Care Relationships Research Articles

Beyond experiential knowledge: a classification of patient knowledge

AbstractPatients’ experiential knowledge is increasingly documented as a valid form of knowledge in the health sector and is often said to be a source of valuable information to complement the knowledge of health professionals. Although this increased recognition is outlined in the health science literature and formalized in certain organizational and clinical contexts, it remains difficult for various actors of the health ecosystem to contour the different forms of knowledge patients acquire through their experience as well as to consider them as essential in co-building care plans and as an asset to build care relationships. The aim of this review is twofold: (1) to challenge the dominant model of knowledge in medicine and healthcare by making the various forms of patient knowledge more explicit and tangible and (2) to provide a better understanding of what experiential knowledge consists of by classifying the various forms of knowledge patient acquire, develop, and mobilize throughout their care journey. A narrative review allows to classify six types of patient knowledge according to their source of learning: embodied, monitoring, navigation, medical, relational, and cultural knowledge. The three main sources of learning, namely the self, the system, and the community grounds patients’ learning process in their health journey.

Digitalization and care relationships of people living alone in old age: acritical analysis of policy documents

Digitalization is transforming social life and relationships. New cultural ideas of care, cooperation and reciprocity are emerging that can create challenges for older people. These are particularly poignant for older people living alone, who use digital devices less frequently and rely on support to manage the increasing number of digital tasks (appointments, bookings, financial matters). This article explores the relationship between digitalization and care relationships among older people living alone using acritical document analysis approach according to Bacchi. This approach makes it possible to look at the understanding behind the terms living alone, care relationships, and digitalization, each in relation to older people and in interaction as well as to render gaps visible. The analysis of laws and social policies as well as of political and civil society orientated documents leads to two key findings: Firstly, an individual responsibility to deal with needs arising from gaining access to and handling of digitalization is expected of older people and their social networks. This is striking as digitalization is presented as ameans of dealing with the large-scale social challenges, such as demographic change and shortage of care staff. Secondly, the analysis shows that legal documents that set out the structure for policies do not focus on digitalization in later life. With older people not being atarget group of policy of digitalization, fewer strategies are put into practice.

A poetics of opacity: disability, race and gender in Khady Sylla’s Une fenêtre ouverte

ABSTRACT Une fenêtre ouverte/An Open Window (2005), a documentary by the Senegalese writer and filmmaker Khady Sylla, offers an intimate, unsettling portrait of the mental health difficulties suffered by both Sylla and her friend, Aminta Ngom. This article reads Sylla’s film as embracing Black female disabled subjectivities that have been historically constructed – through intersecting patriarchal, colonialist and ableist regimes – as abject or aberrant. While scholarship on Sylla’s film has addressed ideas of female madness, it has not engaged with (Black feminist) disability studies – a critical lacuna addressed here. Drawing on ideas of opacity (Glissant), ‘mad methodology’ (Bruce) and Black feminist disabled perspectives that question emancipatory or healing coherence (Pickens, Nack Ngue), the article reads Sylla’s film in terms of a poetics of opacity that opens to a cripping of cinematic time and space. While focusing on a relationship of female friendship, solidarity and care that offers refuge from fraught familial dynamics, the film’s empathy is capacious, extending to Aminta’s mother and daughter too. As Une fenêtre ouverte traces the tensions that structure these various relationships, it reveals its feminist approach, its mode of feeling in solidarity, to be one that embraces strategies of opacity and ethical ambiguities.

Sur la scène des consultations en chiropraxie : une lecture de la relation de soin

The caregiver-patient relationship has been the subject of numerous studies in the field of medicine, but has received little attention in the context of chiropractic care, particularly in France. This ethnographic and sociological study aims to gain a better understanding of the characteristics of the chiropractic relationship in chiropractic care through the observation of consultations followed by interviews with both patients and caregivers. These observations were carried out in the Franco-European Chiropractic Institute’s two outpatient clinics and in three private practices. The data were collected between October 2022 and March 2023. Most of the patients treated their health as an asset to be preserved or even improved, and had a good knowledge of their body as a tool for work and/or sports performance. They turned to chiropractic care to find relief from their pain and a form of care combining technical and interpersonal skills. Chiropractic care is based on manual therapy, combined with a dimension of self-management by the patient. Follow-up of the exercises and advice given by chiropractors varies greatly from patient to patient, from diligent application to non-application, and with everything in between. Trust is the foundation of all care, and even more so in manual therapy, because of the way the hands act on the body. To establish a working alliance with the patient, the chiropractor has to adapt his or her professional ethos and accept compromises regarding the treatment plan envisaged. Cooperation between a patient and a chiropractor is based on trust, the negotiation of objectives, and the division of tasks between the two parties.

