This synthesis details the unique qualities and conditions of SBs that merit particular attention from planners and occupational health policy makers. In particular, the informal workplace social relations can limit workers' and employers' apprehension of risk, and policy and complex contractual conditions in which SBs are often engaged (such as chains of subcontracting) can complicate occupational health responsibilities. This review questions the utility of SB exemptions from OHS regulations and suggests a legislative focus on the particular needs of SBs. It considers ways that workers might activate their own workplace health concerns, and suggests that more qualitative research on OHS solutions is needed. It suggests that answers to the SB OHS problems identified in this review might lie in third party interventions and improved worker representation.
Women undergoing cancer treatments and their healthcare providers encounter challenges in fertility preservation (FP) discussions and decision‐making. A systematic review of qualitative research was conducted to gain in‐depth understanding of factors influencing FP discussions and decision‐making. Major bibliographic databases and grey literature in English from 1994 to 2016 were searched for qualitative research exploring patient/provider perspectives on barriers and facilitators to FP decision‐making. Two researchers screened article titles, abstracts and full‐texts. Verbatim data on research questions, study methodology, participants, findings and discussions of findings were extracted. Quality assessment and thematic analysis were conducted. The search yielded 74 studies dating from 2007 onwards; 29 met the inclusion criteria. Analysis revealed three types of barriers: (a) FP knowledge, skills and information deficits contributed to discomfort for providers and discontent for patients; (b) psychosocial factors and clinical issues influenced providers’ practices around FP discussions and patients’ decision‐making; and (c) material, social and structural factors (e.g., lack of resources and accessibility) posed challenges to FP discussions. Potential facilitators to FP discussions and decision‐making were also identified. A discussion of ways to improve physician's knowledge and facilitate women's decision‐making and access to FP is presented, along with areas for policy development and further research.
This qualitative study uses interviews with 22 Canadian clinicians to examine the perceived barriers to discussing fertility and fertility preservation with young women with cancer.
BackgroundCancer patients of reproductive age are at risk of infertility as a result of their treatment. Oncofertility decision support resources can assist patients with fertility decision-making before treatment yet available oncofertility resources contain varying levels of detail and different fertility options. The key information/sections needed in oncofertility resources remain unclear. To explore the information needs for oncofertility decision-making before cancer treatment, we aimed to evaluate existing oncofertility decision support resources with breast cancer patients and providers.MethodsWe conducted 30 to 90-min interviews that included a survey questionnaire and open-ended questions with patients and providers between March and June 2016. Interviews were transcribed verbatim. Analysis involved descriptive statistics for survey responses and thematic analysis of qualitative data.ResultsA total of 16 participants completed interviews. Key information perceived by most participants as necessary for fertility decision-making included tailored post-treatment pregnancy rates, cost ranges and financial assistance for the fertility options based on patients’ situation. However, patient and provider participants expressed differing opinions on the inclusion of all before and after treatment fertility options and the amount of fertility information required at diagnosis.ConclusionThe evaluation identified fertility information needs among patients in addition to providers’ views on patient needs. While existing oncofertility resources contain information perceived as necessary for decision-making there is an opportunity to use these findings to create or enhance resources to better meet the needs of patients. Additionally, patients and providers differing views on information needs highlight the opportunity for provider training to ensure better communication using resources in clinic to understand specific patient needs.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3901-z) contains supplementary material, which is available to authorized users.
Part-time, casual, contract, temporary and self-employment are some of the more commonly known forms of 'contingent work' . Recent employment surveys indicate an increase in these forms of work while permanent forms of employment have ostensibly declined. Contingent work has become a focus of concern for those interested in the effects of changing labor market patterns on health. There are however two significant impediments to understanding the contingent work and health relationship. First, its current conceptual apparatus is diffuse and inconsistent. Definitions of contingent work and the assumptions that underlie its numerous descriptors differ within and across disciplines. Second, there is little conceptual clarity around what aspects of contingent work might be related to health. In this article, we distil and synthesize literature from a range of disciplines and develop a framework for conceptualizing contingent work and its relationship to health. We suggest that low reciprocity, uncertainty, discontinuity and marginality are core concepts that underlie many conceptualizations of contingent work. Drawing on related theoretical insights and empirical findings from the literature, we identify possible structural, social and psychological pathways between these four features of contingent work and ill health.
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