Cultural Context Of Patient Research Articles

Reflexivity and positionality applied to medical practice: a study on implicit gender bias with medical students in a Swiss university

BackgroundAn array of evidence shows how the presence of implicit bias in clinical encounters can negatively impact provider-patient communication, quality of care and ultimately contribute to health inequities. Reflexive practice has been explored as an approach to identify and address implicit bias in healthcare providers, including medical students. At the Lausanne School of Medicine, a clinically integrated module was introduced in 2019 to raise students’ awareness of gender bias in medical practice using a reflexivity and positionality approach. The purpose of this study is to describe the gender bias that were identified by medical students, analysing their types, places and modes of emergence during a clinical encounter. It further explores how positionality supported students’ reflection on the way in which social position modulates their relationship to patients.MethodsAs part of the teaching activity, medical students individually reflected on gender bias in a specific clinical encounter by answering questions in their electronic portfolio. The questionnaire included a section on positionality. We qualitatively analysed the students’ assignments (n=76), applying a thematic analysis framework.ResultsMedical students identified and described gender biases occurring at different moments of the clinical encounter (anamnesis (i.e. patient history), physical exam, differential diagnosis, final management). They causally associated these biases with wider social phenomena such as the gendered division of labour or stereotypes around sexuality and gender. Analysing students' reflections on how their position influenced their relationship with patients, we found that the suggested exercise revealed a major contradiction in the process of medical enculturation: the injunction to be neutral and objective erases the social and cultural context of patients and impedes an understanding of gender bias.ConclusionGender biases are present in the different steps of a clinical consultation and are rooted in broader gendered social representations. We further conclude that the tension between a quest for objectivity and the reality of social encounters should be made explicit to students, because it is constitutive of medical practice.

Prevalence of temporomandibular disorders and their associated factors in Confucian heritage cultures: A systematic review and meta-analysis.

Temporomandibular disorders (TMDs) may be an 'idiom' of psychological distress in Confucian heritage cultures (CHCs). This systematic review/meta-analysis estimated the prevalence of TMDs in CHCs and compared the differences in TMD occurrence between time periods and age groups. Additionally, the associated biopsychosocial risk factors were also examined. The study protocol was developed a priori following the PRISMA guidelines and Joanna Briggs Institute systematic review methodology (CRD42021245526). Electronic searches of seven databases were conducted from January 2002 to Dec 2021. Reference lists of identified studies were hand-searched for additional articles. Study selection, quality assessment, and data extraction were done. Meta-analysis was performed using the RevMan 5.4 software. Forty-eight articles were included in the systematic review. Overall prevalences were: TMDs-15% (95% CI: 15-16%); TMD pain-8% (95% CI: 7-9%); TMJ sounds-24% (95% CI: 21-27%); and TMJ locking-7% (95% CI: 1-13%). While TMD prevalence appeared to have declined from 2002 to 2011 to 2012-2021, the occurrence of TMD pain, TMJ sounds, and locking increased marginally or remained constant. TMD prevalence in children/adolescents was 18% (95% CI: 14-22%) and 17% (95% CI: 16-18%) among adults. Significant associations between TMDs and bruxism/psychological distress/education levels were specified by 73%/90%/88% of the relevant studies. TMDs are prevalent in CHCs and a slight increase in TMD pain (2%) and TMJ sounds (8%) were discerned over the past two decades. TMDs are related to a myriad of biopsychosocial variables, particularly psychological distress, and these factors must be addressed within the cultural context of patients.

Ethical loneliness in the psychiatric clinic: The manufacture of non-belonging

Summary Arguing for the importance of the clinical encounter as a site of bioethical inquiry, I focus particularly on persons experiencing severe psychic distress. Acknowledging the historical wrongs that have been done to persons with severe psychic distress, I suggest that the contemporary colonization of psychiatric care by the medical model and by neoliberal values that prioritize accountability, metrics, and cost over personhood are doing a grave disservice to such patients. I draw on the writings of social theorists including Agamben to argue that the treatment of psychiatric sufferers produces a risk of causing patients to experience bare life and relegation to the status of nonpersons. Drawing on Stauffer's concept of ethical loneliness, I illustrate the kind of harm that is done when the institutions that we design to listen to patients and receive suffering fail in that responsibility. In the second half of the paper, I offer two illustrative examples of how an emphasis on attuned listening, relationality, and acknowledgement of the rich familial and cultural context of patients’ lives can allow us to engage in ethical listening that leads to receptivity and potential healing. The first illustration draws on a psychoanalytic understanding of the deep psychic injuries caused by inaugural losses in a person's earliest experience, and the second draws on a case that offers rich texture for understanding the experience of a young man who showed up at an emergency room in Morocco in a state of severe psychic distress.