Anthropology and ethnobotany in health mediation: an illustration of a clinical, personalized approach for Haitian migrants in a French Guianese hospital.

In French Guiana, a European territory in Guiana shield in the Amazon area, close to 40% of the current population was born abroad. In this context, it is important to listen to the experiences of migrants to better understand the difficulties encountered within the healthcare pathways. This is the aim of ANRS Parcours d'Haïti project, an epidemiological, biographical and socio-anthropological study conducted on a representative sample of the Haitian community in French Guiana and focusing on the social determinants of health. Within the framework of this study, the Infectious and Tropical Diseases clinical team of Cayenne Hospital has established close collaboration with health mediators and the ethnobotanist anthropologist of the study. To illustrate the contribution of a personalized approach to health mediation, we report the case of a migrant woman of Haitian origin admitted to the Infectious and Tropical Diseases Unit. We highlight the different socio-cultural aspects addressed and their place in the care process through a thematic discussion and socio-anthropological analysis of the care relationship, based on participatory ethnography and inductive analysis of an in-depth interview with the patient. This example illustrates the need for a multidisciplinary approach to ensure culturally adapted care for patients. Personal interviews are important because they allow to better take into account the cultural specificities of patients' experiences and the socio-cultural environment in which they live (and especially, in the case of Haitian patients, their religious affiliation). By allowing them to speak and express themselves freely, they integrate not only their own cultural baggage, but also their own expectations and representations of the disease they suffer from and how it should be treated. Ultimately, this tripartite collaboration between patient, caregiver, and anthropologist or health mediator leads to a better therapeutic alliance. The analysis of this health care relationship is emblematic of the issue of cultural competence and pre-conceptualizes what intercultural mediation in health care could be, as close as possible to the caregiver and the individual.

The Relationship Between Postpartum Mothers' Knowledge About Breast Care and The Incidence of Breast Milk Dam in Postpartum Mothers Days 3-6 in The Bps Area Mrs. Titik Ekawati, S.St Ds. Kintelan Kec. Puri Kab. Mojokerto

The emergence of dam milk at days 3-6 due to a lack of knowledge about the treatment of post partum mothers the right breast. The purpose of this study was conducted to know the relationship of maternal knowledge about postpartum care with the incidence of breast milk dam on postpartum days 3-6 in Region Connecticut District Puri Ny.Titik Ekawati, S.ST Village Kintelan Mojokerto regency. The design of this study using a cross sectional analytic methods. Its population is around 3-6 days post partum mothers who are in the BPS Ny.Titik Ekawati,S.ST the sample was 13 respondents residing in the territory of BPS Ny.Ekawati,S.ST, sampling is the accidental sampling technique, a variable of this study is the independent variable "knowledge of post-partum mothers about breast care "and the dependent variable" incidence of dam milk ". Data collected using questionnaires and observation Wilcoxon then tested and the results are presented in the form of a frequency distribution table. Results showed the majority (54%) of respondents whose knowledge is lacking, and almost half (46%) of respondents experienced dam milk and a small portion (8%) respondents who did not have dams milk. Wilcoxon test results obtained no knowledge of the relationship of maternal postpartum care with the incidence of breast milk dams on postpartum days 3-6 with a significance level α = 0.05 obtained significant number ρ = 0.036 which means that H1 is received.

Professional voice use in health and nursing care - Time for reconsideration? A scoping review.

