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Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change.

Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players.

Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms.

Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.

Purpose: We respond to a call for studies of “embodied experiences of stigma in context” by investigating how transgender embodiment shapes perceived needs for access to and experiences of “sex-specific” cancer screenings (SSCS) (e.g., breast and prostate exams, Pap smears) in the North American healthcare system.

Design/Methodology/Approach: We analyze data from semistructured interviews with a diverse sample of 35 transgender-identified adults. Based on thematic narrative analysis, we explore four themes in relation to embodiment: discrimination; discomfort and hyperawareness of genitalia; strategic reframing and active management; and SSCS health care encounters as positive and gender affirming.

Findings: In relation to SSCS, transgender individuals experience discrimination, do emotion work, and actively manage situations to obtain needed health care, and sometimes forego care because barriers are insurmountable. Health care providers' responses to transgender embodiment can disrupt health care encounters, but they can also facilitate access and create opportunities for affirmation, agency, advocacy, and new forms of interaction. Embodiment- and gender-affirming interactions with health care providers, which varied by gender, emerged as key influences on participants' experiences of SSCS.

Research Limitations/Implications: Our sample primarily includes binary gender-identified individuals, and while our interview guide covered many topics, the SSCS question did not explicitly reference testicular exams.

Practical Implications: Cancer prevention and detection Cancer prevention and detection require health care professionals who are prepared for differently embodied persons. Preventive cancer screenings are not “sex-specific”; they are relevant to individuals with medically necessary needs regardless of gender identity or embodiment.

Social Implications

Originality/Value: Few medical sociologists have focused on transgender embodiment. Findings enhance our understanding of how transgender embodiment and minority stress processes influence access to needed SSCS.

The discovery of the BRCA1 and BRCA2 genes has facilitated the construction of a new group of women referred to as “previvors” – individuals who are survivors of a predisposition to cancer but who are not presently ill. These “previvors” constitute the first generation of women faced with the option to make preventative health choices based on this kind of genetic information. Therefore, this research examines how young BRCA positive women negotiate the medicalization of their bodies based on their new “potentially ill” status. Analyzing the posts in an online forum specifically for “young previvors,” the findings indicate that the majority share an “anything's better than cancer” mantra, suggesting that fear of death largely outweighs all other fears or concerns. Consequently, asserting control by taking preventative action is considered a mechanism for quelling the fear, uncertainty, and stress associated with being a BRCA gene carrier. Constructed as a medical diagnosis, carrying the BRCA mutation is consequently perceived as requiring a corresponding medical treatment. As such, despite the connection these women describe feeling with the “parts that make them a woman,” they appear to believe that they must undergo prophylactic surgery and disassociate from their bodies in order to save their lives. Ultimately, they convince themselves to view their breasts and ovaries simply as nonessential organs, rather than as core components of their feminine, sexual, and reproductive identities.

Purpose – The goal of this chapter is to understand the role of nonprofit voluntary health organizations (VHOs) in the lives of Canadian women coping with breast cancer.

Methodology – Through qualitative interviews with breast cancer survivors and records of VHOs active in this field, we assess the level and nature of their interactions and impact on women's quality of life.

Findings – Our findings suggest that at the micro-level, VHOs are venues for women to receive auxiliary services such as information, counseling, and support that complement the mainstream health care provision. While VHO services empower women as health care consumers, we show that they also serve as venues for women to reciprocate by volunteering. This process of reciprocity helps women cope with their own healing and allows them to be not only consumers but also producers of health services.

Research limitations – The non-random nature and the small sample size make our findings not easily generalizable to the larger population of breast cancer survivors; rather they are indicative of the experiences of Canadian women in one large urban metropolitan area.

Value of the chapter – We demonstrate the role of VHOs as venues of health consumerism as well as places for consumers to become involved in the production of services by volunteering.

This chapter explores the relationships between 12 single mothers with breast cancer and their children, a subtheme of a larger qualitative study.

Qualitative data were collected via interviews. The study used the ecological systems theoretical framework to explain findings.

In speaking with women about how they constructed and altered their social networks post-diagnosis, many talked about their relationships with their children. This chapter explains how these mothers discussed their diagnoses with their children in age-appropriate ways; how they relied on their children during treatment for informational and emotional support; and how relationships with their children changed during treatment and recovery.

Based on findings from this study, family scientists, public health professionals, and oncology care providers may have a better understanding of the specific concerns and experiences related to the children of breast cancer patients without partners.

This study yields new information about the support needs of single breast cancer patients and their children, and offers insight into what researchers and medical teams can do to better support families affected by breast cancer.

The health industry is rapidly adopting digital services and face-to-face offerings are being replaced by e-services. One example is peer-to-peer survivor networks for cancer patients. This study investigates the virtual exchanges in survivor networks and whether these exchanges are valued for economic, symbolic, or expressive worth. The research seeks to address whether the alleviation of loneliness is possible.

The qualitative work in this study utilizes netnographic explorations and in-depth interviews with cancer survivors, average age 62, to investigate the social exchange continuum in peer-to-peer online patient survivor networks.

This study shows that technological innovations can aid survivorship when the exchanges are meaningful. Meaningful interactions within gift systems are valued for expressive worth and are established upon the notion of selfless gifts where the giver expects nothing in return. For networks to operate via expressiveness, informants must be open and vulnerable to others. Findings show that biographical narratives are useful tools for creating an expressive environment and givers become more giving after engaging in selfless acts. The intangibility and immaterial nature of virtual gifts creates a collective identity and fosters an aggregate extended self.

