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    Breaking bad news about cancer : the experiences of patients, patients' family/whānau members and healthcare professionals : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, New Zealand
    (Massey University, 2020) Matthews, Tamyra
    Breaking bad news is a reality of medical practice in oncology, and can be a challenging task for those receiving and delivering the news. For patients and their family members, ‘bad news’ is understandably accompanied by strong emotions and ongoing implications for their lives as they adjust to the news. For healthcare professionals (HCPs), there are numerous variables to consider and balance when having these difficult conversations, as well as managing the personal impact. The current study aims to explore the subjective experiences of patients, patients’ family/whānau members, and HCPs when bad news was delivered to patients about their cancer within the surgical departments of MidCentral District Health Board. The study is designed to allow multiple perspectives to be gathered and compared, and recommendations for practice to be made that align with the goals of those involved in the project’s inception, as well as attend to the underrepresentation of family members’ perspectives and New Zealand-based data in the literature. To achieve this, the current study utilised a qualitative approach with the epistemological and methodological basis informed by interpretative phenomenological analysis. The study also included a consumer perspective with the involvement of the Otaki advisory group to guide how the study was conducted and provide feedback on the study outcomes. Data was collected through semi-structured interviews with 10 patients, 6 family/whānau members, 5 surgeons, and 6 nurses. Interviews were analysed in two ways: by participant group (i.e., patients, family members, and HCPs) and by ‘linked case’ (i.e., direct comparisons of the perspectives of all those involved in the same patient’s case of breaking bad news). The findings are presented as a series of superordinate and subordinate themes. The group-based analysis highlighted that patients understood their bad news experiences through the lens of their health beliefs and expectations of care, the relational and support needs they, and others, had during and following the encounter, and the ongoing shifts in perspective and priorities they experienced. Family members identified the patient as the focus of care, but also acknowledged their need for support in order to cope. HCPs recognised that breaking bad news was challenging based on the variation between instances of breaking bad news and patients’ needs, organisational constraints they had to work under, and the personal toll this task could take. The linked case-based analysis demonstrated that the receivers of bad news have a range of emotional and informational needs and that HCPs and family members fulfil important roles in accurately meeting patients’ needs. Four conclusions can be drawn from the study as a whole about the process of breaking bad news. Firstly, there is variability in the situations, delivery approaches and needs of those involved in breaking bad news, requiring a flexible and tailored approach. Secondly, establishing an interpersonal connection between the deliverer and receiver of bad news is a central part of the process. Thirdly, breaking bad news is a challenge for all and receiving support in order to cope, is paramount. Lastly, there is a shared responsibility across healthcare organisations, training providers, HCP teams, and individual HCPs to make this process go as well as possible for all those involved. The current research makes an important contribution to understanding that, without doubt, breaking bad news is a complex process for those delivering and receiving the news, and improvements in this area require careful consideration, prioritising and resourcing as part of delivering effective cancer care.
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    What makes a 'good' doctor? : the patients' perspective : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Manawatu, New Zealand
    (Massey University, 2018) Lane, Michael Craig
    Personalised care by doctors has been shown to facilitate better engagement by patients in their care (Thorne, Oliffe, & Stajduhar, 2013). However, the communication required for care that is more effective has been primarily characterised from the perspective of medical experts. The patient perspective remains understudied. The aims of the current study were three-fold. Firstly, to explore the way patients’ interpret their General Practitioner’s (GP’s) communication behaviour. Secondly, to organise these behaviours into practice styles describing patient preferences. Finally, to compare the practice styles patients prefer to the practice styles they experience, and examine the impact of preference mismatch upon patient-doctor alliance. To address these aims participants were interviewed about their positive experiences with their GPs, and thematic analysis conducted on the transcripts. This identified a set of 90 communication behaviours, which participants sorted by similarity, and multi-dimensional scaling was utilised to map the behaviour. To organise the behaviour further into practice styles preferred and experienced, 100 participants sorted 67 of the behaviours by both degree of helpfulness and relative frequency with which their GP utilises the behaviours. As hypothesised, participants described behaviours consistent with collaborative interactions, which incorporate patient perspective, feelings, and problem-solving. The organisation of communication behaviours within the multi-dimensional map were consistent with such collaborative interactions, with decision-making and biomedical behaviours grouping with behaviours facilitating participation. Furthermore, the map also demonstrated communication varied along a unique relational dimension in addition to the predicted instrumental and affective dimensions. Participants organised GPs’ communication behaviour into five practice styles consistent with past research, but surprisingly, a high doctor-control, paternal practice style was not evident. The discrepancy between participants’ preferred and experienced styles had a weak negative impact on patient-doctor alliance. These findings support the theories of social reciprocity and socio-pragmatics in General Practice consultations. The absence of a paternalistic practice style is consistent with the personality traits associated with GPs, which include agreeableness, abasement, and nurturance. The findings imply that it is important for doctors to facilitate patient participation and tailor practice behaviour to patient preferences for a personalised experience.
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    New Zealand women's preference for treatment decision-making when considering hormone replacement therapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2002) McLellan, Tracey
    The menopause phase has increasingly been defined as a deficiency disease amenable to treatment. The main medical treatment for menopause is Hormone Replacement Therapy (HRT). At present very little is known about how New Zealand women make their decisions regarding HRT. What is known is that the medical information concerning HRT is uncertain and doctors are an important factor in the decision-making process. Recent research has shown that there is much dissatisfaction with the service doctors are providing New Zealand women. Much of this dissatisfaction may result from the mismatch of decision-making styles between doctors and women. Accordingly it was necessary to investigate the style preferences of New Zealand women. The aim of the present study was to test the Charles, Gafni & Whelan (1999) theoretical framework for treatment decision-making on New Zealand women considering HRT. The present study seeks to identify three distinct styles of decision-making preference and investigate whether the style preferences are maintained throughout the entire process. One hundred and forty-eight mid-aged women were surveyed about their decisional style preferences. The measure used was designed specifically for the present study and was unique with regard to incorporating stages within the decision-making process. The Charles et al. (1999) framework was found to be an appropriate model for conceptualising the decision-making context of HRT. Support was also found for the dynamic nature of treatment decision-making proposed by Charles et al. (1999) as the three main styles were also found to be amenable to change. The Charles et al. (1999) framework could be a useful educational and assessment tool for doctors and women. Future research is needed to replicate the results of the present study.