Man's Search for Meaning: An Introduction to Logotherapy.

Shared decision-making is increasingly advocated as an ideal model of treatment decision-making in the medical encounter. To date, the concept has been rather poorly and loosely defined. This paper attempts to provide greater conceptual clarity about shared treatment decision-making, identify some key characteristics of this model, and discuss measurement issues. The particular decision-making context that we focus on is potentially life threatening illnesses, where there are important decisions to be made at key points in the disease process, and several treatment options exist with different possible outcomes and substantial uncertainty. We suggest as key characteristics of shared decision-making (1) that at least two participants-physician and patient be involved; (2) that both parties share information; (3) that both parties take steps to build a consensus about the preferred treatment; and (4) that an agreement is reached on the treatment to implement. Some challenges to measuring shared decision-making are discussed as well as potential benefits of a shared decision-making model for both physicians and patients.

Shared Decision-making in the Medical Encounter: What Does It Mean? (Or, It Takes at Least Two to Tango)

Background: eHealth is developing rapidly and brings with it a promise to reduce social health inequalities (SHIs). Yet, it appears that it also has the potential to increase them. Objectives: The general objective of this review was to set out how to ensure that eHealth contributes to reducing SHIs rather than exacerbating them. This review has three objectives: (1) identifying characteristics of people at risk of experiencing social inequality in health; (2) determining the possibilities of developing eHealth tools that avoid increasing SHI; and (3) modeling the process of using an eHealth tool by people vulnerable to SHI. Methods: Following the EPPI approach (Evidence for Policy and Practice of Information of the Institute of Education at the University of London), two databases were searched for the terms SHIs and eHealth and their derivatives in titles and abstracts. Qualitative, quantitative, and mixed articles were included and evaluated. The software NVivo (QSR International) was employed to extract the data and allow for a metasynthesis of the data. Results: Of the 73 articles retained, 10 were theoretical, 7 were from reviews, and 56 were based on empirical studies. Of the latter, 40 used a quantitative approach, 8 used a qualitative approach, 4 used mixed methods approach, and only 4 were based on participatory research-action approach. The digital divide in eHealth is a serious barrier and contributes greatly to SHI. Ethnicity and low income are the most commonly used characteristics to identify people at risk of SHI. The most promising actions for reducing SHI via eHealth are to aim for universal access to the tool of eHealth, become aware of users’ literacy level, create eHealth tools that respect the cultural attributes of future users, and encourage the participation of people at risk of SHI. Conclusions: eHealth has the potential to widen the gulf between those at risk of SHI and the rest of the population. The widespread expansion of eHealth technologies calls for rigorous consideration of interventions, which are not likely to exacerbate SHI. [J Med Internet Res 2017;19(4):e136]

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Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies

Existe un considerable bagaje teorico y metodologico para desarrollar investigacion cualitativa en salud siguiendo la diversidad de tradiciones analiticas que aportan principalmente las ciencias sociales. Sin embargo este maridaje que se produce en torno a lo socio-sanitario abre un espacio multidisciplinar no suficientemente explorado aun que suscita numerosos interrogantes. En este articulo se realiza una vision panoramica de los principales paradigmas, metodologias y orientaciones teoricas que han inspirado los analisis cualitativos en el contexto de las ciencias de la salud. Partiendo de una clasificacion primaria, se proponen los dos polos que delimitan el continuum del analisis cualitativo: desde los disenos que ponen enfasis en la descripcion de los datos, con un caracter puramente exploratorio, hasta aquellos se adentran en las formas de teorizacion para establecer interpretaciones e inferencias. La investigacion cualitativa abre un espacio en el analisis de los problemas de salud desde una perspectiva social y cultural, adoptando para ello diversos procedimientos, como el analisis de contenido o el analisis del discurso, que permiten un acercamiento a las formas de comunicacion y escudrina en la ideologia que se oculta tras el lenguaje. La tradicion sociologica y antropologica aportan de esta manera metodologias singulares que permiten conocer el contexto donde surgen los fenomenos y elaborar propuestas teoricas para explicarlos, como es el caso de la etnometodologia, la induccion analitica o la teoria fundamentada. Por ultimo se proponen algunas claves para construir un espacio comun desde el que construir nuevas perspectivas epistemologicas a partir de la confluencia multidisciplinar.

