Gonzalo Bacigalupe

They Don't Want Anything to Do with You: Patient Views of Primary Care Management of Chronic Pain

OBJECTIVE Chronic pain is one of the most frequent complaints of patients in primary care, yet both patients and providers report low satisfaction with chronic pain care. This study was designed to explore the views held by a diverse sample of patients with chronic pain complaints about their care experiences to identify ways to improve care. DESIGN Qualitative analysis of 17 patient focus groups (size 3-7 participants). Groups used structured questions and were tape recorded, transcribed, and coded using qualitative software. Eleven groups were conducted in English, six groups in Spanish. PATIENTS Convenience sample of 72 adult patients (68% female, 44% Latino, mean age=48.1 years) recruited from four diverse primary care practices in Central Massachusetts. RESULTS Across all 17 groups, and all gender, ethnicity, and age groups, most patients reported suboptimal interactions with their providers when seeking care for chronic pain. Subjects acknowledged feeling disrespected and distrusted, suspected of drug-seeking, and having their symptoms dismissed as trivial and/or not warranting medical care. Patients reported more satisfaction when they felt a provider listened to them, trusted them, was accessible to address pain concerns between visits, and used patient-centered approaches to establish goals and treatment plans. Patients also recommended some management techniques related to the chronic disease management model to improve pain care. CONCLUSIONS Implementing patient-centered approaches in caring for individuals with chronic pain and using principles drawn from the chronic disease management model to improve care systems may improve both patient and provider satisfaction with chronic pain care.

The Discourse of Race and Culture in Family Therapy Supervision: A Conversation Analysis

Family therapy literature has emphasized the importance of examining contextual variables in supervision. This study explored how the talk of race, ethnicity, and culture is accomplished within the supervision session using conversation analysis. Conversation analysis is a naturalistic and descriptive methodology that examines patterns across naturally occurring conversations. The results indicated that the participants accomplished four domains of talk that involved the discourse of race, ethnicity, or culture. These domains included contextual markers, self of the therapist issues, cross cultural issues in the therapeutic relationship and cultural issues affecting the supervisory relationship. Implications for supervision and future directions are discussed.

Technology in families and the clinical encounter: results of a cross-national survey

Information communication technologies (ICT) are an integral part of contemporary family life, though the existing research about its impact is scarce, less than definitive, and individually based, as well as failing to attend to cross-cultural and cross-national dimensions. This study investigates how family clinicians construe the impact of ICT in the clinical context. A survey directed at family clinicians (N = 258) in four countries (Canada, Mexico, Spain and the USA) was designed to gather data on their beliefs about the impact of the emerging ICT on families and on their own clinical practice. The study found differences in the use of ICT across countries and correlation analyses showed there were more positive attitudes about the impact of emerging ICT on family dynamics among the clinicians whose use them the most.

Family Violence in Chile: Exploring Prevalence and Clinical Dimensions

Abstract Family violence, particularly the battering and abuse by men of women and children, has taken on different meanings over time in various cultures. This critical review of the literature looks at prevalence studies of family violence in Chile and explores how Chilean clinical practitioners construe domestic violence intervention and prevention. Systemic and family therapy ideas in Chile are reviewed in the context of clinical trends that have prevailed in the understanding of family violence. The review includes exploratory, empirical, and qualitative research studies. An outline of intervention ideas extracted from qualitative interviews of interdisciplinary teams is included to show how they implemented these clinical ideas.

Emerging Technologies and Family: A Cross-National Study of Family Clinicians’ Views

ABSTRACT Emerging technology adoption poses new challenges and opportunities to families and clinicians. Research that explores clinicians’ understanding and use of information-communication technologies; however, is still scarce. Our study, a replication of a cross-national study in four countries (Canada, Mexico, Spain, and the United States), investigated the relationship among clinicians’ use of and attitudes toward emerging technologies and their beliefs about technology’s impact on families in Turkey. We further inquired the relationship of two factors: the impact of emerging technology on the clinicians’ own families and the impact of cultural values on the attitudes toward technology use. The Turkish version of the modified Emerging Technologies and Families Survey was administered to family clinicians. The analytical strategy included a comparison of the data we collected in Turkey (n = 97) and the raw data from the original study (n = 258). We found significant cross-national differences in clinicians’ use of and attitudes toward information-communication technologies, and their assessments of families’ struggles with emerging technology. We analyzed the data vis-a-vis cultural differences and gave a special emphasis on implications for enhancing clinical practice. Emerging technologies challenge families’ and family therapists’ assumptions about healthy family processes; attention to the self of the therapist at the intersection of cultural values is core in a sound assessment of families adopting emerging technologies. Cultural humility and a curious stance may counteract the pervasive negative discourse about emerging technology adoption. Empowering parents and couples to put technology in “its place” may ease the negative impact and enhance the positive influence of these technologies on families.

