Discussion Of Sensitive Topics Research Articles

Perceived benefits from peer-support among family caregivers of people with amyotrophic lateral sclerosis and cognitive impairments in a palliative rehabilitation blended online learning programme.

Family caregivers of persons with amyotrophic lateral sclerosis and cognitive and/or behavioural impairments (PALS/CIs) experience various challenges and needs, including emotional and practical support from peers. Various forms of peer-support have shown different strengths and weaknesses; however, little is known about how family caregivers of PALS/CIsinteract with and perceive virtual face-to-face peer-support. The aim of this study was to understand how caregivers of PALS/CIsinteract with and perceive virtual face-to-face peer-support in a palliative rehabilitation programme designed to promote targeted palliative rehabilitation initiatives for caregivers of PALS/CIs. A qualitative design using participant observations of 17 recorded virtual group-facilitated meetings from two rounds of a 4-month intervention was performed. The Medical Research Council framework, the inductive interpretive description methodology and the theoretical framework of Sense of Coherence guided the study. Nineteen participants, divided into four groups, were included. Three themes emerged: 'Relating my situation to others', 'Making room for forbidden thoughts' and 'Longing for normalcy'. The themes reflected the various ways participants interacted in online group meetings and how the interactions evolved around practical, emotionaland forbidden thoughts. Sharing personal and sorrowful concerns and frustrations engendered feelings of trust and a sense of belonging, which empowered the participants to address their genuine wish and longing for normalcy with all the trivialities of which ALS/CIs had robbed them. Virtual face-to-face peer-support can enable caregivers of PALS/CIsto share experiences of everyday life challenges that cannot always be shared elsewhere. Being able to relate to and learn from other'sexperiences alleviated feelings of loneliness, frustration, and concerns and thereby enhanced comprehensibility, manageabilityand meaningfulness. Online palliative rehabilitation interventions should provide an opportunity for caregivers to meet regularly in interactive group meetings. Familiarization takes time online and is necessary to improve their sense of feeling safe to share their deepest thoughts. Such group interventions, facilitated by trained healthcare professionals, offer a means to support dynamic group interactions and discussion of sensitive topics.

Child Sexual Abuse Prevention: Parental Discussion, Protective Practices and Attitudes.

Understanding parental practices and attitudes regarding child sexual abuse (CSA) prevention could be used to improve CSA prevention, but little information is available. In this study, we summarise survey data collected from 248 Australian and UK parents (87% female) with at least one child aged 6-11 years (M = 8.6, SD = 1.8). This is the first study to quantify parental use of protective practices, other than prevention education, which may guard against CSA. Parental media mediation, which may safeguard against online dangers, was another unique focus of this study. Participants reported their discussion of sensitive topics with their children including CSA; behaviors that may reduce the incidence of CSA (e.g., monitoring, supervision, delegation of care and checking-in with the child); mediation of their child's media use; and attitudes towards CSA prevention education. Parents reported discussing sexual abuse less than other sensitive topics such as abduction dangers, drugs, and death but more than issues surrounding puberty, sex and pornography. Parents reported using high levels of protective behaviours, however some areas of concern were revealed. Of concern was the low-moderate level of parental media mediation, with substantial numbers of children potentially exposed to online risks such as using devices unsupervised in bedrooms or chatting to individuals unknown to their parents and not having their devices checked for concerning content. Almost all parents were supportive of CSA prevention education and felt they should provide this education. However, two-thirds of parents thought CSA education may be associated with harms for the child and two-thirds of parents believed children could prevent their own abuse. Reported results will aid in our understanding of which areas of parenting could be strengthened to create safer environments for children. This research has particularly highlighted the need for parents to be more protective around their children's access to online devices.

Perception of physicians and nursing staff members regarding outside versus bedside ward rounds: ancillary analysis of the randomised BEDSIDE-OUTSIDE trial.

