Shelley Raffin Bouchal

Cultural Background and Socioeconomic Influence of Immigrant and Refugee Women Coping with Postpartum Depression

Postpartum depression is a serious condition that can have long lasting traumatic effects on women and their families. Until recently postpartum depression research has focused more on the population as a whole rather than refugee and immigrant women. Informed by Kleinman’s explanatory model and the postcolonial feminist perspective, 30 immigrant and refugee women were interviewed to find out what factors influenced them in seeking postpartum care and what strategies would be helpful in prevention and treatment of postpartum depression. We found that the immigrant and refugee women in our sample: (a) were influenced by both cultural background and socioeconomic factors in seeking support and treatment; (b) were influenced by cultural differences and social stigma when making decisions about health care practices; and (c) employed numerous coping strategies to deal with postpartum depression. Recommendations are provided for more culturally appropriate and equitable mental health care services for immigrant and refugee women living in Canada.

Sympathy, empathy, and compassion: A grounded theory study of palliative care patients’ understandings, experiences, and preferences:

Background: Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent. Aim: The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice. Design: Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory. Setting/participants: Data were collected from 53 advanced cancer inpatients in a large urban hospital. Results: Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful. Conclusion: Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.

'Not yet' and 'Just ask': barriers and facilitators to advance care planning--a qualitative descriptive study of the perspectives of seriously ill, older patients and their families.

Objectives To explore seriously ill, older hospitalised patients’ and their family members’ perspectives on the barriers and facilitators of advance care planning (ACP). Methods We used qualitative descriptive study methodology to analyse data from an interviewer administered, questionnaire-based, Canadian multicentre, prospective study of this population. Results Three main categories described these barriers and facilitators: (1) person (beliefs, attitudes, experiences, health status), (2) access (to doctors and healthcare providers, information, tools and infrastructure to communicate ACP preferences) and (3) the interaction with the doctor (who and how initiated, location, timing, quality of communication, relationship with doctor). Conclusions Based on the findings, we suggest strategies for both healthcare systems and individual healthcare providers to improve the quality and quantity of ACP with this population. These include assessing readiness for participation in ACP and personalising relevance of ACP to each individual, routinely offering scheduled family meetings for exploring a persons own goals and sharing information, ensuring systems and policies are in place to access previous ACP documentation and ensuring doctors’ education includes ACP communication skills.

Using Critical Ethnography to Explore Issues among Immigrant and Refugee Women Seeking Help for Postpartum Depression

Critical ethnography was used as a pragmatic research methodology to explore the postpartum depression (PPD) experiences of immigrant and refugee women. We examined the social, political, economic, and historical factors that affected the help-seeking behavior of these women during PPD episodes. The critical ethnography method allowed participants to share their experiences with each other and afforded opportunities to the researchers to acknowledge and validate, rather than simply observe and record, their testimony. This study of PPD thus increased our awareness and understanding of the health issues of immigrant and refugee women.

Holding On and Letting Go: Families' Experiences of Anticipatory Mourning in Terminal Cancer

Although grief and family caregiving have been extensively studied, there exists limited knowledge of anticipatory grief as it relates to families’ transition in illness to bereavement. Evidence suggests the need for a deeper understanding of the role that anticipatory grief plays to support families’ quality of life. The process of understanding is so embedded within our human nature that it is often left invisible in its everydayness. This qualitative pilot study was undertaken to explore the retrospective experiences of anticipatory grief of eight families who have lost a loved one from cancer. Findings revealed that family members lived in a complex tension of the duality of holding on and letting go throughout the illness and continued into bereavement. Retrospective reflection offered a deep awareness of the whole of the grieving process that included the understanding of grief in the midst of illness and its impact on postdeath grief.

Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study.

Objectives The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers. Setting Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada. Participants: Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs. Results Data were analysed using the qualitative approach of latent content analysis. Addressing spiritual issues was understood by patients and healthcare providers, as a core, yet under addressed, component of comprehensive care. Both sets of participants felt that addressing basic spiritual issues was the responsibility of all members of the interdisciplinary team, while recognising the need for specialised and embedded support from a spiritual care professional. While healthcare providers felt that the impact of the illness and treatment had a negative effect on patients’ spiritual well-being, patients felt the opposite. Skills, challenges, key time points and clinical indicators associated with addressing spiritual issues were identified. Conclusions Despite a number of conceptual and clinical challenges associated with addressing spiritual issues patients and their healthcare providers emphasised the importance of an integrated approach whereby basic spiritual issues are addressed by members of the interdisciplinary team and by an embedded spiritual care professional, who in addition also provides specialised support. The identification of clinical issues associated with addressing spiritual needs provides healthcare providers with clinical guidance on how to better integrate this aspect of care into their clinical practice, while also identifying acute incidences when a more targeted and specialised approach may be of benefit.

