Terminally ill cancer patients' wish to hasten death

This exploratory study investigated factors associated with the wish to hasten death among a sample of terminally ill cancer patients. Semi-structured interviews conducted on a total of 72 hospice and home palliative care patients were subjected to qualitative analysis using QSR-NUDIST. The main themes to emerge suggested that patients with a high wish to hasten death had greater concerns with physical symptoms and psychological suffering, perceived themselves to be more of a burden to others, and experienced higher levels of demoralization, while also reporting less confidence in symptom control, fewer social supports, less satisfaction with life experiences and fewer religious beliefs when compared with patients who had a moderate or no wish to hasten death. The implications of these findings will be discussed.

Doctors and their patients: A context for understanding the wish to hasten death

There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n = 24) involved in the treatment and care of terminally ill patients were (i) the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii) the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii) the doctors' attitudes to euthanasia and (iv) the doctors' perception of their patients' views/beliefs 'regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group. This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill. Copyright (C) 2003 John Wiley Sons, Ltd.

An organizational perspective on goal setting in community-based brain injury rehabilitation

Purpose. To use a taxonomy of goal content, developed in community-based brain injury rehabilitation to examine and compare the content of goals set within two different service settings; and to further examine the potential of the taxonomy to be a reliable and comprehensive framework for classifying goals. Method. Qualitative analysis and categorization of 1492 goal statements extracted from a community-based brain injury rehabilitation service over two time periods (1996-97, 1998-99), and cross-organizational comparison of ratings of goal classifications using a random sample of 100 goal statements drawn from this data set and the original 1765 goal statements used in developing the taxonomy. Results. Application of the taxonomy beyond the original service setting in which it was developed indicated a strong inter-rater reliability, with a high test-retest agreement reported over time. For both services, a small number of categories accounted for a substantial proportion of goals set within the two time periods, while considerable change was evident in goals between the two periods for one service. Further, both placed emphasis on individually focused goals rather than relationship or family-related goals. Conclusion. The taxonomy provides a reliable means for classifying goals and is a useful tool for exploration of the multiple influences on goal setting. Further application of the taxonomy to examine the relative influence on goal setting of client factors versus a range of organizational factors would be beneficial.

Cluster measurement and benchmarking - A recent Welsh approach

Drawing on extensive academic research and theory on clusters and their analysis, the methodology employed in this pilot study (sponsored by the Welsh Assembly Government’s Economic Research Grants Assessment Board) seeks to create a framework for reviewing and monitoring clusters in Wales on an ongoing basis, and generate the information necessary for successful cluster development policy to occur. The multi-method framework developed and tested in the pilot study is designed to map existing Welsh sectors with cluster characteristics, uncover existing linkages, and better understand areas of strength and weakness. The approach adopted relies on synthesising both quantitative and qualitative evidence. Statistical measures, including the size of potential clusters, are united with other evidence on input-output derived inter-linkages within clusters and to other sectors in Wales and the UK, as well as the export and import intensity of the cluster. Multi Sector Qualitative Analysis is then designed for competencies/capacity, risk factors, markets, types and crucially, the perceived strengths of cluster structures and relationships. The approach outlined above can, with the refinements recommended through the review process, provide policy-makers with a valuable tool for reviewing and monitoring individual sectors and ameliorating problems in sectors likely to decline further.

Work at hand: an exploration of gesture in the context of work and everyday life to inform the design of gestural input devices

This research explores gestures used in the context of activities in the workplace and in everyday life in order to understand requirements and devise concepts for the design of gestural information appliances. A collaborative method of video interaction analysis devised to suit design explorations, the Video Card Game, was used to capture and analyse how gesture is used in the context of six different domains: the dentist's office; PDA and mobile phone use; the experimental biologist's laboratory; a city ferry service; a video cassette player repair shop; and a factory flowmeter assembly station. Findings are presented in the form of gestural themes, derived from the tradition of qualitative analysis but bearing some similarity to Alexandrian patterns. Implications for the design of gestural devices are discussed.