Implications emphasize the need among survivors of trauma to connect with others. Digital technologies allow connections on a global scale, so survivors can find others with similar needs. Peer-to-peer networks provide a way for survivors to meet, interact with, and extend their aggregate selves through other survivors, while experiencing a transcendent sense that they are part of something bigger than self alone.

Purpose: The issue of whether participation in online peer-support communities has positive or negative impacts on the psychological adjustment of cancer patients warrants further explorations from new perspectives. This research investigates the role of personality traits in moderating the impact of online participation on the psychological adjustment of cancer patients in terms of their general psychological well-being and cancer-specific well-being.

Methodology: Study participants consisted of adults diagnosed with leukemia. Questionnaires were collected from 111 participants in two leukemia-related forums in China, Baidu Leukemia Community and Bloodbbs. Information regarding the personality traits, online participation, and psychological adjustment were collected using an online questionnaire. A linear regression model was used to test the moderation effect of personality traits on the relationship between online participation and psychological adjustment.

Findings: The main effect of participation in online support communities on psychological adjustment was not statistically significant. Importantly, two personality traits (i.e., emotional stability and openness to experience) moderated the relationship between online participation and psychological adjustment to cancer. Leukemia patients with high emotional stability and high openness to experience reported better psychological adjustment as they participated more in the online community. However, this was not the case for patients with low stability and low openness, who reported worse psychological adjustment as their participation in the online support community increased.

Value: This study introduces two personality moderators into the discussion of how participation in online support communities influences the lives of cancer patients. The moderation effects help to explain why there have been contradictions in the findings of previous studies. In addition, this study adds to the current literature on online support communities as little research on this topic has been conducted outside of the US and Europe. Practically, this study not only highlights the need to evaluate the personality traits of patients who are recommended to participate in online communities, but also underlines the necessity of intervention in these communities.

In order to study whether far-infrared fabrics can be used as a garment for breast cancer patients, or as an adjuvant rehabilitation underwear for breast cancer patients after postoperative radiotherapy and chemotherapy, to eliminate tissue edema. To explore the effect of different far-infrared fabrics on the proliferation and invasion of breast cancer cells as a basic in vitro study.

Six kinds of fabrics of the same specification with different far-infrared nanoparticles were selected. MCF7 and Bcap37 breast cancer cells were used to study the effect of far-infrared fabrics on cell proliferation and invasion. Six kinds of far-infrared fabrics were used to culture breast cancer cells and explore their effects on breast cancer cell growth and the difference between different far-infrared fabrics.

It is found that the far-infrared emissivity of six kinds of fabrics are different, among which tea carbon fabric is the highest, followed by volcanic fabric, graphene fabric and biomass graphene fabric are the lowest. The results show that the far-infrared fabrics can significantly inhibit the proliferation and invasion of breast cancer cells, the higher the far-infrared emissivity is, and the longer the time of far-infrared radiation, the more significant the inhibition effect is.

Far-infrared fabrics can inhibit proliferation and invasion of breast cancer cells in vitro. Therefore, far-infrared fabrics can be used for adjuvant rehabilitation of breast cancer patients. This conclusion provides a basis for the application of far-infrared functional fabrics in the medical field. This conclusion provides a basis for the application of far-infrared functional fabrics in medical field.

Cancer-related stigma is a troubling challenge faced by working cancer survivors and organizations aiming to promote inclusive work environments. Research suggests that a harmful stereotype faced by cancer survivors is that the cancer survivors are low in competence. Leveraging the concept of the looking glass self and social cognitive theory, the authors develop a theoretical model about psychological processes through which cancer survivors' competence metaperceptions are related to work outcomes.

The authors recruited 200 working cancer survivors from online research panels and empirically test a theoretical model on how cancer survivors' metaperceptions of competence are related to the survivors' turnover intention and vigor at work. The authors additionally conducted an experimental vignette study among a sample of 133 students to examine confounds concerning causal order.

The authors found that favorable competence metaperceptions were related to decreased turnover intentions and increased vigor through cancer survivors' enhanced self-efficacy, especially for survivors high in need for emotional support.

This study suggests that inclusive organizations should pay attention to employees with cancer histories as a hidden disadvantaged group. To protect and motivate working cancer survivors, managers need to create a positive socio-cognitive working environment where cancer survivors are respected and valued.

By examining cancer survivors' metaperceptions and showing that survivors may internalize others' stereotype about individuals with a history of cancer, the authors advance the understanding about cancer survivors' return-to-work challenges.

To investigate the factors associated with the use of screening mammography for breast cancer and cervical smear tests for cervical cancer, a theoretical framework was used comprising elements from the Health Belief Model, the Theory of Reasoned Action, and illness representations from the self‐regulatory model. Items reflecting older women’s illness representations about cancer and cancer screening were derived from an earlier qualitative study. Using a highly structured interview schedule, telephone interviews were conducted with 1,200 women aged 50‐70 years. There were considerable similarities between the factors associated with both mammography and cervical smear test behaviours. The factors associated with screening mammography behaviour were: perceived barriers, perceived benefits, social influence, the illness representations, and marital status. The factors associated with cervical smear test behaviour were: perceived barriers, perceived benefits, emotions as a cause of cancer, feeling frightened of cancer, the illness representations, having a usual general practitioner, and being younger.