An ethnography of managing emotions when talking about life-threatening illness.

AIM: This ethnographic study was concerned with how dying patients, palliative care staff and family caregivers communicate about life-threatening illness in a palliative care setting in Ethiopia. BACKGROUND: Ethiopia, as a developing country, had few resources for caring for those requiring end-of-life care. However, palliative care was supported by local champions in Ethiopia and by the Federal Ministry of Health. INTRODUCTION: The disclosure of bad news was discouraged because it was believed that such disclosure may lead to unnecessary distress and to loss of hope. METHODS: Non-participant observation amounting to 276 h of observation and ethnographic interviews with four patients, six family caregivers and five palliative care staff during two periods of data collection (November 2011-January 2012 and May 2012-August 2012) in Addis Ababa, Ethiopia. FINDINGS: Although palliative care staff create openness in communication with patients and family caregivers about terminal illness and dying, ultimately palliative care staff deferred to family wishes about significant news disclosures, in order to avoid upset. Family caregivers were found to avoid disclosing news of a terminal illness to their family member and wished to keep the patient in closed awareness. In contrast, an open awareness context existed between palliative care staff and family caregivers. DISCUSSION: In managing truth telling in different cultural settings, medical and nursing staff as well as health policy makers need to take into account the various awareness contexts highlighted in this study. Palliative care staff should consider how actions such as protecting patients from upset may inadvertently deny the patient the right to exercise control. CONCLUSION AND IMPLICATIONS FOR POLICY: Health policy makers should ensure that the design and implementation of palliative care services should not be a wholesale adoption of Western style services but ensure that such services are adapted to reflect the religious, cultural and social needs of the community. Foreign workers and volunteers who deliver palliative care services and education in Ethiopia should reflect local religious and cultural sensitivities.

E-mail contact as an effective strategy in the maintenance of weight loss in adults.

BACKGROUND: Professional face-to-face contact is known to be beneficial in effective weight management, but costly, in supporting weight maintenance. Within the UK, studies have examined using the Internet to achieve weight loss; however, there is a need to evaluate the use of dietetic intervention via e-mail to support the maintenance of weight loss in a National Health Service (NHS) setting. The present study aimed to assess the effects of dietetic support through e-mail on weight loss maintenance on individuals who were successful in weight loss. METHODS: Fifty-five patients, who had lost ≥5% body weight, were assigned to either an intervention group (weekly e-mail messages and monthly personal e-mail message with reporting of weight, n = 28) or a control group (n = 27). The level of weight maintenance, plus dietary changes and the ability to maintain a level of activity, were recorded after 6 months. RESULTS: At 6 months, the e-mail group maintained an average weight loss of 10%, which was significantly (P = 0.05) greater than the mean percentage weight loss maintained by the control group (7.3%). The control group regained weight at a statistically significant greater velocity (P = 0.02) than the intervention group. There were correlations between the amount of fruits and vegetables (P = 0.07) eaten and exercise episodes (P = 0.01) against weight change in maintenance. CONCLUSIONS: The present study showed that dietetic support using e-mail can be used effectively in reducing weight gain velocity and assisting in the maintenance of weight loss. It is a system that can be used in the UK NHS to reach many people.

Patients' decision-making for migraine and chronic daily headache management. A qualitative study.

The objective of this study was to gain insight into the patients' decision-making for migraine and chronic daily headache management. Patients were recruited by theoretical sampling in Surrey (UK). Semi-structured and tape-recorded interviews (n = 13) were conducted, transcribed verbatim, coded and analysed according to the grounded theory methodology. Thirteen patients (8 migraine and 5 chronic daily headache) described their management. All patients employed multiple behaviours to manage their headaches. From the patients' descriptions emerged their decision-making. Based on experience, perceptions and new information, the decision-making process involved four stages: headache severity, evaluation, decision making and behaviours. Although the participants were passive with regards to certain management strategies, overall they were actively involved in treating and preventing their headaches. Furthermore, they were active decision-makers in choosing appropriate management. Migraine and chronic daily headache patients are actively involved in managing their headaches. They are key decision-makers and should not be overlooked as a resource for effective management.

South Asian patients' lived experience of acute care in an English hospital: a phenomenological study.

Studies on utilization of hospital services by South Asian patients in the United Kingdom have consistently demonstrated levels of dissatisfaction with care in relation to meeting religious and cultural needs, although there are few studies on minority ethnic patients' utilization of acute hospital services. This study aimed to describe and interpret from the consumer's view the 'lived experience' of acute hospital care from the perspectives of South Asian patients and their family carers. The purposive sample of 10 patients and six carers consisted of 13 females and three males (five Hindus, six Muslims and five Sikhs) who were interviewed at home 2 to 3 weeks after discharge from hospital. Data were gathered through semi-structured interviews that were tape recorded and transcribed. A phenomenological approach was used, and data were analysed using the principles of Heideggerian hermeneutics. Five themes were identified, ranging from feelings of satisfaction with care, unhappy about the service, fitting-in strategies and post-discharge coping mechanisms. Patients seemed to want to cause as little disruption as possible to the ward environment and tried to fit in to what they refer to as an 'English place'. The findings, although not generalizable, offer important insights into how South Asian patients survive their journey through their hospital stay and have implications for the provision of nursing care for minority ethnic patients.