Mealtimes
As the number of older people increases globally, there is likely to be a greater demand for residential care. The high rates of malnutrition in care homes has therefore become a priority for researchers and policymakers. In order to better understand the factors that might lead to this, an Exeter-based research team conducted a systematic review to examine the attitudes, perceptions, and experiences of mealtimes among care home residents and staff.1 They found that mealtimes were an essential part of care home life, providing structure to the day and opportunities for companionship. Enhancing the mealtime experience, though, is not an easy task as the environment needs to cater for individual care as well as the communal encounters.
Breast reconstruction
Shared decision making is set to be an integral feature of clinical practice in the decades ahead. In the context of breast cancer, it means that any treatment decisions, including reconstruction procedures, are discussed to ensure that patients have all available information to make decisions in an informed way. In reality, though, most people deal with intrusive life events such as cancer care with their intimate partners. A recent French study explored heterosexual couples’ decision-making process for breast reconstruction in the cancer context and particularly to investigate the partners’ involvement in this process.2 They found that the decision-making process is often reported as an interrelated experience and the partner’s role is depicted as consultative and mostly supportive. Male partners mentioned the cancer experience, the treatments, and the process of breast reconstruction as a stressor that they had to cope with, just as the female participants did. The authors suggest further prospective studies are needed to help understand the progression of decision-making over time.
Stillbirth
Stillbirth is common and most GPs will regularly meet parents who have experienced it and be fully aware of what a significant impact it can have. Although we recognise the importance of robust clinical and emotional care after stillbirth, there has been relatively little work exploring its impact on subsequent pregnancies. A recent Irish study included interviews with the parents of 10 stillborn babies and found that parents considered the prospect of a subsequent pregnancy to be daunting, and had fears about the potential loss of another child.3 They also found that, although mothers tended to plan future pregnancies, fathers were more reluctant to think about this in the days after the stillbirth. Parents were also unsure about what level of care they might need in future pregnancies and wanted follow-up appointments with maternity staff to talk about this.
Neoliberalism
Self-management has become an important aspect of chronic disease management, and social and educational inequalities therefore have a considerable impact on the capacity and capabilities of people to manage their long-term condition. In the UK, postwar social democratic policies have gradually shifted to a neoliberal consensus, characterised by an emphasis on individual responsibility, consumer choice, privatisation of services, and the values of self-interest and competition. Researchers from the UK and Bulgaria recently studied the different articulations of neoliberalism manifest in the arena of personal illness management in their respective countries.4 The UK narratives were framed within an individual responsibility discourse whereas in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. People with a chronic illness in Bulgaria were more likely than UK users to behave as consumers, as evidenced by the much higher rates in their utilisation of healthcare services. The authors suggest that the Bulgarian experience may project one of the possible futures for the UK. Let’s hope they’re wrong.
- © British Journal of General Practice 2017