Ulrich Teucher

Waiting for surgery from the patient perspective

The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.

Time While Waiting Patients’ Experiences of Scheduled Surgery

Research on patients’ experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients’ experiences of time while waiting for three types of surgery with varied wait times—hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care.

Developing and pilot-testing a Finding Balance Intervention for older adult bereaved family caregivers: A randomized feasibility trial.

PURPOSE This study aimed to test the feasibility of a psychosocially supportive writing intervention focused on finding balance for older adult bereaved family caregivers of advanced cancer patients. METHOD The Finding Balance Intervention (FBI) was tested for feasibility, acceptability and potential influence on increasing hope, coping and balance through a multi-method pilot study employing a randomized trial design with 19 older adults with an average age of 72 years. The intervention group received the FBI and a follow up visit from an RN-RA. The control group received the FBI at a second visit. The FBI, a theory-based intervention was developed from grounded theory qualitative data, applying Delphi methods to design a self-administered, psychosocially supportive, writing intervention for older adults who had lost a spouse after caregiving. RESULTS Feasibility was assessed and specific modifications identified. The FBI was easy to use, acceptable and of benefit. The FBI offered validation of emotions and ways to discover new ideas to find balance, which may enable bereaved caregivers to move forward on a unique journey through grief. The treatment group showed a statistically significant increase in restoration-oriented coping and higher oscillation activity. CONCLUSIONS The results suggest the FBI was easy to use, acceptable and of benefit. A full scale study, with specific modifications to the design, is needed to test the effectiveness of this innovative intervention.

Waiting for scheduled surgery: A complex patient experience

The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants’ waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.

Cultural Variations in Developing a Sense of Knowing Your Own Mind: A Comparison between British and Japanese Children.

We often have a feeling that we know ourselves much better than others know us, coupled with a feeling that our minds are not transparent to other people. In this article we begin to explore cultural variations in the development of this feeling. Children in Britain and Japan aged 7, 9 and 11 years judged how well they and how well their parent/teacher knew about aspects of the child’s mind (e.g., dreams, feeling sick, feeling hungry). Compared with British children, Japanese children credited adults with relatively large amounts of knowledge about themselves and this was most notable in the youngest group. Differences in patterns of judgements between the two nations could arise from differences in the cultural influences on the rate of development.

An Abundance of Selves: Young Adults' Narrative Identities While Living With Cancer.

Background: Identity negotiations of people living with cancer have been shown to be significant psychosocial challenges throughout cancer trajectories but have not been adequately explored among young adults with cancer. Narrative approaches might help to reveal moments of (dis)empowerment that affect their identity negotiations. Objective: The aim of this study is to explore how young adults speak to their identities in relation to their narratives of having cancer and receiving care. Methods: A total of 21 young adults (18–45 years old) provided cancer narratives through semistructured life history interviews. Thematic narrative analysis was used to determine how participants represented themselves in their stories. Results: Participants used a wide diversity of identities well beyond those most familiar in dominant discourses (eg, patients, survivors, and fighters), and their identities frequently changed at significant “turning points” in their narratives, especially in relation to good and bad experiences of care. Conclusions: Cancer-related identities often undergo personal and social negotiation over time, and not just among young adults still feeling the effects of treatment. Psychosocial oncology could take further steps toward incorporating this fluidity and multiplicity within the discipline’s discourses of identity. Implications for Practice: The identities gathered here may contribute to a more comprehensive toolkit of narrative resources for empowering young adults (and others) with cancer, serving as a starting point for negotiating identities with their care providers. Our findings raise questions about which identities should be fostered and how healthcare professionals might be (unknowingly) involved in patients’ identity negotiations.

Reduced prevalence of small-for-gestational-age and preterm birth for women of low socioeconomic position: a population-based cohort study comparing antenatal midwifery and physician models of care

Objective Our aim was to investigate if antenatal midwifery care was associated with lower odds of small-for-gestational-age (SGA) birth, preterm birth (PTB) or low birth weight (LBW) compared with general practitioner (GP) or obstetrician (OB) models of care for women of low socioeconomic position. Setting This population-level, retrospective cohort study used province-wide maternity, medical billing and demographic data from British Columbia, Canada. Participants Our study included 57 872 pregnant women, with low socioeconomic position, who: were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, delivered between 2005 and 2012 and received medical insurance premium assistance. Primary and secondary outcome measures We report rates, adjusted ORs (aOR), and 95% CIs for the primary outcome, SGA birth (<the 10th percentile), and secondary outcomes, PTB (<37 weeks’ completed gestation) and LBW (<2500 g). Results Our sample included 4705 midwifery patients, 45 114 GP patients and 8053 OB patients. Odds of SGA birth were reduced for patients receiving antenatal midwifery versus GP (aOR 0.71, 95% CI 0.62 to 0.82) or OB care (aOR 0.59, 95% CI 0.50 to 0.69). Odds of PTB were lower for antenatal midwifery versus GP (aOR 0.74, 95% CI 0.63 to 0.86) or OB patients (aOR 0.53, 95% CI 0.45 to 0.62). Odds of LBW were reduced for midwifery versus GP (aOR 0.66, 95% CI 0.53 to 0.82) or OB patients (aOR 0.43, 95% CI 0.34 to 0.54). Conclusion Antenatal midwifery care in British Columbia, Canada, was associated with lower odds of SGA birth, PTB and LBW, for women of low socioeconomic position, compared with physician models of care. Results support the development of policy to ensure antenatal midwifery care is available and accessible for women of low socioeconomic position. Future research is needed to determine the underlying mechanisms linking midwifery care to better birth outcomes for women of low socioeconomic position.