We recently compared the effects of bedside and outside the room ward rounds on patients' knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds. Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100. Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (± standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 ± 16.96 versus 68.25 ± 21.10 respectively; age-, gender- and centre-adjusted difference of -10.46, 95% confidence interval [CI] -12.73 to -8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 ± 20.32 versus 65.32 ± 20.92, respectively; adjusted difference 4.35, 95% CI -1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 ± 13.87 versus 66.59 ± 21.82; adjusted difference -16.51, 95% CI -20.29 to -12.72; p = 0.002). While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987.

Perception of physicians and nursing staff members regarding outside versus bedside ward rounds: ancillary analysis of the randomised BEDSIDE-OUTSIDE trial.

We recently compared the effects of bedside and outside the room ward rounds on patients' knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds.Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100.Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (± standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 ± 16.96 versus 68.25 ± 21.10 respectively; age-, gender- and centre-adjusted difference of -10.46, 95% confidence interval [CI] -12.73 to -8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 ± 20.32 versus 65.32 ± 20.92, respectively; adjusted difference 4.35, 95% CI -1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 ± 13.87 versus 66.59 ± 21.82; adjusted difference -16.51, 95% CI -20.29 to -12.72; p = 0.002).While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987.

Perceived benefits and limitations of using patient-reported outcome measures in clinical practice with individual patients: a systematic review of qualitative studies.

Patient-reported outcome measures (PROMs) are increasingly used in clinical settings to inform individual patient care. In-depth understanding of end-users' experiences may help identify factors that promote or hinder their use in clinical decision-making. We aimed to examine stakeholder perceptions of the utility of using PROMs in clinical practice based on real-life experience. Systematic review searching Medline, Embase and PsychINFO from inception to May 2021. Qualitative studies examining patients' and/or clinicians' experiences of using PROMs in clinical settings were included. Study screening and data extraction were performed by two independent reviewers. Qualitative data from included studies was analysed thematically. Of 2388 abstracts retrieved, 52 articles reporting 50 studies met eligibility. Five key benefits were identified: (1) promotes active patient involvement (enables goal setting and discussion of sensitive topics); (2) enhances the focus of consultations (prioritizes patient needs); (3) improves quality of care (enables tailored, holistic care and prompts action); (4) enables standardized monitoring of patient outcomes; and (5) enhances the patient-clinician relationship (provides reassurance). Perceived limitations included the capacity of PROMs to shift the focus of consultations; inaccurately estimate problems; raise unrealistic expectations for care; inhibit patient-clinician interaction; lack clinically meaningful information; and not be suitable for all patients. Both patients and clinicians reported benefits of using PROMs across diverse health conditions and clinical settings, but also highlighted several limitations. These limitations shed some light on why PROM use may not always improve patient outcomes and provide considerations for the design and implementation of future PROM initiatives.

Patient and Caregiver Experience with Outpatient Palliative Care Telemedicine Visits.

Background: Telemedicine visits reduce the physical and financial burdens associated with in-person appointments, especially for patients with serious illness. Little is known about patient and caregiver preferences regarding telemedicine visit timing and the discussion of sensitive topics by telemedicine.Objective: To characterize the experience of patients with serious illness and their caregivers receiving palliative care (PC) by telemedicine.Design: Mixed-methods telephone survey.Setting/Subjects: Patients and family caregivers who had at least one telemedicine visit with the outpatient PC team at our urban academic medical center.Results: A total of 35 patients and 15 caregivers were surveyed. Patient mean age was 61 years, 49% had cancer, and 86% were Caucasian. Caregiver mean age was 62 years. Mean satisfaction with PC telemedicine visits was 8.9 out of 10 for patients; 8.8 for caregivers. Patients (97%) and caregivers (100%) felt comfortable discussing sensitive topics over video. Participants felt telemedicine was an acceptable format to discuss most sensitive topics but 53% of caregivers preferred to receive bad news in person. Participants valued the convenience of telemedicine; they had concerns about rapport building and desired a more user-friendly telemedicine platform.Conclusions: Patients with serious illness and their caregivers rated telemedicine visits highly and felt comfortable discussing sensitive topics by video. Concerns included rapport building and telemedicine platform setup and quality. The rapid growth of telemedicine during coronavirus disease 2019 creates an imperative for research to understand the impact on the quality of care and mitigate any negative effects of telemedicine within a diverse population of patients.

