Biased media? How news content influences age discrimination claims.

Information distributed via the news media is acknowledged as a potential source of negative beliefs about, and biased behaviors toward, older workers. Focusing on the Netherlands, the current study explains age discrimination claims filed by older workers by investigating the impact of visibility and media stereotypes of older workers in the news media, while controlling for real-world events and older workers' expectations of unemployment (2004-2014). The results, based on time-series analysis, reveal that the visibility of older workers in the news media is associated with higher levels of age discrimination claims. This effect can be partly explained with the visibility of the negative media stereotype that older workers experience health problems in the content of news coverage. Furthermore, unemployment expectations decreased the number of age discrimination claims. These results offer support for the notion that the news environment is a source of variation in the experience of age discrimination at the workplace.

Between Accommodating and Activating: Framing Policy Reforms in Response to Workforce Aging across Europe.

In the past decade, European governments have implemented activating policy reforms to maximize older workers' employment and employability, representing a paradigmatic change in approaches to work and retirement. This study isolates the factors that explain the relative success and failure of competitive frames that are either in favor of or against activating policies in European news coverage, by applying time-series analysis (ordinary least squares with panel-corrected standard errors) to monthly aggregated news coverage in the Netherlands, the United Kingdom, Denmark, and Spain over the timespan 2006-2013. The results show that pro-activating and counteractivating frames generally coincide in competitive framing environments. The pro-activating frame proliferated in times of high employment protection, whereas the counteractivating frame prevailed stronger in conservative compared with progressive newspapers, and gained momentum during the aftermath of the financial crisis and in times governments on the economic left were in power. The study advances knowledge of competitive issue framing by demonstrating how the economic, policy, and political context matters for the emergence and evolvement of competing frames. In addition, the findings contribute to the understanding of the factors that contribute to news representations that promote active aging in European news, which may foster support for policy reforms that sustain older workers' employability.

Teleconsultation for integrated palliative care at home: A qualitative study.

BACKGROUND: Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services. AIM: This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach. DESIGN: This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews. SETTING/PARTICIPANTS: A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24-85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians. RESULTS: Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport. CONCLUSION: Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.

Telemedicine's Potential to Support Good Dying in Nigeria: A Qualitative Study.

OBJECTIVES: This qualitative study explores Nigerian health care professionals' concepts of good dying/a good death and how telemedicine technologies and services would fit the current Nigerian palliative care practice. MATERIALS AND METHODS: Supported by the Centre for Palliative Care Nigeria (CPCN) and the University College Hospital (UCH) in Ibadan, Nigeria, the authors organized three focus groups with Nigerian health care professionals interested in palliative care, unstructured interviews with key role players for palliative care and representatives of telecom companies, and field visits to primary, secondary and tertiary healthcare clinics that provided palliative care. Data analysis consisted of open coding, constant comparison, diagramming of categorizations and relations, and extensive member checks. RESULTS: The focus group participants classified good dying into 2 domains: a feeling of completion of the individual life and dying within the community. Reported barriers to palliative care provision were socio-economic consequences of being seriously ill, taboos on dying and being ill, restricted access to adequate medical-technical care, equation of religion with medicine, and the faulty implementation of palliative care policy by government. The addition of telemedicine to Nigeria's palliative care practice appears problematic, due to irregular bandwidth, poor network coverage, and unstable power supply obstructing interactivity and access to information. However, a tele-education 'lite' scenario seemed viable in Nigeria, wherein low-tech educational networks are central that build on non-synchronous online communication. DISCUSSION: Nigerian health care professionals' concepts on good dying/a good death and barriers and opportunities for palliative care provision were, for the greater part, similar to prior findings from other studies in Africa. Information for and education of patient, family, and community are essential to further improve palliative care in Africa. Telemedicine can only help if low-tech solutions are applied that work around network coverage problems by focusing on non-synchronous online communication.

How outpatient palliative care teleconsultation facilitates empathic patient-professional relationships: a qualitative study.

OBJECTIVE: The problems and needs of advanced cancer patients and proxies normally increase as the disease progresses. Home-based advanced cancer patients and their proxies benefit from collaborations between primary care physicians and hospital-based palliative care specialists when confronted with complex problems in the last phase of life. Telemedicine might facilitate direct, patient-centered communication between patients and proxies, primary care physicians, and specialist palliative care teams (SPCTs). This study focuses on the impact of teleconsultation technologies on the relationships between home-based palliative care patients and hospital-based palliative care specialists. METHODS: This work consists of a qualitative study among patients, family members, and caregivers that utilizes long-term direct observations, semi-structured interviews, and open interviews following the observations. RESULTS: The analysis of the empirical data resulted in three key concepts that describe the impact of teleconsultation on the patient-professional relationship in palliative homecare: transcending the institutional walls of home and hospital; transparency of teleconsultation technology; and technologized, intimate patient-professional relationships. Teleconsultation offers (1) condensed encounters between home-based palliative care patients and distant professionals, (2) a unique insight into the patients' daily lives for palliative care specialists, and (3) long-term interaction that results in trustful relationships and experiences of intimacy and relief. CONCLUSIONS: Teleconsultation fits the practice of home-based palliative care. Teleconsultation can, if well applied, facilitate computer-mediated but empathic patient-palliative care specialist relationships, which enable professional care attuned to the patient's context as well as patient involvement. This article proposes a teleconsultation implementation guide for optimal use of teleconsultation in daily palliative care practice.