Listening to the voice of patients with head and neck cancer: A systematic review and meta-synthesis.

The aim was to conduct a systematic review and a meta-synthesis of primary qualitative studies exploring experiences of head and neck cancer patients (HNC) undergoing radio and/or chemotherapy, in order to provide a better understanding of this phenomenon and supply new directions for care and clinical practice. Six databases were systematically searched, and 13 studies were included. The meta-synthesis methodology was adopted to conceptualise the way in which patients lived their cancer journey and the impact of treatments on their daily life. Four themes embracing various aspects of HNC patients' experiences were identified: (a) self-body image and perceived quality of life; (b) experiences and treatment of symptoms; (c) cancer journey; and (d) the relationship with health professionals. The finding demonstrates the importance of acknowledging that treatment sequelae and patients' daily issues do not appear, develop and affect people's lives in isolation and should be considered and analysed as a whole within the social and cultural context of patients' lives. Further research is needed to explore the treatment experience of HNC patients throughout their cancer journey with a more holistic approach that involves health professionals, caregivers and other family members and peers in the community.

Promoting Cultural Competence in Academics and Clinical Education

In the 21st century, academic climate educators must be knowledgeable of and sensitive to differing cultural values and customs of the students we educate and patient populations we serve. Demographic projections for the United States over the next 20–40 years suggest a decrease in the current white majority to that of a minority, with corresponding increases among Hispanic and Asian American Groups (Pew Research Hispanic Center, 2008). Most facets of our society are, and will continue to be, impacted by such large transformations, and this includes all components of academic programs in Communication Sciences and Disorders (CSD). This burgeoning growth of cultural diversity in the United States is mirrored in both the student body and the patient populations we serve. As such, developing “cultural competence” has become an imperative for CSD programs as there is a growing need to work effectively within the cultural context of patients, their families, and their communities. In this paper, we focus on Rush University’s (RU) ongoing experience with creating cultural competence among students, faculty, and preceptors in academics and clinical education.

Agreement between self-report and medical records on signs and symptoms of respiratory illness

Information on patient symptoms can be obtained by patient self-report or medical records review. Both methods have limitations. To assess the agreement between self-report and documentation in the medical records of signs/symptoms of respiratory illness (fever, cough, runny nose, sore throat, headache, sinus problems, muscle aches, fatigue, earache, and chills). Respondents were 176 research participants in the Hutterite Influenza Prevention Study during the 2008-2009 influenza season with information about the presence or absence of signs/symptoms from both self-report and primary care medical records. Compared with medical records, lower proportions of self-reported fever, sore throat, earache, cough, and sinus problems were found. Total agreements between self-report and medical report of symptoms ranged from 61% (for sore throat) to 88% (for muscle aches and earache), with kappa estimates varying from 0.05 (for chills) to 0.41 (for cough) and 0.51 (for earache). Negative agreement was considerably higher (from 68% for sore throat to 93% for muscle aches and earache) than positive agreement (from 13% for chills to 58% for earache) for each symptom except cough where positive agreement (77%) was higher than negative agreement (64%). Agreements varied by age group. We found better agreement for earache (kappa = 0.62) and lower agreements for headache, sinus problems, muscle aches, fatigue, and chills in older children (aged >5 years) and adults. Agreements were variable depending on the specific symptom. Contrary to research in other patient populations which suggests that clinicians report fewer symptoms than patients, we found that the medical record captured more symptoms than selfreport. Symptom agreement and disagreement may be affected by the perspectives of the person experiencing them, the observer, the symptoms themselves, measurement error, the setting in which the symptoms were observed and recorded, and the broader community and cultural context of patients.

The cultural context of patient's autonomy and doctor's duty: passive euthanasia and advance directives in Germany and Israel.

The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient’s autonomy and doctor’s duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive.

Lived Experience of Spirituality in Taiwanese Women with Breast Cancer

This study explored spirituality as a lived experience through in-depth, face-to-face interviews of 15 Taiwanese women with breast cancer. A Phenomenological research method was employed to guide the study. Four main themes and 12 subthemes, conceptualized under a meta-theme of hsin, emerged as characteristic of the current “lifeworlds” of the study participants. Interpretation of the findings revealed that spirituality is a journey and a unidirectional evolving process that the participants experienced at different levels of wholeness and integration. Spirituality in Taiwan not only must be seen as metaphysics but also should be approached in the cultural context of patients. Nurses should attend to each patient as a unique person, focus on “here-and-now” encounters, and help their patients transform and evolve to a higher plane of wholeness and integration. Nurses should, as well, nurture and support their own spirituality to be available healing resources for others.