A TYPICAL WEEK WITH MILD COGNITIVE IMPAIRMENT: A PHOTO-ELICITATION STUDY

Mild cognitive impairment (MCI) is an important precursor to dementia syndromes and carries with it both public and personal health significance, yet affected individuals may experience stigma, fear, and reluctance to participate in research or access services. Identifying the experience of people with MCI may help develop research agendas, interventions, and other supports to better match patients’ needs. To this end, we conducted photo-elicitation interviews with 11 community-dwelling adults aged 57-79 years with diagnosed MCI. Interviews took place remotely using teleconferencing software to reduce access barriers. Each semi-structured interview used 5-10 participant-generated photographs to elicit the experience of living with MCI, barriers to daily activities, and facilitators and supports. Interviews were transcribed, coded, and analyzed using Dedoose software. Qualitative analysis revealed themes of important activities, including physical activity, social engagement, and cognitive stimulation. Barriers presented by MCI included difficulty with former routines (e.g., cooking, finances), reduction of activities, and perceived stigma or fear of disclosure. Facilitators of daily activities included increased use of new strategies and environmental supports (e.g., calendars, smartphones), in addition to social and familial support. Multiple participants noted that the diagnosis of MCI led to opportunities for inner reflection and seeking a sense of inner calmness. Incorporating participant-generated images aided in data collection and facilitated discussion of sensitive topics with a cognitively impaired sample. Clinicians and researchers should support engagement in meaningful activities, assess barriers to important daily activities, and consider support to match the experience and needs of those with MCI.

Focus group methodology: some ethical challenges

Focus group methodology generates distinct ethical challenges that do not correspond fully to those raised by one-to-one interviews. This paper explores, in both conceptual and practical terms, three key issues: consent; confidentiality and anonymity; and risk of harm. The principal challenge in obtaining consent lies in giving a clear account of what will take place in the group, owing to unpredictability of the discussion and interaction that will occur. As consent can be seen in terms of creating appropriate expectations in the participant, this may therefore be hard to achieve. Moreover, it is less straightforward for the participant to revoke consent than in one-to-one interviews. Confidentiality and anonymity are potentially problematic because of the researcher’s limited control over what participants may subsequently communicate outside the group. If the group discussion encourages over-disclosure by some participants, this problem becomes more acute. Harm in a focus group may arise from the discussion of sensitive topics, and this may be amplified by the public nature of the discussion. A balance should be struck between avoiding or closing down potentially distressing discussion and silencing the voices of certain participants to whom such discussion may be important or beneficial. As a means of addressing the above issues, we outline some strategies that can be adopted in the consent process, in a preliminary briefing session, during moderation of the focus group, and in a subsequent debriefing, and suggest that these strategies can be employed synergistically so as to reinforce each other.

A qualitative assessment of a dog program for youth offenders in an adult prison.

Dog programs occurring in prison tend to generate positive public opinion and media portrayals, yet they often lack empirical validation. This is the first study to examine the key themes that drive a dog program aimed at incarcerated youth serving time in an adult prison. A sample of male youth (n=31) were provided survey questions on a rescue dog program. A grounded qualitative approach was employed with open-ended responses. The following themes emerged: the symbolism of the dog its role in therapy, perceptions of positive behaviors and rehabilitation, a sense of normality, and universal support by inmates. This study supports the potential for utilizing rescue dogs in therapeutic interventions in which the vulnerable inmate can discuss early trauma, interpersonal dysfunction and histories of deviance. The dog symbolized the potential for incarcerated youth to engage in discussion of sensitive topics in a safe manner. Policy implications also include the function of dogs in creating a normalizing effect on the prison unit itself, one that can promote rehabilitation. There was universal support for the program which is rare in the prison milieu. Theoretically, positive outcomes occurred in an indirect manner, though more research is needed.

