Bolivian health and social care professionals' experiences of decision-making in oncology and palliative care

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncológico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering.

Special Education Today in the United Kingdom

This chapter attempts to provide a critical analysis of special needs education within the United Kingdom today. Central to such an analysis is an understanding of the rapidly changing social and political milieu within which special needs education is embedded, including the rapidly changing demographics of schooling, and the devolution of political power into four separate but linked countries - England, Wales, Scotland and Northern Ireland. Following a discussion of such wider social, political and educational issues, the authors thoroughly explore the convergences and divergences in policy and practice across the four devolved administrations. They describe a plethora of contemporary texts within each of the four administrations that speak to the need for special needs education to change in response to 21st century concerns about the problems of access to, and equity in education for all children. Despite this, they explain why they remain circumspect about the potential of such developments to lead to successful inclusive practices and developments on the ground. Their analysis in the last section centres on the issue of teacher education for inclusion and some very innovative UK research and development projects that have been reported to successfully engage teachers with new paradigm thinking and practice in the field of inclusive special needs education.

Beyond Individualism: Social Work and Social Identity

Individualism continues to have a notable impact on social work. The personalisation of services and the individualisation of care are just two examples of this societal trend. While helping service users to articulate their aspirations for a better future, individualism, if taken too far, undermines the social aspects of life. In response to this concern, this paper argues that social work must appreciate the interplay between the individual and the collective spheres, and its impact on identity formation, in order to enhance human well-being. To give substance to this argument, Jenkins's model of social identity is appropriated and augmented to take account of four interlinked, yet distinct, orders of experience, namely the individual, interactional, institutional and societal orders. This reworked conceptualisation is then considered in terms of its implications for social work practice.

Service user perspectives on palliative care education for health and social care professionals supporting people with learning disabilities

Background and objectives
Evidence from European and American studies indicates limited referrals of people with learning (intellectual) disabilities to palliative care services. Although professionals’ perceptions of their training needs in this area have been studied, the perceptions of people with learning disabilities and family carers are not known. This study aimed to elicit the views of people with learning disabilities, and their family carers concerning palliative care, to inform healthcare professional education and training.

Methods
A qualitative, exploratory design was used. A total of 17 people with learning disabilities were recruited to two focus groups which took place within an advocacy network. Additionally, three family carers of someone with a learning disability, requiring palliative care, and two family carers who had been bereaved recently were also interviewed.

Results
Combined data identified the perceived learning needs for healthcare professionals. Three subthemes emerged: ‘information and preparation’, ‘provision of care’ and ‘family-centred care’.

Conclusions
This study shows that people with learning disabilities can have conversations about death and dying, and their preferred end-of-life care, but require information that they can understand. They also need to have people around familiar to them and with them. Healthcare professionals require skills and knowledge to effectively provide palliative care for people with learning disabilities and should also work in partnership with their family carers who have expertise from their long-term caring role. These findings have implications for educators and clinicians.

Angels with dirty faces? European identity, politics of representation and recognition of Romani interests

The contradiction between acknowledgement of cultural differences and their accommodation in public has been a constant theme in studies of diverse societies. This review essay discusses five volumes that grapple with questions of Romani inclusion and the problems Roma face across Europe. The volumes under review point to problems faced by Romani communities and analyse the various legal, political and social challenges that situation of the Roma poses to institutions of contemporary societies. The essay reviews the challenging nature of the status of Roma as we move away from the one-sided towards more reciprocal relationship engagement of state with society in general, and the multiply excluded groups, in particular. The essay finds that the role Roma play in these relationships is either over-, or under-estimated by the literature, largely as a result of limited opportunities to acknowledge and, in effect, accommodate Roma who are rarely understood as actors in their own right.

Economic and social integration the challenge for EU constitutional law

'At a time of crisis and therefore a crucial juncture in European politics, Dagmar Schiek offers us an inspiring vision of the potential of the European Union. In her brilliant study, she exposes the obstacles that economic integration has posed for achievement of social justice, and provides a bold solution. Rejecting more limited models of constitutionalism, she presents a convincing alternative which is socially embedded, allowing space for action by manifold actors at multiple levels of governance.' - Tonia Novitz, University of Bristol, UK. © Dagmar Schiek 2012. All rights reserved.