The costs, barriers and enablers of providing PGY2 placements in general practice in Aotearoa New Zealand: a mixed-methods study.

Introduction Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers. Aim This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s. Methods A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically. Results The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890-$9183), increasing to $13 727 per placement (range $5750-$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing. Discussion Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s' remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s.

Communication Network Structures and Content of Men with Prostate Cancer: Models for Explaining Health-Related Quality of Life.

Communication networks contribute to health-related quality of life (HRQOL) for men living with prostate cancer. However, the mechanisms for understanding how communication networks shape HRQOL are not well understood. The purpose of this study was to test three models explaining the communication networks and related communication variables for HRQOL. A total of 214 men with prostate cancer in New Zealand completed a survey questionnaire describing aspects of their networks including opportunities for connection, social support/undermining, status disclosure, communication efficacy, and HRQOL. The findings support a mediating model of communication networks where social undermining has a direct and negative impact on HRQOL, and an indirect effect mediated through communication efficacy, which has a direct and positive impact on HRQOL. Contrary to previous studies, social support and disclosure did not significantly impact HRQOL in this sample. The benefits of developing communication efficacy and reducing social undermining for enhancing long-term psychosocial health in this cohort of men are two key findings.

Communication networks of men facing a diagnosis of prostate cancer.

AIMS AND OBJECTIVES: This study seeks to identify the factors that shape the communication networks of men who face a potential diagnosis of prostate cancer, and how these factors relate to their disclosure about their changing health status. BACKGROUND: Men facing a potential diagnosis of prostate cancer are in a challenging situation; the support benefits of disclosing their changing health status to others in their communication networks is set against a backdrop of the potential stigma and uncertainty of the diagnosis. DESIGN: All men on a prostate biopsy waiting list were eligible for inclusion in an exploratory and interpretive study. METHODS: Semi-structured interviews with 40 men explored their network structures and disclosure of health information. Thematic analysis highlighted the factors which contributed to their network structures and their disclosure about their health status. RESULTS: Four network factors shaped men's perspectives about disclosing their health status: (1) tie strength, comprising both strong and weak ties; (2) knowledgeable others, with a focus on medical professionals in the family; (3) homophily, which included other individuals with a similar medical condition; and (4) geographical proximity, with a preference for face-to-face communication. CONCLUSION: Communication networks influence men's disclosure of their health status and in particular weak ties with medical knowledge have an important role. Men who use the potential for support in their networks may experience improved psychosocial outcomes. RELEVANCE TO CLINICAL PRACTICE: Using these four network factors-tie strength, knowledgeable others, homophily or geographical proximity-to forecast men's willingness to disclose helps identify men who lack potential support and so are at risk of poor psychosocial health. Those with few strong ties or knowledgeable others in their networks may be in the at-risk cohort. The support provided in communication networks complements formal medical care from nurses and other health professionals, and encouraging patients to use their communication networks improves the psychosocial health of the men themselves, their partners and their families.

Men's use of networks to manage communication tensions related to a potential diagnosis of prostate cancer.

PURPOSE: This study used relational dialectics theory to explore the communication tensions experienced by men who were on a prostate biopsy waiting list and how they managed these tensions using their communication networks. METHOD: The study utilised dialectical analysis of 36 semi-structured interviews conducted from July to September 2012 in a city in the North Island of New Zealand. RESULTS: Dialectical analysis revealed men experienced four tensions; a) obligation to disclose/autonomy not to disclose; b) confident to help others/vulnerable and needing help from others; c) accept support/not accept support and d) desire for normality/need to tolerate uncertainty. These tensions were predominantly managed by vacillation. Specifically, the men used their communication network to select one pole with some people and the other pole with others to maintain balance between the poles of the dialectical tensions. CONCLUSIONS: Health care professionals can help men in this situation by having a conversation about disclosure and support prior to them being diagnosed, educating men to reframe or connect as a more effective form of tension management, and linking men who have small or ineffective networks to other resources such as social support networks to facilitate tension management.