Connecting with patients and instilling realism in an era of emerging communication possibilities: a review on palliative care communication heading to telecare practice.

OBJECTIVE: Appropriate palliative care communication is pivotal to optimizing the quality of life in dying patients and their families. This review aims at describing communication patterns in palliative care and discussing potential relations between communication patterns and upcoming telecare in the practice of palliative care. METHODS: This review builds on a systematic five-step qualitative analysis of the selected articles: 1. Development of a 'descriptive table of studies reviewed' based on the concept of genre, 2. Open coding of table content and first broad clustering of codes, 3. Intracluster categorization of inductive codes into substantive categories, 4. Constant inter- and intracluster comparison results in identification of genres, and 5. Labeling of genres. RESULTS: This review includes 71 articles. In the analysis, two communication genres in palliative care proved to be dominant: the conversation to connect, about creating and maintaining a professional-patient/family relationship, and the conversation to instill realism, about telling a clinical truth without diminishing hope. CONCLUSION: The abovementioned two genres clarify a logical intertwinement between communicative purposes, the socio-ethical background underlying palliative care practice and elements of form. PRACTICE IMPLICATIONS: Our study supports understanding of current communication in palliative care and anticipates future communicative actions in an era of new communication technologies.

Transmural palliative care by means of teleconsultation: a window of opportunities and new restrictions.

BACKGROUND: Audio-visual teleconsultation is expected to help home-based palliative patients, hospital-based palliative care professionals, and family physicians to jointly design better, pro-active care. Consensual knowledge of the possibilities and limitations of teleconsultation in transmural palliative care is, however, largely lacking.This paper aims at describing elements of both the physical workplace and the cultural-social context of the palliative care practice, which are imperative for the use of teleconsultation technologies. METHODS: A semi-structured expert meeting and qualitative, open interviews were deployed to explore professionals' assumptions and wishes, which are considered to contain latent presumptions about the practice's physical workplace and latent elements of the cultural-social context, regarding (1) the mediating potential of audio-visual teleconsultation, (2) how the audio-visual teleconsultations will affect medical practice, and (3) the design and usage of the teleconsultation technology. We used a qualitative analysis to investigate how palliative care professionals interpret the teleconsultation package in preparation. The analysis entailed open and axial coding techniques developed in a grounded theory approach. RESULTS: Respondents assume: 1. teleconsultation will hinder physical proximity, thereby compromising anamnesis and diagnosis of new or acutely ill patients as well as "real contact" with the person behind the patient; 2. teleconsultation will help patients becoming more of a pivotal figure in their own care trajectory; 3. they can use teleconsultation to keep a finger on the pulse; 4. teleconsultations have a healing effect of their own due to offered time and digital attention; 5. teleconsultation to open up an additional "gray" network outside the hierarchical structures of the established chain of transmural palliative care. This network could cause bypassing of caregivers and uncertainty about responsibilities; 6. teleconsultations lead to an extended flow of information which helps palliative care professionals to check the stories of patients and medical specialists. CONCLUSIONS: Professionals assume teleconsultation co-defines a new patient-professional relationship by extending hospital-based caregivers' perceptions of as well as attention for their patients. At the cost, however, of clinical and personal connectedness. Secondly, a hermeneutics is needed to carefully interpret teleconsultation images. Thirdly, teleconsultations transform caregiving cultures as formerly separated care domains collide, demanding a redefinition of roles and responsibilities.

Dynamics of Internet usage during the stages of in vitro fertilization.

Hospitals and clinics develop Internet strategies to emancipate and empower their patient population. At Radboud University Nijmegen Medical Centre, we developed an Internet-based personal health record that provides patients with general and personal information about their treatment and that provides facilities for communication with fellow patients and with physicians. Because not much is known about information and communication needs of IVF and ICSI patients in relation to their treatment, we observed the intensity of use of this personal health record during the various stages of IVF treatment. We measured the numbers of page views and the number of contributions to the chat room. Data regarding Website use and treatment schedules were available for 51 couples. These couples generated 25,420 page views and posted 11,403 utterances. Two-way analysis of variance showed that significant individual changes occurred in the intensity of use during the different stages of the treatment. During the stages in which there is no contact between the patient and the clinic, patients make use of the Website's communication functions. This reflects the patients' need for continued communication and support during the last stages of treatment, a service that IVF clinics traditionally cannot or do not provide.

Chat about what matters most: an analysis of chat contributions posted to an outpatient fertility website.

A content analysis of chat utterances generated by in vitro fertilization (IVF) patients and healthcare professionals revealed that most chat is about the treatment itself and not about childlessness; 56% discloses psychological aspects, 27% physical aspects, and 17% social aspects of the treatment; and that accounts of both external and internal coping behaviors could be identified.