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Discussions of "code status" on a family practice teaching ward: what barriers do family physicians face?

https://arctichealth.org/en/permalink/ahliterature196437
Source
CMAJ. 2000 Nov 14;163(10):1255-9
Publication Type
Article
Date
Nov-14-2000
Author
B. Calam
S. Far
R. Andrew
Author Affiliation
Department of Family Practice, University of British Columbia. bcalam@providencehealth.bc.ca
Source
CMAJ. 2000 Nov 14;163(10):1255-9
Date
Nov-14-2000
Language
English
Publication Type
Article
Keywords
Attitude to Death
Canada
Communication Barriers
Family Practice - education
Female
Freedom
Humans
Internship and Residency
Male
Patient Participation
Physician-Patient Relations
Resuscitation Orders
Abstract
Patients want physicians to ascertain their wishes related to resuscitation, yet such discussions of "code status" are often delayed in the hospital setting, which compromises patient autonomy. Few studies have examined family physicians' views on this topic. Our objectives were to explore the experiences of family physicians and family practice residents in establishing code status with their patients who had been admitted to hospital and to identify barriers to these discussions.
Semistructured, in-depth interviews were conducted with 5 family physicians and 5 family practice residents admitting patients to a family practice teaching ward in a university-affiliated urban tertiary care hospital. Interview transcripts were analysed inductively, and grounded theory was used to identify conceptual categories and recurring themes. Key findings were validated by means of member checking with participants, consensus meetings of the research team and consultation with qualitative researchers.
Barriers to code-status discussions included personal discomfort with confronting mortality, fear of damaging the doctor-patient relationship or harming the patient by raising the topic of death, limited time to establish trust, and difficulty in managing complex family dynamics. In spite of these challenges, family physicians and residents viewed discussions of resuscitation as a significant part of their role.
Family physicians and residents need to develop personal awareness about difficulties in confronting mortality, enhance their communication strategies for broaching the topic of code status in the context of a trusting doctor-patient relationship and sharpen their skills in understanding and managing family dynamics related to end-of-life decisions. Awareness of the barriers to code-status discussions can inform research, education and hospital policy. Consultation with patients is needed to develop effective communication strategies.
Notes
Cites: Can Crit Care Nurs J. 1988 Jun;5(2):9-113390760
Cites: CMAJ. 1988 Jul 15;139(2):121-43390780
Cites: QRB Qual Rev Bull. 1989 Apr;15(4):108-132498799
Cites: Arch Intern Med. 1990 Mar;150(3):653-82310285
Cites: Fam Pract Res J. 1992 Jun;12(2):157-691621536
Cites: Arch Intern Med. 1993 Jan 25;153(2):228-328422210
Cites: J Med Ethics. 1993 Dec;19(4):200-58308873
Cites: BMJ. 1994 Jun 25;308(6945):1677-87993423
Cites: Am Fam Physician. 1994 Nov 1;50(6):1293-9, 1303-47942428
Cites: Arch Intern Med. 1994 Oct 24;154(20):2311-87944853
Cites: Arch Intern Med. 1994 Oct 24;154(20):2321-77944854
Cites: J Fam Pract. 1995 Jan;40(1):41-47807036
Cites: J Gen Intern Med. 1994 Nov;9(11):622-67853071
Cites: J Gen Intern Med. 1995 Aug;10(8):436-427472700
Cites: JAMA. 1995 Nov 22-29;274(20):1591-87474243
Cites: Arch Intern Med. 1996 Jun 24;156(12):1285-98651836
Cites: CMAJ. 1996 Dec 1;155(11):1563-88956833
Cites: J Am Geriatr Soc. 1997 Apr;45(4):399-4069100706
Cites: J Palliat Care. 1997 Spring;13(1):5-89105151
Cites: Int J Geriatr Psychiatry. 1997 Jun;12(6):667-709215951
Cites: Aust N Z J Med. 1997 Aug;27(4):379-839448877
Cites: Ann Intern Med. 1998 Sep 15;129(6):441-99735081
Cites: Crit Care Med. 1999 Sep;27(9):2005-1310507632
Cites: Can Fam Physician. 2000 Feb;46:340-610690490
Cites: JAMA. 1986 Jul 11;256(2):233-73723709
PubMed ID
11107460 View in PubMed
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Haida perspectives on living with non-insulin-dependent diabetes.

