Background
We know little about patient–physician communication during visits to discuss diagnosis and treatment of prostate cancer.
Objective
To examine the overall visit structure and how patients and physicians transition between communication activities during visits in which patients received new prostate cancer diagnoses.
Participants
Forty veterans and 18 urologists at one VA medical centre.
Methods
We coded 40 transcripts to identify major communication activities during visits and used empiric discourse analysis to analyse transitions between activities.
Results
We identified five communication activities that occurred in the following typical sequence: ‘diagnosis delivery’, ‘risk classification’, ‘options talk’, ‘decision talk’ and ‘next steps’. The first two activities were typically brief and involved minimal patient participation. Options talk was typically the longest activity; physicians explicitly announced the beginning of options talk and framed it as their professional responsibility. Some patients were unsure of the purpose of visit and/or who should make treatment decisions.
Conclusion
Visits to deliver the diagnosis of early stage prostate cancer follow a regular sequence of communication activities. Physicians focus on discussing treatment options and devote comparatively little time and attention to discussing the new cancer diagnosis. Towards the goal of promoting patient-centred communication, physicians should consider eliciting patient reactions after diagnosis delivery and explaining the decision-making process before describing treatment options.
Catholicism is the most restrictive world religion in its position on assisted reproductive technologies (ARTs). The opposition of the Church, combined with the widespread acceptability of ARTs in the United States, creates a profound moral dilemma for those who adhere to Church doctrine. Drawing on interviews from 33 Catholic women, this study shows that devout women have different understandings of these technologies than women from treatment-based studies. These differences are rooted in devout women’s position of navigating two contradictory cultural schemas—“religious” and “secular”—regarding the meaning of reproductive technologies. Religious schemas provide devout women with different cultural resources that help them to avoid using ARTs while still reckoning with the ideal of biological parenthood. I show how devout women draw on religion to find value and meaning in their suffering, move beyond biological motherhood, and achieve a moral femininity. While religion increases the burden of reproduction for devout women, it also provides the cultural resources to resist the financial, emotional, and physical difficulties experienced by women who use ARTs.
Previous research assessed the impact of state regulations on clinics and patients, but how bureaucrats implement them is less understood and increasingly important as states arbitrate abortion regulation. We conducted a case study of how bureaucrats use discretion to implement state regulations on abortion, focusing on two abortion facilities in Southwest Ohio from 2010-2022. Ohio abortion facilities are required to obtain a written transfer agreement, despite it offering no demonstrable health or safety benefits. We find that state requirements for obtaining variances, a process that allows abortion facilities to operate without a written transfer agreement, have become exceedingly difficult to comply with. We show how state statutes and administrative law enabled bureaucrats to wield unlimited discretion and enforce arbitrary requirements. This unlimited bureaucratic discretion and accompanying administrative burden exacerbated clinic instability and threatened abortion availability in Southwest Ohio for almost a decade. As implementation and interpretation of abortion policy is increasingly left to state bureaucrats and civil servants following the Supreme Court’s Dobbs decision, how bureaucrats use discretion will influence clinic stability and abortion availability. We posit that unlimited bureaucratic discretion may exert greater influence on abortion availability across the nation as states scramble to clarify and implement policies post-Dobbs.
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