Fact or Fiction? Designing Stories for Active Learning Exercises

ABSTRACTStories can be employed in a variety of ways in college classrooms—such as in case studies, simulations, and problem-based learning (PBL) activities. Sometimes these stories are historically accurate, while in other instances they are fictional. What might be the benefits and challenges of using fictional narratives? This article draws upon data from student surveys and 15 years of teaching practice to consider the advantages and drawbacks of using fictional stories in PBL exercises. It finds that using fictional stories develops problem-solving and teamwork skills, promotes deep learning, enables the discussion of sensitive topics, and helps to build a community of learners. Also, the stories can be easily modified so as to meet learning objectives and enhance instructional flexibility. Moreover, the challenges of using fictional stories are manageable. Writing such narratives can be easier than imagined if professors fictionalize a case study with which they are familiar. Concerns about the acquisition of substantive knowledge can be addressed by discussing the similarities between fictional stories and real-world cases. Students report that the use of fictional narratives clarifies abstract concepts and aids in the long-term retention of course material. While this article focuses on PBL, its findings are pertinent to other forms of active learning.

Just between Us: An Integrative Review of Confidential Care for Adolescents

IntroductionConfidential care is recommended for all adolescents to facilitate risk behavior screening and discussion of sensitive topics. Only 40% of adolescents receive confidential care. The purpose of this integrative review is to describe research related to the practice of confidential care for adolescents. Evidence was analyzed to identify strategies to increase confidential care and improve risk behavior screening. MethodWhittemore and Knafl's integrative literature review process was applied. ResultsThe 26 research articles included in this review included patients', parents', and physicians' perspectives. Confidential care practice is inconsistent. Strategies to improve practice are known. ConclusionsFour key elements should be considered to establish a practice culture of confidential care for adolescents. Strategies for implementing the key elements of confidential care and supporting resources for efficient use of time alone are provided.

Breaking Down Barriers in Pediatric Mental Health Consultations: Understanding Patients’ Use of I DON’T KNOW

ABSTRACTBarriers to effective provider–patient communication take many forms that can be difficult to recognize and appropriately address. This paper offers probabilistic indicators for one such form, patient-produced “I don’t know” (IDK), distinguishing its use as a cognitive claim and its use as a strategy for resisting discussion of sensitive topics. A total of 95 audio-recorded psychiatrist–child interactions are drawn from a US-wide corpus of physician–patient consultations. From these, 376 patient-produced IDKs are extracted and coded for linguistic/social factors, including form, function, prosody, age, gender, and primary diagnosis. Two multiple logistic regressions are performed to determine the predictors of cognitive and resistive IDK functions respectively. Cognitive IDK uses are associated with the full form (p < 0.01) and unstressed prosody (p < 0.01). Use of resistive IDK is correlated with decreasing patient age (p < 0.01) and emotionally labile mental health diagnoses (p < 0.01). Cognitive and resistive IDK uses have distinctive linguistic and social distributions in psychiatrist–child interactions, where cognitive uses have two objectively identifiable linguistic characteristics and resistive uses are associated with certain patient types. Providers may learn to recognize cognitive and resistive IDK uses, thus acquiring the ability to correctly interpret interactional cues relevant to the diagnosis and treatment of pediatric mental health conditions.

Empowering processes within prostate cancer online support groups

A growing body of literature suggests that participation in online support groups may empower patients. Indeed, a number of potentially empowering processes have been identified, however to date these processes have been described using data derived from either female or mixed gender support groups. Little is known about how participation in predominantly male online support groups (e.g., prostate cancer) may potentially empower members. A total of 682 messages from two prostate cancer online support groups were analysed using deductive thematic analysis, coding for the presence of potentially empowering processes, as described by van Uden-Kraan et al. (2008). The analysis confirmed the existence of all six potentially empowering processes, including: ‘information provision’, ‘provision of emotional support’, ‘provision of esteem support’, ‘noting similarity of experiences’, ‘discussion of sensitive topics’ and ‘chit-chat’. The discussion between members illustrated the value they attached to knowledge, mastery and control over their lives with cancer, strongly favouring informed choice and active participation in disease management. In conclusion, the findings from this study extend our knowledge of the potentially empowering processes which members may encounter as a result of participation in online support groups and suggest that similar processes may be found in predominantly male support groups, such as prostate cancer.