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Los modos de análisis en investigación cualitativa en salud: perspectiva crítica y reflexiones en voz alta

PURPOSE/OBJECTIVES: To describe the nature of suffering and the goals of nursing. DATA SOURCES: Data sources informing this work included descriptions of suffering as derived from the literature; narrative data from patients, family caregivers, and nurses; and personal and professional experiences of the authors. DATA SYNTHESIS: Previous descriptions of suffering from seminal sources are insufficient to elucidate suffering from a nursing perspective. This article is parallel to Cassell's description in 1982 of the nature of suffering and the goals of medicine. Nurses play a fundamental role in caring for those who suffer. Suffering is associated with loss, intense emotions, spiritual distress, and inability to express those experiences. CONCLUSIONS: The 10 basic tenets of suffering describe its nature and the goals of nursing; they include listening, intimate care of the body, and presence. IMPLICATIONS FOR NURSING: Oncology nurses witness suffering in their daily work. This article is intended to acknowledge suffering experienced in oncology nursing and to stimulate future research.

The Nature of Suffering and the Goals of Nursing

Les methodes qualitatives occupent une place grandissante en sciences humaines et sociales, constituant depuis leurs origines americaines un courant aussi riche que diversifie.Cet ouvrage, veritable manuel, permet d’apprehender aussi bien l’histoire que les enjeux epistemologiques et applications pratiques de ces methodes dans leur diversite (analyses thematique, a l’aide des categories, en mode ecriture...).Reactualise dans cette 4e edition, il cible toute la fecondite du denominateur commun a ces methodes : une demarche rigoureuse de reformulation, d’explicitation ou de theorisation des donnees d’enquete participant de la decouverte et de la construction de sens.

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L'analyse qualitative en sciences humaines et sociales

Cet article presente en detail les etapes d’une methode d’analyse qualitative, l’analyse par theorisation ancree, qui est une adaptation-transformation de la grounded theory approach. La methode permet de theoriser un phenomene empirique a travers la codification, la categorisation, la mise en relation, l’integration, la modelisation et la theorisation. La presentation de la methode est illustree par des exemples de recherches menees par l’auteur.

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L’analyse par théorisation ancrée

La méthodologie qualitative : Postures de recherche et travail de terrain

The essential mandate of medicine is the relief of suffering. However, the quest for an integrated model towards a conceptualization of suffering is still ongoing and empirical studies are few. Qualitative inquiry using 31 in-depth interviews and content analysis was carried out between 1999 and 2001 in 26 patients diagnosed with terminal cancer. The suffering experience was described through a multiplicity of heterogenous elements from the physical, psychological, and social spheres. Systematic synthesis of interview material yielded three apparently irreducible core dimensions. Respondents defined their suffering in terms of 1) being subjected to violence, 2) being deprived and/or overwhelmed, and 3) living in apprehension. Cassell wrote, in 1991, that to know the suffering of others demands an exhaustive understanding of what makes them the individuals they are (1). Our model can be of use in structuring and eliciting this necessary information. Understanding how a particular patient feels harmed, deprived or overburdened, and overtaken by fear, provides a lever for action tailored to the specifics of that person's experience.

The nature of suffering and its relief in the terminally ill: a qualitative study

OBJECTIVE To explore terminally ill patients9 perceptions of their own suffering in order to describe, from these patients9 perspective, some elements of health care providers9 response to suffering. DESIGN Qualitative study using content analysis methods suited to a grounded theory approach. SETTING Teaching and nonteaching hospital oncology clinics, palliative care services (both ambulatory and in-unit), and family practices. PARTICIPANTS Twenty-six patients diagnosed with terminal cancer. METHODS Interviews were audiotaped and transcribed verbatim. Data from each interview were coded and categorized to identify and define themes. Themes were discussed and refined until those rating them agreed on them. Data were collected until saturation of emerging issues was reached. MAIN FINDINGS In our health care system, patients are caught in a pervasive pattern of suffering avoidance, which in turn contributes to increased suffering. Health care services are perceived as a battlefield where physicians and patients are engaged in a losing struggle to ward off illness and death. Both physicians and patients engage in avoiding skepticism and muffling distress. The unavoidable avowal of powerlessness in the face of terminal disease is perceived as capitulation and therapeutic abandonment. Budgetary restraints and understaffing, along with a pervasive culture that implicitly denies death, produce an environment conducive to the avoidance of suffering. To counter this, health care practices that foster increased overlap and continuity between the spheres of oncology, palliative care, and family medicine seem worth developing. CONCLUSION The suffering of gravely ill patients might be hard to alleviate in the context of modern health care organizations. In some cases, health care delivery directly contributes to increased suffering. Providing support while also helping patients and their families to face upcoming harsh realities is a delicate balancing act that needs to be further explored.

https://www.cfp.ca/content/cfp/52/12/1574.full.pdf

Pierre Paillé

Papers

L'analyse qualitative en sciences humaines et sociales

L’analyse par théorisation ancrée

La méthodologie qualitative : Postures de recherche et travail de terrain

The nature of suffering and its relief in the terminally ill: a qualitative study

Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients.