Dataset Information

Discussing alcohol use with the GP: a qualitative study.

ABSTRACT: BACKGROUND:Despite most GPs recognising their role in the early diagnosis of alcohol use disorder (AUD), only 23% of GPs routinely screen for alcohol use. One reason GPs report for not screening is their relationship with patients; questions regarding alcohol use are considered a disturbance of a relationship built on mutual trust. AIM:To analyse the feelings and experiences of patients with AUD concerning early screening for alcohol use by GPs. DESIGN & SETTING:A qualitative study of patients (n = 12) with AUD in remission or treatment, recruited from various medical settings. METHOD:Semi-structured interviews were conducted, audiorecorded, and transcribed verbatim. The authors conducted an inductive analysis based on grounded theory. The analysis was performed until theoretical data saturation was reached. RESULTS:The participants experienced AUD as a chronic, destructive, and shameful disease. The participants expected their GPs to play a primary role in addressing AUD by kind listening, and providing information and support. If the GPs expressed a non-judgmental attitude, the participants could confide in them; this moment was identified as a key milestone in their trajectory, allowing relief and a move toward treatment. The participants thought that any consultation could be an opportunity to discuss alcohol use and noted that such discussions required a psychological and benevolent approach. CONCLUSION:The participants felt fear or denial from the GPs, even though they felt that discussing alcohol use is part of the GP's job. The participants requested that GPs adopt non-judgmental attitudes and kindness when approaching the subject of alcohol use.

SUBMITTER: Coste S

PROVIDER: S-EPMC7330215 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Discussing alcohol use with the GP: a qualitative study.

Coste Sandra S Gimenez Laetitia L Comes Aurélie A Abdelnour Xavier X Dupouy Julie J Escourrou Emile E

BJGP open 20200623 2

<h4>Background</h4>Despite most GPs recognising their role in the early diagnosis of alcohol use disorder (AUD), only 23% of GPs routinely screen for alcohol use. One reason GPs report for not screening is their relationship with patients; questions regarding alcohol use are considered a disturbance of a relationship built on mutual trust.<h4>Aim</h4>To analyse the feelings and experiences of patients with AUD concerning early screening for alcohol use by GPs.<h4>Design & setting</h4>A qualitati ...[more]

PMID: 32345694

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Project description:PurposeThe first aim of this qualitative study was to identify general practitioners' (GPs') views on depression screening combined with GP-targeted feedback in primary care. The second aim was to determine the needs and preferences of GPs with respect to GP-targeted feedback to enhance the efficacy of depression screening.MethodsA semistructured qualitative interview was conducted with officially registered GPs in Hamburg (Germany). Interviews were audio recorded and transcribed verbatim. An inductive approach was used to code the transcripts.ResultsNine GPs (27 to 70 years; 5 male) from Hamburg, Germany, participated. Regarding depression screening combined with GP-targeted feedback, five thematic groups were identified: application of screening; screening and patient-physician relationships; GPs' attitudes towards screening; benefits and concerns related to screening; and GPs' needs and preferences regarding feedback. While the negative aspects of screening can be described in rather general terms (e.g., screening determines the mental health competence, screening threatens the doctor-patient relationship, revealing questions harm the patients), its advantages were very specific (e.g., promoting the identification of undetected cases, relief of the daily workload, wider communication channel to reach more patients). Standardized GP-targeted feedback of the screening results was perceived as helpful and purposeful. GPs preferred feedback materials that eased their clinical workload (e.g., short text with visuals, pictures, or images).ConclusionAddressing GPs' needs is essential when implementing depression screening tools in clinical practice. To overcome prejudices and enhance the efficacy of screening, further education for GPs on the purpose and application on depression screening may be needed. Standardized GP-targeted feedback in combination with depression screening could be the missing link to improve the detection of depression in primary care.

Project description:OBJECTIVES:To explore the views and experiences of people who are homeless and those supporting them regarding conversations and approaches to palliative care SETTING: Data were collected between October 2015 and October 2016 in homeless hostels and day centres and with staff from primary and secondary healthcare providers and social care services from three London boroughs. PARTICIPANTS:People experiencing homelessness (n=28), formerly homeless people (n=10), health and social care providers (n=48), hostel staff (n=30) and outreach staff (n=10). METHODS: In this qualitative descriptive study, participants were recruited to interviews and focus groups across three London boroughs. Views and experiences of end-of-life care were explored with people with personal experience of homelessness, health and social care professionals and hostel and outreach staff. Saturation was reached when no new themes emerged from discussions. RESULTS:28 focus groups and 10 individual interviews were conducted. Participants highlighted that conversations exploring future care preferences and palliative care with people experiencing homelessness are rare. Themes identified as challenges to such conversations included attitudes to death; the recovery focused nature of services for people experiencing homelessness; uncertainty regarding prognosis and place of care; and fear of negative impact. CONCLUSIONS:This research highlights the need for a different approach to supporting people who are homeless and are experiencing advanced ill health, one that incorporates uncertainty and promotes well-being, dignity and choice. We propose parallel planning and mapping as a way of working with uncertainty. We acknowledge that these approaches will not always be straightforward, nor will they be suitable for everyone, yet moving the focus of conversations about the future away from death and dying, towards the present and the future may facilitate conversations and enable the wishes of people who are homeless to be known and explored.