Characterizing Readiness for Advance Care Planning From the Perspective of Residents, Families, and Clinicians: An Interpretive Descriptive Study in Supportive Living

Background and Objectives Advance care planning (ACP) involves reflection on health care preferences and communication of the persons wishes in case of future incapacity. ACP is particularly pertinent in supportive living (SL) as residents are at high risk of cognitive decline and changes in health status, but the readiness of residents, families, and health care practitioners to engage in ACP discussions is not known. The purpose of this study was to explore the readiness among these stakeholders and the factors that influence the degree of readiness. Research Design and Methods Twenty-seven participants (10 residents, 8 family members, 9 health care practitioners) affiliated with 4 SL facilities in Calgary, AB, Canada took part in semistructured, one-on-one interviews. An interpretive descriptive approach was utilized to generate clinically relevant findings. Results Variability in the conceptualization of ACP, including confusion regarding terminology, emerged as a major theme. Themes that influenced readiness for engagement in ACP discussions included the influence of prior experience for residents and family members, perception of treatment goals, and understanding of roles in the process between the groups. Discussion and Implications Recommendations for clinicians include clarifying ACP concepts for themselves and residents, shifting focus toward an elucidation of values and preferences rather than on documentation, greater clarity about the roles of the various stakeholders, and recognizing the importance of prior experience for residents and family members. These findings can be used to contribute to the understanding of ACP engagement in SL and inform an approach to engaging in meaningful discussions about ACP.

A qualitative study of pregnancy-related anxiety among women in Tanzania

Objectives To explore and understand the experiences and priorities of pregnant women living with fears and worries related to fetal/infant and maternal health, the birthing process and ability to parent the infant (ie, pregnancy-related anxiety (PRA)) in Mwanza, Tanzania. Design Descriptive phenomenological approach. Setting Two clinics in the Ilemela and Nyamagana districts of Mwanza. Participants Pregnant and postpartum women who obtained high scores on a PRA scale during pregnancy in a larger quantitative study were contacted to participate in an interview (10 women, aged 18–34 years; 3 HIV positive). Measures Semi-structured interviews were undertaken, with guiding questions related to the womens experience during pregnancy. The Colaizzi method was used with transcripts that had been translated and back translated from Swahili to English and then hand-coded by the interviewer, with independent review by another researcher to verify the analysis. Results PRA, as experienced by women in Mwanza, was a state of worry and concern, often causing physical symptoms, and disrupting personal sense of peace. While some themes in the womens experiences reflected the domains examined in the PRA scale used to identify potential participants, others such as lack of knowledge, partner relationship, interactions with the healthcare system, spirituality and fear of HIV/AIDS were otherwise missing. Their prominence in the participants’ stories broadens our understanding of PRA. Conclusions The realities and viewpoints of women in low-income and middle-income countries (LMIC) experiencing PRA are still relatively unknown. The findings from this study provided much-needed insight into the perspectives and priorities of women in Mwanza who have experienced PRA and further support the need to explore this phenomenon in other LMIC. The additional domains identified reinforce the need for a PRA tool that accurately and adequately capture the complexities of PRA for women in this region.

Perspectives on advance care planning in haematopoietic stem cell transplantation: a qualitative study

BACKGROUND Advance care planning (ACP) engagement and completion of advance directives remain low in patients undergoing haematopoietic stem cell transplantation, despite the high risk of treatment-related mortality. AIM To understand the barriers to and facilitators of ACP in haematopoietic stem cell transplantation. METHODS This qualitative study used interpretive description methodology. The researchers conducted audio-recorded semi-structured interviews with participants. The constant comparative method was used to analyse data. RESULTS A total of six patients, five family members and eight clinicians participated in the study. Perceived barriers to ACP included: lack of time, lack of process, lack of understanding of disease/treatment and ACP, need to keep positive and prognostic uncertainty. Potential facilitators of ACP included: early and frequent discussion of ACP, incorporating ACP into routine care, involvement of the multidisciplinary team and framing discussions on ACP as positive. CONCLUSIONS Haematopoietic stem cell transplantation poses unique challenges for patients, families and clinicians when it comes to ACP. Introducing advance care planning as part of standard care and providing ongoing facilitation of ACP, including discussion of disease and treatment expectations at the outset and when complications arise may assist patients and families in recognising how ACP can fit into and enhance their care.