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1.  Movie making as a cognitive distraction for paediatric patients receiving radiotherapy treatment: qualitative interview study 
BMJ Open  2013;3(1):e001666.
Objectives
To establish the outcomes achieved by using an innovative movie-making programme designed to reduce fear of radiotherapy among paediatric patients.
Design
Qualitative descriptive evaluation based on semistructured, qualitative interviews with purposeful sampling and thematic analysis.
Setting
Tertiary Cancer Centre.
Participants
20 parents of paediatric patients who had produced a movie of their radiation therapy experience and were in a follow-up phase of cancer management.
Results
Participants attributed a broad range of outcomes to the movie-making program. These included that the programme had helped reduce anxiety and distress exhibited by paediatric patients and contributed to a willingness to receive treatment. Other outcomes were that the completed movies had been used in school reintegration and for maintaining social connections.
Conclusions
Allowing children to create a video of their experience of radiotherapy provided a range of benefits to paediatric patients that varied according to their needs. For some patients, movie-making offered a valuable medium for overcoming fear of the unknown as well as increasing understanding of treatment processes. For others, the development of a personalised video offered an important cognitive/attentional distraction through engaging with an age-appropriate activity. Together these outcomes helped children maintain self-control and a positive outlook.
doi:10.1136/bmjopen-2012-001666
PMCID: PMC3549231  PMID: 23328308
Radiotherapy; paediatric; anxiety; distraction; video-audio media
2.  Diverse voices, simple desires: a conceptual design for primary care to respond to depression and related disorders 
Family Practice  2010;27(4):447-458.
Background. The World Health Organization and the World Organization of Family Doctors have called for ‘doable’ and ‘limited’ tasks to integrate mental health into primary care. Little information is provided about tasks GPs can undertake outside of guidelines that suggest to prescribe medication and refer to specialists.
Objectives. The reorder study aimed to gather diverse patient and community perspectives to inform the development of an effective system of depression care.
Method. Five hundred and seventy-six patients completed computer-assisted telephone interviews. Two hundred and seventy-six community stakeholders completed a modified two round Delphi. Responses were analysed to identify tasks and these were synthesised into a conceptual design.
Results. Fifteen core tasks were identified, 5 were agreed upon and a further 10 identified by each group but not agreed upon. Listen, understand and empathize, provide thorough and competent diagnosis and management, follow-up and monitor patients, be accessible and do not rush appointments and provide holistic approach and tailor care to individual needs were agreed on. Other tasks included: develop plans with patients, assess for severity and suicide risk, account for social factors, be well trained in depression care and offer a range of treatment options, appropriate and timely referral, support and reassurance, educate patients about depression, prescribe appropriately and manage medication and be positive and encouraging.
Conclusions. The tasks form the basis of a conceptual design for developing a primary care response to depression. They fit within three domains of care: the relational, competency and systems domains. This illustrates tasks for GPs beyond prescription and referral.
doi:10.1093/fampra/cmq016
PMCID: PMC2908158  PMID: 20378630
Depression; doctor–patient relationship; health service management; mental health; qualitative research
3.  Treatment costs and priority setting in health care: A qualitative study 
Background
The aim of this study is to investigate whether the public believes high cost patients should be a lower priority for public health care than low cost patients, other things being equal, in order to maximise health gains from the health budget. Semi-structured group discussions were used to help participants reflect critically upon their own views and gain exposure to alternative views, and in this way elicit underlying values rather than unreflective preferences. Participants were given two main tasks: first, to select from among three general principles for setting health care priorities the one that comes closest to their own views; second, to allocate a limited hospital budget between two groups of imaginary patients. Forty-one people, varying in age, occupation, income and education level, participated in a total of six group discussions with each group comprising between six and eight people.
Results
After discussion and deliberation, 30 participants rejected the most cost-effective principle for setting priorities, citing reasons such as 'moral values' and 'a personal belief that we shouldn't discriminate'. Only three participants chose to allocate the entire hospital budget to the low cost patients. Reasons for allocating some money to inefficient (high cost) patients included 'fairness' and the desire to give all patients a 'chance'.
Conclusion
Participants rejected a single-minded focus on efficiency – maximising health gains – when setting priorities in health care. There was a concern to avoid strategies that deny patients all hope of treatment, and a willingness to sacrifice health gains for a 'fair' public health system.
doi:10.1186/1743-8462-6-11
PMCID: PMC2685807  PMID: 19416546

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