was to examine the experiences and attitudes of dentists regarding infection control, patients with BBV, occupational risk, and related matters, and identify reasons for non-compliance with infection control guidelines. A purposive sample of 25 Victorian dentists took part in semi-structured interviews between November 2003 and November 2004. Interviews were taped, transcribed and coded for thematic analysis. The majority of participants expressed compliance with standard precautions; however, many admitted to changing their routine infection control practices for patients known or assumed to have a BBV. Approximately half disclosed minor changes, such as double gloving; a small minority reported having treated people with a BBV at the end of a session. Most participants experienced apprehension about the risk of occupational exposure to BBV and admitted this as the reason for changing infection control practices. Reasons offered by participants for poor compliance included ignorance of either the effectiveness of standard precautions or BBV transmission, or confusion and frustration regarding inadequate or impractical infection control guidelines. It is suggested that infection control guidelines be specifically designed for dental practice, and that these be promoted in both undergraduate dental education and professional development.

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