Clinician-Patient Relationships in Virtual Care: A Dimensional Analysis of the Symbolic World of Cancer Care.

Rapid uptake of telehealth technologies has shifted clinician-patient relationships, a well-studied topic of sociological inquiry. The purpose of this dimensional analysis study was to understand the symbolic interaction of clinicians and patients within virtual supportive cancer care. Seventeen clinicians, eighteen patients, and three care partners receiving or providing care at a multi-site cancer center in the United States participated in interviews. Our analysis of supportive cancer care experiences reveals a key tension: clinicians need to rely on patients in order to share clinical tasks in a virtual care setting but can be reluctant to do so. We posit that dimming the light on cancer is a process that enables clinicians to overcome their reluctance to engage in clinician-patient task sharing by strengthening the relationship. Taken together, these findings reconceptualize the symbolic interaction of the clinician-patient relationship and highlight opportunities to actualize models of relationship-centered virtual care. We discuss implications for clinical practice, ethical relational care, and the literature on clinician-patient relationships and trust.

The impact and implications of virtual supportive cancer care during the COVID-19 pandemic: integrating patient and clinician perspectives.

PURPOSE: Many cancer centers made rapid shifts in supportive care delivery modalities at the onset of the COVID-19 pandemic. Improving virtual supportive cancer care requires deeply understanding both patient's and clinician's experiences. We aimed to integrate the perspectives of clinicians and patients to describe the transition to virtual supportive cancer care during COVID-19. METHODS: In clinical-academic partnership between a multi-site cancer care center in the Northeastern USA and a school of nursing, we conducted a study using dimensional analysis method. Theoretical sampling drove recruitment of patients and clinicians who engaged in virtual supportive cancer care from March 15, 2020 to December 15, 2020. In this sub-analysis, we coded the dimensional analysis data from semi-structured interviews using a descriptive approach with inductive conventional content analysis. RESULTS: We interviewed 17 clinicians, 18 patients, and 3 care partners about their experiences. We integrate patient and clinician perspectives in four in vivo categories: "When COVID hit," "Not an IT expert," "Those little moments," and "The mothership." CONCLUSION: The findings uncover shared patient and clinician fears of missing or sub-optimal care at the onset of COVID-19, technological and relational challenges to engaging in care, and the mixed impacts of virtual care on access, convenience, and efficiency. This analysis suggests concrete action items to improve virtual supportive care for patients and clinicians. The findings corroborate the importance of convenience, access, and efficiency as care quality indicators and suggest potential to emphasize the clinician-patient relationship as an additional indicator of care quality.

Social Relationships in Nurses' Caring of Adolescents and Emerging Adults With Life-Limiting Illnesses or Injuries.

A multidisciplinary literature theorizes the nurse-patient relationship. Nurses' experiences with and within people's social worlds are comparatively underexamined. The purpose of this dimensional analysis inquiry was to uncover dimensions of social relationships in nurses' caring for adolescents and emerging adults with life-limiting illnesses and injuries. Semi-structured interviews with 21 nurses across roles and care settings in the United States occurred concurrently with theoretical sampling and inductive analysis. From the perspective of Caring for You Around You and within a context, Assessing Right for You, Diagnosing the Circle, and Planning Right for Me establish the conditions under which nurses shift between witnessing and participating in social relationships as they engage in the process I Draw and Redraw the Circle. The findings contribute a theoretical explanation of why and how nurses engage in relational care. Contextualizing the findings in nursing theory, family-centered care, and professional ethics elucidates directions for inquiry and practice.

A Midwest Stakeholder Evaluation of an Adolescent and Young Adult Cancer Survivor Needs Assessment Survey.

Purpose: Over 87,000 adolescents and young adults (AYAs) are diagnosed with cancer in the United States each year. Improvement in outcomes in the AYA population has lagged that of both younger and older patients. This decrement may be attributable to several factors, including insufficient supportive care services. Our team modified the Needs Assessment & Service Bridge (NA-SB) tool, utilizing an iterative approach with patient and clinician stakeholders to meet the needs of the AYA population at a large Midwestern Cancer Center. Methods: We recruited a 10-member AYA Advisory Board (AB) from our Cancer Center patients, and met five times over 9 months to discuss supportive care and the NA-SB. We recruited a multidisciplinary group of oncology clinicians to assess content validity and conducted interviews with nine clinician stakeholders to discuss implementation. Results: The AB generated a 59-item-modified NA-SB, retaining most of the original NA-SB items and adding several more. Five items with concerns for relevance and/or clarity were revised to create the final 58-item-modified NA-SB. Priorities for implementation were identified by AB and clinician stakeholders. Conclusions: The modified NA-SB thoroughly reflects supportive care needs of our Midwestern AYA cancer survivors. When implemented, the tool may facilitate patient-care team communication and provide data to prioritize development of new supportive care resources. AYA cancer survivors have unique supportive care needs that are insufficiently addressed by current care models; using the modified NA-SB may help address those needs, leading to improved AYA outcomes.