https://arctichealth.org/en/permalink/ahliterature3194
Source
CMAJ. 1996 Dec 1;155(11):1563-8
Publication Type
Article
Date
Dec-1-1996
Author
G D Grams
C. Herbert
C. Heffernan
B. Calam
M A Wilson
S. Grzybowski
D. Brown
Author Affiliation
Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver.
Source
CMAJ. 1996 Dec 1;155(11):1563-8
Date
Dec-1-1996
Language
English
Publication Type
Article
Keywords
Adult
Aged
Attitude to Health
British Columbia
Cultural Diversity
Diabetes Mellitus, Type 2 - prevention & control - psychology
Diet
Female
Humans
Indians, North American - psychology
Male
Middle Aged
Research Support, Non-U.S. Gov't
Abstract
OBJECTIVE: To understand the experience of Haida people living with non-insulin-dependent diabetes mellitus (NIDDM), in order to provide a basis for a culturally sensitive community-based approach to managing NIDDM. DESIGN: Qualitative study using grounded theory. SETTING: The villages of Skidegate and Old Massett in Haida Gwaii (Queen Charlotte Islands), British Columbia. PARTICIPANTS: Nine focus groups met at the beginning and six at the end of the project. The focus groups had 8 to 12 members each and roughly the same number of men and women overall. The groups included people with diabetes, family members of people with diabetes, community leaders and elders. FINDINGS: Conceptual findings related to the participants' views on the impact of NIDDM on their lives, their views on what life was like before the effects of NIDDM were felt and their beliefs about the prevention and treatment of NIDDM. Six themes recurred in the discussions: fear; grief and loss; the loss of and desire to regain control; food and eating; physical and personal strength; and traditional ways. CONCLUSIONS: Insights into the illness experience of different cultural groups can inform program development and the creation of culturally sensitive health care interventions.
PubMed ID
8956833 View in PubMed
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Pap screening clinics with native women in Skidegate, Haida Gwaii. Need for innovation.

https://arctichealth.org/en/permalink/ahliterature4002
Source
Can Fam Physician. 1999 Feb;45:355-60
Publication Type
Article
Date
Feb-1999
Author
B. Calam
L. Norgrove
D. Brown
M A Wilson
Author Affiliation
Department of Family Practice, University of British Columbia. bcalam@stpaulshosp.bc.ca
Source
Can Fam Physician. 1999 Feb;45:355-60
Date
Feb-1999
Language
English
Publication Type
Article
Keywords
Adult
Aged
British Columbia
Family Practice
Female
Health Services for the Aged
Humans
Indians, North American
Mass Screening
Middle Aged
Pilot Projects
Research Support, Non-U.S. Gov't
Rural Health Services
Uterine Cervical Neoplasms - diagnosis
Vaginal Smears
Abstract
PROBLEM ADDRESSED: First Nations women in British Columbia, especially elders, are underscreened for cancer of the cervix compared with the general population and are much more likely to die of the disease than other women. OBJECTIVE OF PROGRAM: To develop a pilot program, in consultation with community representatives, to address the Pap screening needs of First Nations women 40 years and older on a rural reserve. MAIN COMPONENTS OF PROGRAM: Identification of key links to the population; consultation with the community to design an outreach process; identification of underscreened women; implementation of community Pap screening clinics; evaluation of the pilot program. CONCLUSIONS: We developed a Pap screening outreach program that marked a departure from the usual screening approach in the community. First Nations community health representatives were key links for the process that involved family physicians and office staff at a local clinic on a rural reserve. Participation rate for the pilot program was 48%, resulting in an increase of 15% over the previously recorded screening rate for this population. More screening clinics of this type and evaluation for sustainability are proposed.
PubMed ID
10065309 View in PubMed
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