Preferences for place of care and place of death among informal caregivers of the terminally ill

Objectives: (1) To determine informal caregivers perceptions about place of care and place of death; and (2) to identify variables associated with a home death among terminally ill individuals who received in-home support services in a publicly funded home care system. Participants and design: A total of 216 informal caregivers participated in a bereavement interview. Data collection included care recipient and informal caregiver characteristics, the use of and satisfaction with community services, and preferences about place of death. Results: Most caregivers reported that they and the care recipient had a preferred place of death (77 and 68%, respectively) with over 63% reporting home as the preferred place of death. Caregivers had a greater preference for an institutional death (14%) than care recipients (4.7%). While 30% of care recipients did not die in their preferred location, most caregivers (92%) felt, in retrospect, that where the care recipient died was the appropriate place of death. Most caregivers reported being satisfied with the care that was provided. The odds of dying at home were greater when the care recipient stated a preference for place of death (OR: 2.92; 95% CI: 1.25, 6.85), and the family physician made home visits during the care recipients last month of life (Univariate odds ratios (OR): 4.42; 95% CI: 1.46, 13.36). Discussion: The ethic of self-control and choice for the care recipient must be balanced with consideration for the well being of the informal caregiver and responsiveness of the community service system. © 2005 Edward Arnold (Publishers) Ltd.

Exploring consumer's preferences for farmed sea bream

Sea bream (Sparus aurata) production plays a significant part in Italian aquaculture, contributing to almost 18% of national pisciculture sales revenue. In recent years, Italian firms faced higher competition from countries with lower production costs. This prompted responses toward both cost reduction and product differentiation. The objective of this study was to investigate the preferences of Italian consumers for sea bream from fish farms, with a focus on aspects of product differentiation as gleaned from the analysis of the market situation: price, product origin, type and place of fish farming, and, in particular, type of feed. Data were collected with a consumers’ survey using personal interviews conducted on a questionnaire that included a choice experiment. Consumer preferences were analyzed with choice models based on stated preference data. The models made it possible to evaluate the potential of products with different combinations of attributes for which there is currently no market information available. In particular, the country of origin emerged as an important element of consumer choice, and to a lesser degree, organic certification and fish farming in marine cages also play a relevant role and may command a price premium.

A question of taste: Recognising the role of latent preferences and attitudes in analysing food choices

There has long been substantial interest in understanding consumer food choices, where a key complexity in this context is the potentially large amount of heterogeneity in tastes across individual consumers, as well as the role of underlying attitudes towards food and cooking. The present paper underlines that both tastes and attitudes are unobserved, and makes the case for a latent variable treatment of these components. Using empirical data collected in Northern Ireland as part of a wider study to elicit intra-household trade-offs between home-cooked meal options, we show how these latent sensitivities and attitudes drive both the choice behaviour as well as the answers to supplementary questions. We find significant heterogeneity across respondents in these underlying factors and show how incorporating them in our models leads to important insights into preferences. 

What’s in a (Party) Name?: Examining preferences, discipline, and social identity in a parliamentary free vote

In trying to understand the effects of political parties on shaping the voting behaviour of legislators, research has attempted the difficult task of separating the effects of preferences from rules used by party leaders to enforce discipline. However, little research has explored the prospect that party labels also reflect a social identity that is independent of legislators’ preferences and the rules used by party leaders to enforce discipline. In this study we examine that possibility, employing a data set that permits us to control both for leadership-based effects and legislator preferences on a 2000 free vote dealing with stem cell research. Using the British Representation Studies 1997 – which interviewed Members of Parliament regarding their preferences on several key issues related to the bill – we find significant evidence that party-as-identification plays a role in shaping how legislators vote, even after preferences and discipline are accounted for.

'Conditional candour' and 'knowing me': an interpretive description study on patient preferences for physician behaviours during end-of-life communication

OBJECTIVE: To understand patients' preferences for physician behaviours during end-of-life communication.

METHODS: We used interpretive description methods to analyse data from semistructured, one-on-one interviews with patients admitted to general medical wards at three Canadian tertiary care hospitals. Study recruitment took place from October 2012 to August 2013. We used a purposive, maximum variation sampling approach to recruit hospitalised patients aged ≥55 years with a high risk of mortality within 6-12 months, and with different combinations of the following demographic variables: race (Caucasian vs non-Caucasian), gender and diagnosis (cancer vs non-cancer).

RESULTS: A total of 16 participants were recruited, most of whom (69%) were women and 70% had a non-cancer diagnosis. Two major concepts regarding helpful physician behaviour during end-of-life conversations emerged: (1) 'knowing me', which reflects the importance of acknowledging the influence of family roles and life history on values and priorities expressed during end-of-life communication, and (2) 'conditional candour', which describes a process of information exchange that includes an assessment of patients' readiness, being invited to the conversation, and sensitive delivery of information.