Communication is a key tool in the nursing profession. It is known that listeners are sensitive to the speaker's voice and interpret the speaker's intentions primarily from the non-verbal signal conveyed. To map and discuss the current state of knowledge and research evidence on professional voice use in health and nursing care. A scoping review adherent to the EQUATOR guidelines PRISMA-ScR. Searches in the EBSCO, CINAHL, Medline, PubMed, PsychInfo and PsycArticles databases were conducted between 1 and 28 February 2023. According to the data (n = 23), health professionals use voice as a vital aspect of caring communication and caring relationships, and in leadership as well as inter-professional collaboration, to facilitate information exchange and understanding and promote shared decision-making. The data showed that there is also a rising tendency to explore vocal demands and problems among health professionals. No studies were found on the use of voice in digital health and nursing care services or by social robots. Most of the reviewed studies were cross-sectional, rather small, and focused primarily on the perspectives of healthcare professionals. The use of voice should be explored as a vital aspect of caring communication and caring relationships from the patients' perspective, and the effects of voice use on listeners' emotions and actions should be examined in different contexts with modern, voice-specific data collection methods. Studies focusing on voice use in digital health care and by social robots are also needed. By integrating training programmes, education and technological innovations, health care can leverage the full potential of voice-based communication to promote a more coordinated and patient-centred care environment, true inter-professional collaboration and effective leadership. Professional voice use is an essential part of all health and nursing care and an impressive method that should be used consciously. Therefore, the meaning and methods of voice use, including speech accommodation, should be systematically introduced into health and nursing care and included in nursing education.

Does a participatory live music practice support nurses to deliver compassionate care to hospitalised patients? A qualitative study.

To gain more insight into how nurses experience a participatory live music practice in relation to their ability to deliver compassionate care to medically hospitalised patients. Qualitative interpretive design. Sixteen nurses participating in a live music practice with patients were interviewed using in-depth interviews with open-ended questions. Audio recordings were transcribed verbatim and subsequently coded. Theory-driven inductive and deductive approaches were applied in thematic data analysis. We identified four themes: (1) Nurses' empathy and compassion; (2) The caring nurse-patient relationship; (3) Person-centred approaches to care and (4) Nurses' subjective wellbeing. By observing patients' reactions to the music, nurses described that they obtained a deeper insight and understanding of patients' emotional wellbeing. These observations led to increased feelings of compassion in patient contact and stimulated informal communication between nurses and patients through a sense of shared humanity. According to nurses, these aspects positively affected collaboration with patients in delivering care and stimulated them to pursue person-centred approaches to care. Participating in the live music practice also positively affected nurses' wellbeing, enhanced relaxation and created an ambiance in which compassion could be expressed. A live music practice can positively contribute to the delivery of compassionate care by providing meaningful shared moments that increase feelings of empathy and compassion and strengthen the caring relationship. Offering a live music practice at the ward and bedside offers a unique possibility to enhance engagement in person-centred, compassionate care. While compassion and compassionate care are essential component of nursing, nurses often experience multiple barriers to its provision in daily practice. An innovative way to stimulate compassionate care is through the participation of nurses and patients in a live music practice, providing a meaningful moment shared between them. This stimulates feelings of shared humanity and bonding in the caring relationship. The COnsolidated criteria for REporting Qualitative research (COREQ). No Patient or Public Contribution.

Care Relationships Between Support Staff and Adults With a Learning Disability in Long-Term Social Care Residential Settings in the United Kingdom: A Systematic Literature Review

Context: Research exploring care relationships between support staff (e.g., support workers) and adults with a learning disability in long-term social care residential settings in the United Kingdom is relatively neglected. This has potential theoretical and care practice implications. Objectives: This study sought to synthesise relevant literature, expand knowledge, and identify directions for future research. We investigated five questions about care relationships and what makes them positive, exploring definitions of care relationships, relational practices and processes, barriers and facilitators to good care relationships, the impact of relationships, and restoration of disrupted relationships. Methods: Following protocol registration in PROSPERO, a systematic literature review was conducted in June–July 2021. The review was informed by official guidelines and focused on the United Kingdom, covering 41 years of relevant work. Twelve databases and five websites were searched, and experts were contacted. Forty-five reports were included and synthesised using the narrative synthesis framework. Findings: Definitions of care relationships revolved around friendship, equality, professionalism, and power. Practices and processes underlying positive relationships included knowing the person, setting boundaries, and shifting power dynamics. Barriers to positive care relationships included staff interactional patterns, attributions, and staff dilemmas, whilst facilitators included receiving training and using communication tools. Good care relationships were key to effective support and ways to restore disrupted relationships included receiving input from systemic therapy. Limitations: Literature was limited for certain review questions and more extensive for others. Only a few reports addressed care relationships as such with the rest focusing on communication or interactions. Time constraints prevented us from including more kinds of reports. The voice of residents was limited. Implications: We hope that this review contributes to and expands knowledge around care relationships and shapes directions for future research. Findings can be used by support staff, service managers, residents, trainers, advocates, regulators, and researchers.

Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care

Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a “digital-first” primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers’ views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.

