ABSTRACT
BACKGROUND: Biomedicine is the dominant model in Western medicine. This regards disease as an identifiable reality located in people's bodies and best managed through medical interventions. Biomedicine has limited recognition of the effects of societal and cultural forces on health behaviours, so those who reject medical advice are problematic. This highlights the need for a method that considers the wider range of experiences that influence health behaviours. AIM: To describe the use of the literary folkloristic method to understand why people refuse medical interventions that reduce the risk of disease. DISCUSSION: This paper describes an innovative approach that was useful in understanding why people refuse conventional medical interventions. The literary folkloristic method provided a contextualised narrative of the experiences of high-risk women who refused risk-reducing surgery. Their stories revealed how their understandings of the risks from cancer contrasted starkly with the dominant medical discourse, ultimately leading them to reject interventions that could potentially save their lives. CONCLUSION: The literary folkloristic method gave voice to those who might otherwise have been silenced by the healthcare system. IMPLICATIONS FOR PRACTICE: Nurses and nurse researchers can influence policy and practice by offering alternative understandings of poorly understood phenomena, such as patients refusing medical interventions. It is important healthcare providers approach this from the viewpoints of those directly involved, since strategies to support patients may be ineffective without such understanding.
ABSTRACT
AIMS: (i) To determine which aspects of living with a peripherally inserted central catheter (PICC) line cause Modified de Gramont (MdG) patients most difficulty. (ii) To explore MdG patients' views of the PICC-line experience. (iii) To determine if patients view PICC-lines as a benefit or a burden when receiving ambulatory MdG chemotherapy. DESIGN: A two-stage, descriptive study. METHODS: Phase 1 comprised semi-structured interviews. Phase 2 surveyed the MdG population. Phase 1 interview data informed the Phase 2 questionnaire. The setting was a West of Scotland Cancer Care Centre and the sample was: Phase 1, a convenience sample of 10 MdG patients; Phase 2, 62 consecutive patients. RESULTS: A response rate of 93.9% for Phase 2. The majority of PICC-line patients held favourable views towards having a PICC-line and adapted well with minimal disruption to daily life. Concerns were evident regarding coping at home with a PICC-line, chemotherapy spillage, dealing with complex information and the responsibility of patients/carers regarding PICC-line management. Patients preferred ambulatory chemotherapy to in-patient treatment. CONCLUSIONS: PICC-lines should be considered for more chemotherapy patients but service development is necessary to ensure individual needs are addressed. RELEVANCE TO CLINICAL PRACTICE: Contributes to the PICC-line literature by providing a national patient perspective on a range of daily living activities (DLAs). PICC-line patients prefer out-patient ambulatory chemotherapy rather than in-patient treatment. The longer a patient has a PICC-line, the more able they are to manage activities such as dressing. Concerns remain over chemotherapy spillage, partner/carer responsibility for PICC-line maintenance and the proper balance between required information and what the patient wants to know.