CONCLUSIONS: Our findings suggest that patients prefer a nuanced approach to truth telling when having end-of-life discussions with their physician. This may have important implications for clinical practice and end-of-life communication training initiatives.

Patient preferences for dental clinical attire: a cross-sectional survey in a dental hospital

AIMS AND OBJECTIVES: This cross sectional descriptive study was designed to survey patient opinion towards dental clinical attire, name badges and commonly used cross-infection control measures.

METHOD: Patients attending a dental hospital for a consultation appointment were asked to complete a questionnaire accompanied by photographs of models portraying a range of clinical attire. A representative sample of patients completed 188 questionnaires over a four week period.

RESULTS: The study found that the majority of patients felt clinical attire was important and that they preferred dental professionals to wear name badges. The majority of patients also preferred dentists to use both safety glasses and face masks. When asked to indicate which clinical attire was most appropriate for a consultant/specialist to wear, the overwhelming opinion was that of smart dress accompanied with a white coat. In addition, most respondents wished their dentist to wear a traditional white, dental tunic.

CONCLUDING REMARKS: It is hoped that this study will be informative for the dental team and that the results will be taken into consideration when considering appropriate clinical attire in accordance with patient opinions.

Transitional justice, demobilization, and peacebuilding amid political violence: Examining individual preferences in the Caribbean coast of Colombia

The conventional wisdom in the transitional justice literature is that there is no one-size-fits-all approach. This article suggests that this may also be true within a given state. The current paper reports on quantitative and qualitative data from 184 participants in a survey conducted in the Caribbean coast of Colombia. Results suggest widespread support for transitional justice mechanisms – such as perpetrator accountability, public acknowledgement and structural change – but dissatisfaction with national-level initiatives, specifically the 2005 Justice and Peace Law. Yet, despite a distrust of the national government and protracted conflict, individuals report social trust, community cohesion and reliance on local government institutions. These attitudes and behaviours suggest that decentralised transitional justice mechanisms may be more effective in meeting victims' needs. Moreover, analyses indicate that individual preferences are influenced by community factors, such as the presence of demobilised paramilitaries, which can be addressed through more localised approaches to promote peacebuilding. The paper concludes with best practices derived from the findings.

On the halogenation of N(1),N(2)-di-t-Boc-5-hydroxy-piperazic acid esters and the conformational preferences of their 5-halo-piperazic acid products. The importance of A1,3 rotameric-strain in determining N(2)-acyl piperazic acid ring conformation

In this Letter, an unambiguous synthetic strategy is reported for the preparation of enantiomerically purecis-5-halo-piperazic acid derivatives in single diastereoisomer form. Contrary to the recent report by Shin and co-workers (Chem. Lett. 2001, 1172), in which it is claimed that the Ph₃P and N-chlorosuccinimide (NCS)-mediated chlorination of (3R,5S)-trans-N(1),N(2)-di-t-Boc-5-hydroxy-piperazic acid derivative 1proceeds with retention of configuration at C(5) to give 2, we now show that this and related Ph₃P-mediated halogenations all occur with S_N2 inversion at the alcohol center, as is customary for such reactions. Specifically, we demonstrate that the (3R,5S)-trans-5-Cl-piperazic acid derivative 2 claimed by Shin and co-workers (Chem. Lett. 2001, 1172) is in actual fact the chlorinated (3S,5R)-enantiomer 6, which must have been prepared from the cis-(3S,5S)-alcohol 3, a molecule whose synthesis is not formally described in the Shin paper. We further show here that the cis-(3R,5R)-5-Cl-Piz 13 claimed by Shin and co-workers inChem. Lett. 2001, 1172, is also (3S,5R)-trans-5-Cl-Piz 6. Authentic 13 has now been synthesized by us, for the very first time, here. Since Lindsley and Kennedy have recently utilized the now invalid Shin and co-workers’ retentive Ph₃P/NCS chlorination procedure on 1 in their synthetic approach to piperazimycin A (Tetrahedron Lett. 2010, 51, 2493), it follows that their claimed 5-Cl-Piz-containing dipeptide 25 probably has the alternate structure 26, where the 5-Cl-Piz residue has a 3,5-cis-configuration. The aforementioned stereochemical misassignments appear to have come from a mix-up of starting materials by Shin and co-workers (Chem. Lett. 2001, 1172), and an under-appreciation of the various steric and conformational effects that operate in N(2)-acylated piperazic acid systems, most especially rotameric A^1,3-strain. The latter has now been unambiguously delineated and defined here under the banner of the A^1,3-rotamer effect.