Remembering Donna Rockwell (1957–2023)

Donna embraced, embodied, and modeled mindful living and authentic loving. She approached neither mindfulness nor love as a buzzword or an obligatory topic. Rather, she profoundly lived and breathed those principles as her essence—ongoingly committed to cultivating clarity, wisdom, and perspective-taking through deep listening and to promoting inclusivity and compassion via caring relationships and unconditional positive regard.

Rescuing the profession we love: general practice training sector recommendations for improving the attractiveness of general practice training. A qualitative analysis.

To investigate the views of the general practice training sector about responding to recruitment challenges, with the aim of identifying effective initiatives and other solutions. Qualitative study; focus group discussion of recommendations from a medical educator workshop. An initial online appreciative enquiry workshop for medical educators followed by focus group discussions by a broader selection of people involved in general practitioner training (Royal Australian College of General Practitioners fellows, supervisors, practice managers, medical educators, registrars). Key overarching themes and major recommendations for increasing recruitment derived from focus group responses to workshop recommendations, based on qualitative descriptive analysis. The 26 medical educators at the workshop made four major recommendations: increase the number of student and junior doctor clinical placements in general practice; increase exposure of students and junior doctors to general practitioner teachers and educators; improve general practitioner trainee pay and entitlements; and improve the integration of general practice and hospital patient care and professional relationships. Thirty-four semi-structured focus group participants broadly supported the recommendations, provided that supervisors and training practices were adequately compensated for the effects on workloads, income, and patient care. Two overarching themes infused participant responses: "rescuing the profession we love" (reflecting participants' passion for general practice and their sense of threat), and "no idea what general practitioners do" (perceptions of being misunderstood and misrepresented by hospital-based practitioners). Clinicians, educators, and policy makers should work together to increase the number of high quality, adequately supported student and junior doctor placements in general practice, improve intra-professional relationships, and trial new models of general practitioner trainee payment and conditions.

Writing research-based theatre on aged care: the ethnodrama, After Aleppo

ABSTRACT This paper documents the visioning, crafting, and writing of an ethnodrama – a type of embodied writing that takes the form of a research-based play script – about one unusual experience within an aged care organization: what might happen when technology, specifically virtual reality, is implemented into this unique organizational setting? As well as reflecting on the artistic and scientific value of research-based theatre, the script of one of the monologue plays, After Aleppo, is shared. Play scripts are a uniquely creative form of embodied writing, helping people see, imagine, and better understand the experiences of others, with ethnodrama the translation and adaption of research into a written script. As well as generating empathy, this research-based theatre provides a novel form of knowledge translation to engage and educate the public and those working in aged care organizations, a diverse workforce dealing with issues of care relationships, ageing, technology, and death.

Redefining the relationship in digital care: A qualitative study of the Digital Therapeutic Alliance

Digital therapeutic programs are emerging almost daily, offering the potential to reduce healthcare access inequalities by providing more flexible and accessible care options. However, as with traditional healthcare, the issue of patient engagement is fundamental, and the latest research have reported that fewer than 30% of users complete these programs in their entirety. Hence, many authors emphasize the importance of studying the role of therapeutic alliances specifically adapted to digital care. The therapeutic alliance encompasses the collaborative aspects of the relationship between the therapist and the patient. In this context there is a need to reconceptualize the alliance within the context of digital healthcare as it can enhance engagement, adherence, and the effectiveness of such treatments. The objective of this qualitative study was to identify the components of the digital therapeutic alliance. A thematic analysis has identified three major themes that appear to constitute the digital therapeutic alliance among 44 users of an online program: trust in the program, perception of interactions, and feeling of consideration. These results prompted a discussion of the challenges of digital healthcare, including the terminology to use. The term “digital therapeutic adherence” is proposed, thereby opening up a field for research and clarification of this important concept distinct from traditional alliance.