Open Intercultural Dialogue: educator perspectives

While language educators are being encouraged to exploit the Web for authentic intercultural communication, research is showing that rather than bringing people from different backgrounds together, the Internet is offering a platform for people to express their opinions with those who share similar ideas. When intercultural contact does occur, it often appears to be highly conflictual. This paper begins with a brief discussion of the open Web and intercultural dialogue, followed by an overview of attitudes to conflict in education and foreign language teaching and learning. We then turn to our preliminary study of the perspectives of educators from European universities on disagreement and the discussion of sensitive topics in online intercultural exchange. Our data indicate a considerable divergence of views and a great need for dialogue amongst educators and further research into this topic.

“I’m positive, I have something to say”: Assessing the impact of a creative writing group for adolescents living with HIV

This paper describes and evaluates “Teens Out Loud,” a creative writing group for adolescents with HIV infection. Youth with HIV frequently face a host of medical and social challenges, and often experience a lack of social support. Relatively few studies have explored interventions designed to support the growing number of perinatally infected youth who are living into adolescence and young adulthood, nor the effects of creative therapies on adolescents with HIV. The Teens Out Loud groups took place monthly in a mid-sized city in the southeastern United States. Interviews were conducted with seven adolescents (mean age 16 years, six females, six African-American), four guardians, and five group leaders regarding perceptions of the group. Interviews were recorded, transcribed, and coded using grounded theory. Qualitative analyses indicated that group members experienced improved confidence, communication skills, support and a desire to share experiences with others. Guardians reported improved self-expression, behavior, and writing skills amongst their participating adolescents. Group leaders noted increased openness among members and described the group as a “safe place” for adolescents talk about HIV. Concerns included disclosure, discussion of sensitive topics, and finding a balance between recreation and academics. Results suggest that creative writing groups can promote personal growth and decreased isolation of youth living with HIV, and confirm the need for more research to further explore benefits of writing as therapy.

Associations of Providers' Language and Cultural Skills With Latino Parents' Perceptions of Well-Child Care

To assess the associations of parent-primary care provider language concordance and providers' self-rated cultural competency items with Latino parent report of well-child care quality. A cross-sectional survey of parents with children 10-50 months old and their children's providers in 3 community health centers. We used the mean scores of quality domains of the Promoting Healthy Development Survey to examine associations of parent-provider language concordance and providers' self-rated cultural competency items with the quality of well-child care provided (all scales range 0-100). Results are based on 462 Latino parent responses and 22 provider responses. Latino parents in language concordant patient-provider relationships did not report higher-quality well-child care. Higher parent-reported quality of care was associated with provider self-reported effectiveness in treating Latino patients in the domains of family-centered care (mean 80.5 vs 70.6; P = .02) and helpfulness of care (mean 84.2 vs 67.9; P = .02). A language-cultural competency summary scale was associated with the domain assessing family risk factors (+11.2 points; P = .02) and its subdomain of emotional assessment (+16.1 points; P = .02). Language concordance was not associated with parental reports of quality of well-child care. Provider self-perceived cultural competency was associated with higher scores in domains related to how content is delivered-that is, helpful and family-centered. The language-cultural competency summary score was associated with discussion of sensitive topics. These findings indicate that provider characteristics other than language concordance have greater association with quality of care and may offer opportunities to strengthen cultural competency, even among monolingual providers.

'I wanna tell you a story': Exploring the application of vignettes in qualitative research with children and young people

Few methodological papers exist which examine the use of vignettes within qualitative research and more specifically, with children and young people. The paper will briefly discuss the application of vignettes within quantitative and qualitative research traditions derived from the available literature before outlining the major theoretical and methodological issues relating to the use of this technique in social research. Using empirical examples of young people's responses to a selected vignette, we then go on to explore the various benefits of vignettes that can ensue when employing this technique in isolation or as part of a multi-method approach. This discussion concludes with an exploration of how vignettes can be harnessed to engage young people, particularly in the discussion of sensitive topics, whilst enabling them to retain a high level of control over the research process.