In this study, the experience of adaptation to diabetic renal disease was examined from a phenomenological perspective. Twenty patients attending a diabetic renal clinic were interviewed in depth. Through the use of a template analysis approach, a set of strong themes relating to changes in lifestyle was identified: changes in the nature of involvement with the medical system, coping strategies, and hopes, fears, and expectations. Almost all participants attempted to construct a "good adaptation" in the face of the uncertainties surrounding their condition by adopting a stoic and fatalistic stance. This is discussed in the context of the claim that contemporary society holds emotional self-expression rather than stoical endurance to be the appropriate response to suffering.
There was considerable support for reflective learning using an electronic portfolio. Acceptability and use were influenced by individual learning style, resources, training and technical support, and these were often inadequate. The balance for consultants between workload demands and support provided did not favour a reflective type of learning.
Patients were unaware how strongly diabetes influences cardiovascular risk. Their ideas about risk were very different from those of conventional medicine, and provided individual rationales for making choices about treatment and risk-influencing behaviour. Contextual factors, such as family milieu, also influenced their behaviour. Clinicians should not assume patients share the same mental model of risk as they, and must be prepared to explore peoples' individual constructs and health beliefs.
The safety, efficacy and cost-effectiveness of intraoperative cell-salvage in metastatic spine tumour surgery, The Spine Journal (2017), http://dx.doi.org
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