Programme de soins psychiatriques : Etude de l’expérience de jeunes patients par une méthode qualitative: Psychiatric care program: A qualitative study of the experience of young patients

Ambulatory care without consent is widely used, but it is controversial, and its effectiveness has not yet been proven. The patient experience remains largely unstudied in France, particularly that of young patients, yet their adherence to care in the early stages of the disease is complex and has an impact on their prognoses. The aim of this study is to investigate the experience of young patients undergoing a program of care (POC) in order to suggest ways of optimizing their care and to enrich the debate on the use of POCs. Semi-structured interviews were conducted with 11 patients between ages 20 and 32, who were either undergoing a POC or had done so in the previous 5 years, followed by a semi-pragmatic phenomenological analysis of the resulting transcripts. (1) The outpatient experience with restraints is contradictory, ranging from deprivation and intrusion to support and protection. (2) The POC is portrayed as a framework for developing awareness of disorders and acceptance of care. (3) Patients report a lack of information about care with restraints, even to the point of being unaware of its existence. Patient-psychiatrist interactions within the POC are complicated by the restraints, but remain perceived as a care relationship. (4) They report constraints in their daily lives in connection to the POC, which can complicate professional involvement. The results support the importance of nurturing the therapeutic relationship within the POC and involving patients more in their care, starting with better information. They support the use of POCs as a temporary tool to be combined with work on adherence to treatment and support for social and professional reintegration. Psychiatry.

Parents’ and neonatal healthcare professionals’ views on barriers and facilitators to parental presence in the neonatal unit: a qualitative study

BackgroundParent and infant separation in the neonatal unit is associated with adverse health outcomes. Family-integrated care has several advantages and the potential to reduce these adverse outcomes but requires parental presence. This study aimed to explore the views of parents and neonatal healthcare professionals (nHCPs) on barriers and facilitators to parental presence in a Swiss neonatal unit and to identify possible differences between nHCPs and parents, and between mothers and fathers.MethodsData were collected through semi-structured interviews with parents and focus group discussions with nHCPs. Inductive content analysis was used to identify barriers and facilitators to parental presence in the neonatal unit.ResultsTwenty parents (10 mothers and 10 fathers) and 21 nHCPs (10 nurses and 11 physicians) participated in the study. Parents and nHCPs experienced barriers and facilitators related to: (1) Structural factors of the institution, such as infrastructure or travel and distance to the neonatal unit. (2) Organization and time management of parental presence, daily activities, and work. (3) Resources, which include factors related to the legal situation, support services, family, and friends. (4) Physical and psychological aspects, such as pain, which mainly affected mothers, and aspects of emotional distress, which affected both parents. Self-care was an important physical and psychological facilitator. (5) Parent-professional interaction. Parental presence was influenced by communication, relationship, and interaction in infant care; and (6) Cultural aspects and language. Some perspectives differed between mothers and fathers, while the overall views of parents and nHCPs provided complementary rather than conflicting insights. Using visit plans to support the organization, educating nHCPs in knowledge skills and available resources to improve encouragement and information to parents, strengthening parent self-care, and improving nHCPs’ attitudes towards parental presence were seen as possible improvements.ConclusionsMultifactorial barriers and facilitators determine parental presence and experience in the neonatal unit. Parents and nHCPs made specific recommendations to improve parental presence.

“This isn’t a high-risk body”: Reframing Risk and Reducing Weight Stigma in Midwifery Practice

This article investigates the standards of care for fat recipients of midwifery care through a lens that questions common risk-focused narratives related to fat pregnant bodies. Throughout this article, we use the term "fat" rather than "obese" or "overweight". We avoid the language of obese/overweight because these medicalized terms are used to stigmatize fat people. Working from a fat liberation standpoint involves reclaiming the word “fat” as a morally-neutral descriptive term for larger bodies. Drawing on data from a research project exploring weight stigma during pregnancy care, we present findings from eleven interviews with fat parents including those who identify as women or transmen who accessed midwifery care during their pregnancy and/or childbirth experiences. Participants had both positive and negative experiences with midwives, often within the same care relationship. Related to weight specifically, many participants reported that midwives focused on the risk factors often associated with being fat while pregnant, even when their clients did not display signs of these risks. We discuss how practitioners—particularly midwives—might shift away from an anti-obesity, risk-based narrative. Instead, practitioners might acknowledge the potential risks of fatness during pregnancy while simultaneously honouring fat individuals' embodied realities and treating fat clients with respect to facilitate positive pregnancy and birthing experiences. This article has been peer reviewed.