Project description:BackgroundRefugees are at high risk of alcohol abuse due to experiences in their country of origin, transit camps, and in host countries. Congolese have been the largest group of refugees resettled in the US since 2016 and Babembe represent one of the largest Congolese refugee sub-groups. There is a growing body of literature highlighting substance abuse among refugees resettled in the US, but little is known about Congolese Babembe. This study aimed to explore factors and practices contributing to alcohol abuse among Congolese Babembe refugees.MethodsA qualitative research design employing a narrative inquiry approach was used in this study. One focus group discussion was conducted with a semi-structured guide in February 2020.A total of 19 hard-to-reach male refugee participants were recruited through snowball sampling. Audio recordings were translated and transcribed before a thematic content analysis was conducted using Nvivo 10.ResultsThe main themes arose in the focus group analysis. First, the role of war, trauma, and migration in the onset of alcohol abuse in a community that once limited alcohol use to only older men for socialization. Second, refugees viewed alcohol abuse in their community as a result of post- resettlement cultural loss. Third, refugees perceived alcohol as serving a purpose to help cope with stressful conditions in the US and bad news received from loved ones in Africa. Further analysis shows the role of interactions with armed forces and other cultures during war and migration contributed to the adoption of alcohol abuse behavior.ConclusionFindings from this study suggest that factors contributing to alcohol abuse among Congolese Babembe refugees include personal traumatic experiences, loss of cultural identity, and conducive conditions in the host country. Understanding these factors can guide the development of appropriate interventions to prevent alcohol abuse in this vulnerable community. Further research is needed to include Babembe women's perspectives.

Project description:BACKGROUND:Overweight in children is a rising problem leading to serious consequences later in life. The Dutch guideline 'Obesity' for general practitioners recommends discussing obesity in children regardless of the reason of consultation and provides diagnostic and therapeutic tools. However, limited literature indicates that general practitioners experience barriers to discuss this topic. The aim of this study was to determine current perceived barriers of general practitioners in discussing overweight during a regular consultation in children aged 4 to 12?years and to what extent they discuss the topic. Furthermore, we attempt to get more insight in the specific needs and ideas for improvement among GPs. METHODS:A semi-structured in-depth interview study was conducted. Dutch general practitioners with a broad range of demographic characteristics were invited to participate. The transcripts were analysed using a modified version of the constant comparative method. Using this method, we identified perceived barriers of general practitioners. RESULTS:Ten general practitioners were included in the study. Four major themes were identified in the interviews: absence of physical or mental complaints related to overweight, internal barriers of the general practitioners, the child's family background and logistics. Major barriers appeared to be a low consultation rate of these children, the sensitivity of the topic (e.g. fear for children's or parents' reactions and/or disturbance of the relation, influence on the self-esteem of the child, resistance in the parents), the absence of a long-standing relation between general practitioner and child or parent, the background of the child and lack of time or prioritizing. CONCLUSION:Dutch general practitioners indicate to experience barriers and need tools for how to discuss children's overweight during regular consultations within the limited time available. The low consultation rate among children aged 4 to 12?years due to lack of physical complaints is mentioned as a new and important barrier. Therefore, the prior focus might be raising awareness among parents concerning overweight in children aged 4 to 12?years and, thereby, stressing the potential supporting role of primary care professionals in tackling the overweight of their child.

Project description:ObjectivesLittle is known about how innovative surgical procedures are introduced and discussed with patients. This qualitative study aimed to explore perspectives on information provision and consent prior to innovative surgical procedures.DesignQualitative study involving semi-structured interviews. Interviews were audio recorded, transcribed and analysed thematically.Participants42 interviews were conducted (26 surgeons and 16 governance representatives).SettingSurgeons and governance representatives recruited from various surgical specialties and National Health Service (NHS) Trusts across England, UK.ResultsParticipants stated that if a procedure was innovative, patients should be provided with additional information extending beyond that given during routine surgical consultations. However, difficulty defining innovation had implications for whether patients were informed about novel components of surgery and how the procedure was introduced (ie, as part of a research study, trust approval or in routine clinical practice). Furthermore, data suggest surgeons found it difficult to establish what information is essential and how much detail is sufficient, and governance surrounding written and verbal information provision differed between NHS Trusts. Generally, surgeons believed patients held a view that 'new' was best and reported that managing these expectations could be difficult, particularly if patient views aligned with their own.ConclusionsThis study highlights the challenges of information provision and obtaining informed consent in the context of innovative surgery, including establishing if and how a procedure is truly innovative, determining the key information to discuss with patients, ensuring information provision is objective and balanced, and managing patient expectations and preferences. This suggests that surgeons may require support and training to discuss novel procedures with patients. Further work should capture consultations where new procedures are discussed with patients and patients' views of these information exchanges.

Dataset Information

Discussing alcohol use with the GP: a qualitative study.

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Discussing alcohol use with the GP: a qualitative study.

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