John Chatwin

Cancer pain management at home (II): does age influence attitudes towards pain and analgesia?

Goals of workOlder patients experience a higher prevalence of pain, including cancer pain, than other age groups and tend to receive poorer pain management. The reasons for unnecessary suffering resulting from pain among older patients are not well understood. This study aimed to identify barriers to cancer pain management for older patients living at home and to compare these with a younger control group.Patients and methodsPatients newly referred to community-based palliative care services were interviewed about their pain and related issues. Data included pain impact (BPI), mood (HAD), health (EuroQol), and barriers to reporting of pain and analgesic use (Barriers Questionnaire).Main resultsFifty-eight patients aged 75 or over and 32 people aged 60 or under were interviewed. Both groups reported that beliefs about the use of analgesics was the greatest barrier to effective pain management. Older patients reported that beliefs about the use of analgesics and communicating with medical staff were significantly more important barriers to pain management than for younger patients. Overall, factors such as communication with medical staff and fatalism were ranked lower than barriers related to medication. Younger patients reported significantly greater sleep disturbance due to pain and greater anxiety.ConclusionsOlder age appears to influence attitudes towards pain and analgesia. Factors such as poorer knowledge about taking analgesia, reluctance to communicate with medical staff, poorer performance status, and being more likely to live alone suggest that older patients may require greater support in the management of their cancer pain than younger patients. Targeted interventions are needed to test this proposition.

Toward an understanding of decision making on complementary and alternative medicine use in poorer countries: the case of cancer care in Pakistan.

During the past 2 decades, the study of complementary and alternative medicine (CAM) in general, and the sociological study of CAM in particular, have developed apace in richer countries. In addition to data on use levels and the nature of provision, there is now increasing research on issues such as motivation for use, decision-making processes, and so on. The integration of nonorthodox therapies into cancer care has been an important focus for such work. However, this interest has yet to be matched by work in poorer countries. While the nature of traditional medicine (TM) has long been of interest to anthropologists, the new context (marked by the globalized nature of CAMs existing alongside TM and allopathic treatment) has yet to be examined in any depth. In this article, the authors discuss the structural and cultural context of the first sociological research to be conducted into the role ofCAMandTMin cancer care in Pakistan. They identify some potentially important processes (ie, those identified in the limited existing literature and in anecdotal commentary), which are being tested by the new empirical study. The specific foci of the work are outlined. It is argued that research in poorer countries is essential both to ensure that an existing academic imbalance is addressed and to underpin more informed policy making in complex medically pluralistic (poorer) countries.

Conversation analysis as a method for investigating interaction in care home environments.

This article gives an outline of how the socio-linguistic approach of conversation analysis can be applied to the analysis of carer–patient interaction in care homes. A single case study from a routine encounter in a residential care home is presented. This is used to show how the conversation analysis method works, the kinds of interactional and communication features it can expose, and what specific contribution this kind of micro-interactional approach may make to improving quality of care in these environments.

Patient narratives: A micro-interactional analysis

The use of narrative as a therapeutic tool is well established in many forms of counseling and psychotherapy. Similarly, it forms a significant element of many holistic consultation approaches. The value of patient narratives are recognized by many practitioners working in primary care too, but opportunities for its utilization can be limited by the practicalities of working within conventional healthcare structures. This article presents a micro-interactional analysis of the ways in which patients routinely frame and self-manage their narratives in the context of primary care encounters, and explores some of the behavioral motifs utilized by practitioners in the management of narrative-based interactions.

Volunteering and overseas placements in the NHS: a survey of current activity

Objective The study aimed to establish current levels of overseas volunteering and placement activity across all staff grades within the National Health Service (NHS) in the North West of England. Design Cross-sectional survey. Instrument Descriptive statistics. Setting 4 main regional hospitals in the North West of England, and additional NHS staff training events. Participants Convenience sample of NHS staff (n=911). Results 911 NHS staff took part in the survey. The medical and dental staff group returned the highest number of responses (32.1%). 42% of staff reported some form of overseas volunteering or placement experience. Most staff took an international placement as students (33.6% men; 40.6% women). Medium-term placements were undertaken by 46.7% of men, and 52.5% of women. Settlement stays (ie, over 1 year) were reported by 7.6% men, and 8.3% women). The majority of respondents engaged in international placement were from the age groups incorporating ‘below 25’ to ‘41–50’ (74%). Multiple placement experiences were uncommon: 2.5% of respondents reported three periods of overseas activity, and 1.5% reported four. All those with multiple placement experience came from the staff groups incorporating midwife/nurse/health visitor, and medical and dental. Conclusions This survey captured a snapshot of current levels of volunteering and overseas placement activity across NHS staff grades in the North West. Owing to relatively homogenous organisational structures, findings are likely to broadly represent the position across the organisation as a whole. Although some degree of overseas placement activity is undertaken by a relatively high proportion of NHS staff, such activity is currently heavily skewed towards higher clinical staff grades. Significant numbers of allied health professionals and equivalent non-clinical cadres also report overseas experience, and we anticipate that the numbers will continue to rise if current policy initiatives gain momentum.