INTERPERSONAL AND SYSTEMIC THEORIES OF PERSONALITY

The spectrum of theories of personality represents a range of accounts and explanations of the phenomena constituting personality development, processes, and functioning. Even more fundamentally, however, each personality theory differs in its conception of what personality is. Certain theoretical viewpoints even question or dispute whether personality, in the sense of a force that controls and directs intentions and actions, exists. Perhaps the best known instance of such a perspective is that of B. F. Skinner (1957), B. F. Skinner (1971)) who argued that behavior is controlled not by the person or personality, but by the environmental consequences of the person’s behavior.

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was −0.93 (P = <.001) for men and −0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and −0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.

Are Crisis Platforms Supporting Citizen Participation

Information systems are central to disaster management, and getting the right information to everyone is fundamental. Besides research, digital systems for disaster management have gained a central role in public and private disaster management organizations. The blogging and social media platforms popularized a decade ago were built around a user-generated content model in which users are not only readers but also producers of information, and their use is now pervasive. During a natural disaster crisis, massive amounts of information are generated via social media, including messages of caution and advice, information about affected individuals, infrastructure damage, volunteering and donations, among others. Based on a review of the literature and a systematic analysis of crisis platforms, we assess the ways in which participation is defined, propose a participation categorization, and evaluate the role that digital platforms may play in supporting community resilience for crisis and extreme events. The present study reviews what kinds of participation crisis computing projects are offered to the citizens of the regions they are scoping, and will evaluate how crowdsourcing is framed and how it is made available to citizens.

Aspectos psicosociales de la enfermedad celíaca en España: una vida libre de gluten

Objetivo: La celiaquia como enfermedad cronica tiene una alta prevalencia en nuestra sociedad. El articulo analiza los aspectos psicosociales de la enfermedad celiaca en los diferentes entornos, valorando el impacto de la implantacion de una dieta estricta libre de gluten. Metodos: Estudio cualitativo entre los meses de Enero del 2013 a Abril del 2013 en el cual, a traves de la teoria fundamentada y el analisis de contenido, se ha profundizado en el analisis de las entrevistas semiestructuradas a personas con enfermedad celiaca en Espana. Se realizaron llamamientos a traves de las redes sociales y grupos de celiacos hasta llegar a la saturacion teorica, que determino el tamano final de la muestra de 24 personas. Resultados: Educacion Sanitaria, Aislamiento social, soledad y desconocimiento social emergieron como categorias centrales en la experiencia de adopcion de la dieta libre de gluten a partir del diagnostico de celiaquia. Conclusion: Los profesionales deben promover y apoyar estrategias de apoyo social basadas en una comprension integra de las experiencias de desarraigo y marginacion que los pacientes celiacos experimentan en sus relaciones sociales a traves de la comida. Se requiere un aumento de la educacion sanitaria para entender e integrar el impacto psicosocial del diagnostico de celiaquia y la dieta libre de gluten.

The Power of Online Patient Communities for HIV Youth

Youth with HIV (YHIV) face social, physical, and emotional stressors related to their diagnosis. Often, these burdens are reinforced by social stigmatization surrounding HIV. For many YHIV, stigma inhibits the formation of social connections and peer support. But with the growth of online patient communities (OPCs), YHIV are more connected than ever as they provide one another with health information, emotional guidance, and a sense of community that spans geographical barriers. We contend that the social power of OPCs can aid in community support and provide opportunities for story telling and meaning-making that social stigmatization obstructs. While OPCs afford individuals with opportunities to build social networks that provide support and experience outlets for the patient narrative, the digital divide can often prevent against the utilization or research of OPCs for YHIV. This chapter argues for the social benefit of OPCs while also highlighting the gaps in research and implementation that require greater attention.