ABSTRACT
PURPOSE: To explore the structure and content of pre-planned consultations as part of the care and treatment of patients undergoing surgery for colorectal cancer. METHODS: The study was based on 50 transcripts of audio-recorded pre-planned consultations between seven patients and 36 healthcare professionals from the time of diagnosis, pre-operative consultation, discharge consultation and pathology report in a colorectal unit. RESULTS: The spread of consultation time between professions was considerable. Total mean consultation time for patients during the care process (7 consultations/patient) was 111 min (range 83-191). The mean consultation time for surgeons was 18 min (7-40), anaesthesiologists 12 min (5-18) and nurses 14 min (5-49). Patients took up 40% of the word space, healthcare professionals used 59% and significant others 1%. Word space changed in such a way that the patient became more active towards the final consultation. Neither during the diagnosis consultation nor during the pre-operative consultation did the patients meet the operating surgeon. Six major subjects emerged: general health, diagnosis, surgical procedure, pre-operative preparations, recovery and treatment and follow-up. CONCLUSIONS: There is a need for clearer structure in the consultations. Most consultations lacked a clear introduction to the subject of the conversation. The study makes it possible to develop methods and structure for supporting conversations in which the patient is given space to help with the difficult issues present after undergoing surgery for colorectal cancer. The study also contributes to providing knowledge of how to organise surgical consultations in order to optimise person-centeredness, teamwork and clinical efficiency.
Subject(s)
Colorectal Neoplasms/surgery , Patient Care Team/organization & administration , Patient-Centered Care/methods , Preoperative Care/methods , Referral and Consultation/organization & administration , Adult , Aged , Aged, 80 and over , Attitude of Health Personnel , Colorectal Neoplasms/diagnosis , Female , Humans , Male , Middle Aged , Needs Assessment , Physician-Patient Relations , Surveys and Questionnaires , Sweden , Time FactorsABSTRACT
In this article we show that persons with communicative disabilities are often involved in storytelling that does not necessarily conform to the conventional expectations of what constitutes a narrative. By analyzing the relationship between story and storytelling event, and the relation between what could be called the primary storyteller and the vicarious storyteller, we show that storytellers with communicative disabilities are often quite inventive in finding ways of presenting themselves as competent storytellers even though they may have certain problems vocally animating a coherent, structured story. This lead us to conclude a necessary redefinition of what a narrative is - that it could be performed as well as it could be told - and that such a redefinition stresses methodological issues: in order to be able to study the life stories of people with communicative disabilities we need to use both narrative and ethnographic research methods.
Subject(s)
Communication Disorders/diagnosis , Disabled Persons/psychology , Narration , Anthropology, Cultural , Communication Disorders/psychology , Disability Evaluation , Female , Humans , Male , Reality Testing , SwedenABSTRACT
The aim of this study was to ascertain whether suicide victims had ever been in contact with a primary health-care centre, a psychiatric out-patient treatment centre or any form of institutional psychiatric care, and whether there had been any change in such patterns over time. The results show an increase in the number of suicide victims seeking help from the primary health-care centres. The transformation within psychiatry from hospitalized care to out-patient care resulted in a corresponding increase in the number of suicide victims who applied to psychiatric out-patient care services. The move towards non-institutional form of care has probably contributed to the decrease in the total number of suicides observed during the study period.
Subject(s)
Primary Health Care , Psychiatry , Suicide/psychology , Adolescent , Adult , Aged , Female , Humans , Incidence , Linear Models , Male , Mental Disorders/epidemiology , Middle Aged , Sweden/epidemiology , Time FactorsSubject(s)
Group Homes , Mental Disorders/rehabilitation , Quality of Life , Adult , Aged , Chronic Disease , Female , Humans , Male , Mental Disorders/nursing , Mental Disorders/psychology , Middle Aged , Social Support , SwedenABSTRACT
How can we know whether people who have been treated for an illness or been helped with a problem have indeed regained their health or solved their problem? Is "health" an objective condition-something that is observable, visible, perhaps even measurable? This article discusses these questions with the help of an analysis of the account given by a patient in psychotherapy regarding her recovery from a problematic life situation. The point of departure here is that recovery from illness or from a condition of ill-health should be understood as a reorganization of cultural, social and psychological elements which together are able to convey the picture that treatment has been successful and full recovery has been achieved. What the patient presents is not a "report" on an "actual" transformation process, nor is it an accumulated description. Rather, the patient presents a narrative, shaped by and created out of her own life situation and the interview situation in which she is engaged. It is a narrative that highlights certain aspects of a course of events and which arranges the pieces of the puzzle in such a way as to convey a picture of transformation and recovery.