Pain in older people with cancer: attitudes and self‐management strategies

Cancer is predominantly a disease of older people. It is also frequently a painful condition. However, the ageing process brings with it any number of other painful conditions, so it can be difficult to quantify the number of older people who are in pain solely because of cancer. In this article, we present a review of the literature concerning issues specifically related to the management of pain in older people. Three main areas are considered: the use of analgesics; the attitudes of older people in relation to pain management and their utilization of pain management strategies. We suggest that although a great deal is known about the efficacy of analgesia, there is relatively little information relating to the subjective experience of older individuals as they engage with treatment processes. This is important because social, psychological and cultural factors can have a significant influence on the effective management of cancer pain in this age group.

The mediation of social influences on smoking cessation and awareness of the early signs of lung cancer

BackgroundWhilst there has been no clear consensus on the potential for earlier diagnosis of lung cancer, recent research has suggested that the time between symptom onset and consultation can be long enough to plausibly affect prognosis. In this article, we present findings from a qualitative study involving in-depth interviews with patients who had been diagnosed with lung cancer (n = 11), and people who were at heightened risk of developing the disease (n = 14).MethodsA grounded theory methodology was drawn upon to conduct thematic and narrative based approaches to analysis.ResultsThe paper focuses on three main themes which emerged from the study: i) fatalism and resignation in pathways to help-seeking and the process of diagnosis; ii) Awareness of smoking risk and response to cessation information and advice. iii) The role of social and other networks on help-seeking. Key findings included: poor awareness among participants of the symptoms of lung cancer; ambivalence about the dangers of smoking; the perception of lung cancer as part of a homogenisation of multiple illnesses; close social networks as a key trigger in help-seeking.ConclusionsWe suggest that future smoking cessation and lung cancer awareness campaigns could usefully capitalise on the influence of close social networks, and would benefit from taking a ‘softer’ approach.

Regulation and the Positioning of Complementary and Alternative Medicine

Most developed and prosperous countries have seen their reliance on conventional medicine paralleled by an exponential growth of interest in complementary and alternative medicine (CAM) (Eastwood, 2000; McGregor and Peay, 1996). In this chapter, we discuss some of the results relating to research conducted by the authors that explored the ways in which CAM is used, understood and evaluated in terms of its perceived utility by patients with cancer in the UK and Pakistan. Our focus here, compared with earlier chapters, is less on formal processes of regulation and evaluation of IHTs, and more on the ways in which patients (and patient groups) position CAM in relation to orthodox medicine. We show how there are quite diverse ways in which this can occur that reflect different interpretive and interactional repertoires used by patients and CAM groups. Focusing on our UK data, we argue that the degree to which it is possible to build a genuinely ‘alternative’ medicine is constrained by organisational and gate-keeping constraints imposed on CAM groups.

Healthcare, frugal innovation, and professional voluntarism : a cost-benefit analysis

This book investigates what international placements of healthcare employees in low resource settings add to the UK workforce and the efficacy of its national health system. The authors present empirical data collected from a volunteer deployment project in Uganda focused on reducing maternal and new-born mortality and discuss the learning and experiential outcomes for UK health care professionals acting as long term volunteers in low resource settings. They also develop a model for structured placement that offers optimal learning and experiential outcomes and minimizes risk, while shedding new light on the role that international placements play as part of continuing professional development both in the UK and in other sending countries.

Understanding the needs and experiences of people with young onset dementia: a qualitative study

Aim Despite an estimated 40 000 people diagnosed with young onset dementia (YOD) in the UK, there is a general lack of awareness of the condition when compared with late onset dementia. The aim of this study was to explore the experiences and needs of people living with YOD (younger than 65 years) and gain an understanding of the issues that impact on them. Setting Participants’ homes, support group premises or university rooms. Participants 14 people with a diagnosis of YOD from a northern UK city. Design Semistructured, in-depth interviews were audio recorded, transcribed and analysed cross-sectionally following principles of interpretative phenomenological analysis. Results Four superordinate themes are reported on ‘process of diagnosis’, ‘the impact of living YOD’, ‘needs of people with YOD’ and ‘living well with YOD’. Nine subordinate themes captured participant experiences of developing cognitive difficulties, after being diagnosed with YOD, and subsequently living with the condition. Key issues that emerging included a lack of general awareness of YOD; how this can delay help seeking; commonalities in prediagnosis trajectories; retrospective understanding of prediagnosis symptom patterns; the difficulties of obtaining a firm diagnosis; the importance of face-to-face support and difficulties associated with daily living. Participants also described the emotional and psychological impact of the condition and the importance of formal and informal support networks. Conclusions People who have a diagnosis of YOD regard themselves as distinct from older people with dementia. Despite similar symptoms, the context in which they experience the condition creates a range of distinct psychosocial concerns not commonly well addressed by health and social care services. As awareness of YOD continues to grow, the development (or adaptation) of services that take into account the idiosyncratic needs of people with YOD should be addressed.