Academic performance, emotional intelligence, and academic burnout: A cross-sectional study of a mediational effect in nursing students

BackgroundCourse failure arises as the ultimate result of students' declining academic performance in the face of high course demands. It can eventually lead to dropout and academic dissatisfaction. Emotional intelligence may play an essential role in decreasing the emotional effects of stress, such as academic burnout in nursing students. However, emotional intelligence is conceptualized multidimensionally, and each of its attributes may have a different impact on burnout reduction. ObjectiveTo explore the dimensions of emotional intelligence that may mediate the association between academic performance (course failure) and academic burnout in nursing students. DesignThe design was cross-sectional, with survey-based data collection. SettingsEducational setting, undergraduate nursing students at a private university in Metropolitan Lima, Peru. Participants154 students (77.3 % female) with a mean age of 25.9 years. MethodsA multiple mediation strategy was used, using the Wong-Law Emotional Intelligence Scale. Four emotional intelligence attributes (self-emotional appraisal, others' emotional appraisal, use of emotion, and regulation of emotion) were evaluated in the relationship of failed courses (dichotomous variable: yes/no) and academic burnout (single item based on physical and emotional exhaustion). The structural equation modeling framework was used. ResultsCourse failure (academic performance) positively affects academic burnout. Regulation of emotion is the only dimension of emotional intelligence mediating between course failure and academic burnout. The proportion of the mediating effect was 0.315, while the rest was around zero. Statistically significant gender differences were detected concerning burnout, with men scoring moderately higher than women. ConclusionsThe results indicate that the regulation of emotion may have a relevant role in reducing burnout compared to other emotional intelligence attributes. These regulatory skills are important for developing health care and positive patient relationships. Interventions focused on the regulatory characteristics of emotions and distinguishing different attributes of emotional intelligence while exploring its mediating effect should be strengthened. These implications are linked to the growing call to include EI in university education.

“Like not having an arm”: a qualitative study of the impact of visitor restrictions on cancer care during the COVID-19 pandemic

PurposeVisitor restriction policies to prevent the spread of COVID-19 among patients and clinicians were widespread during the pandemic, resulting in the exclusion of caregivers at key points of cancer care and treatment decision-making. The aim of this study was to explore how visitor restrictions impacted cancer treatment decision-making and care from patient and physician perspectives.MethodsSixty-seven interviews, including 48 cancer patients and 19 cancer and palliative care physicians from four academic cancer centers in the USA between August 2020 and July 2021.ResultsVisitor restrictions that prevented caregivers from participating in clinic appointments and perioperative hospital care created challenges in cancer care that spanned three domains: practical, social, and informational. We identified eight themes that characterized challenges within the three domains across all three groups, and that these challenges had negative emotional and psychological consequences for both groups. Physicians perceived that patients’ negative experiences due to lack of support through the physical presence of caregivers may have worsened patient outcomes.ConclusionsOur data demonstrate the tripartite structure of the therapeutic relationship in cancer care with caregivers providing critical support in the decision-making and care process to both patients and physicians. Caregiver absences led to practical, psychosocial, and informational burdens on both groups, and likely increased the risk of burnout among physicians. Our findings suggest that the quality of cancer care can be enhanced by engaging caregivers and promoting their physical presence during clinical encounters.

It’s About Getting the Balance Right: Midwives’ Experiences With Using Communication Technology With Pregnant Women/People

INTRODUCTION:The convenience of asynchronous communication such as texting has enabled people to quickly communicate with others. Concerns have been identified around the quality of relationships that are developed during these interactions with respect to privacy and confidentiality of information, particularly within a health care context. This has potential implications on the way midwives use technology when communicating with their clients.AIM:This article reports on how midwives find balance when using communication technology with their pregnant clients. This is achieved through balancing societal expectations on being connected 24/7 while maintaining their own work/life balance.METHODS:This article reports on phase 2A of a multiphase study. Semistructured interviews with 14 midwives who use communication technology such as texting with their pregnant clients were conducted online using the platform Microsoft Teams. Interview data were analyzed using thematic analysis.FINDINGS:The findings indicate that midwives are balancing how they use communication technology when communicating with their pregnant clients in three ways: (a) midwives are balancing the convenience of the technology with the relationships they develop with their pregnant clients within a continuity of care relationship; (b) midwives are balancing these communications while ensuring privacy and confidentiality of information; and (c) midwives are finding a balance between ensuring access for their pregnant clients while maintaining their own work/life balance.DISCUSSION:Midwives recognized that there is a need to balance the convenience of technology with the relationships they develop with their pregnant clients. They are adjusting and adapting to ensure they are connecting but also mindful of challenges with ensuring privacy and confidentiality of information. Midwives have shown how communication technology is part of a solution in enabling them to communicate with their clients while maintaining a better work/life balance.