Fostering Scholarly Development in Nursing Science: The Promise of Dimensional Analysis.

BACKGROUND: Scholarly development in nursing science is a challenging process of academic evolution. In doctoral programs, students move from mastering technical research skills toward developing scholarly identities. This article explores the utility of dimensional analysis as a method of inquiry for nursing PhD students seeking to deepen their scholarly development when completing course assignments and reaching doctoral program milestones. METHOD: Using a brief case study, dimensional analysis was described as an interactionist method used to develop grounded theory and illustrate application of the method throughout a 3-year nursing PhD program. RESULTS: Nursing PhD students have the opportunity to drive the depth of their own scholarly development through engaging with theory, method, and independent inquiry. CONCLUSION: Dimensional analysis holds promise for scholars to simultaneously develop methodological skill, derive situation-specific theory, ground a program of research, and anchor that program of research with theory and method. [J Nurs Educ. 2023;62(2):112-115.].

"You have to trust yourself": The Overlooked Role of Self-Trust in Coping with Chronic Illness.

Self-trust is essential to the well-being of people with chronic illnesses and those who care for them. In this exploratory essay, we draw on a trove of health narratives to catalyze examination of this important but often overlooked topic. We explore how self-trust is impeded at both personal and structural levels, how it can best be nourished, and how it is related to self-advocacy. Because people's ability to trust themselves is intrinsically linked to the trust others have in them, we pay particular attention to the role that allies such as clinical professionals play in the development of self-trust, highlighting the importance of eliciting patient narratives, of curious listening, and of compassionately raising questions. We also contrast the self-trust paradigm with that of self-management, which tends to replace the former's attention to patients' experiences, abilities, qualities, or judgments with a professionally dominated discourse dedicated to addressing illness through behavior changes prescribed by clinicians. We close with a call to action, exhorting readers to focus on supporting self-trust in health care settings and on creative research in this critical yet heretofore underrepresented domain.

Gaps in benefits, awareness, and comprehension that leave those with long COVID vulnerable.

OBJECTIVES: The COVID-19 pandemic has left many suffering from long COVID, an episodic and debilitating chronic condition affecting people's ability to work and manage medical expenses. Though the Biden Administration has committed to conducting research and building support programs to alleviate the strain on those affected, in practice, static eligibility criteria for unemployment and disability benefits, patchy insurance coverage, and insufficient paid leave programs have left many people vulnerable. Given the magnitude of long COVID and the dearth to date of large-scale studies about its financial consequences, a focused qualitative analysis of lived experiences is warranted to understand and highlight gaps in the policy landscape. METHODS: We conducted in-depth semi-structured interviews from 2020 to 2022 with 25 people with experience of long COVID living predominately in the Midwest. RESULTS: Our inductive analysis revealed ways people became financially exhausted by uncertain medical care costs and precarious employment that left them trying, often alone, to access benefits. People described both experiences with workplace benefits and attempts to access federal benefits to address unstable employment situations created by protracted and uncertain functional impairments. DISCUSSION: We explore pre- and post-pandemic era unemployment, disability, and insurance policies and offer recommendations for better supporting people with long COVID.

Negotiation of collective and individual candidacy for long Covid healthcare in the early phases of the Covid-19 pandemic: Validated, diverted and rejected candidacy.

This analysis of people's accounts of establishing their need and experiences of healthcare for long Covid (LC) symptoms draws on interview data from five countries (UK, US, Netherlands, Canada, Australia) during the first ∼18 months of the Covid-19 pandemic when LC was an emerging, sometimes contested, condition with scant scientific or lay knowledge to guide patients and professionals in their sense-making of often bewildering constellations of symptoms. We extend the construct of candidacy to explore positive and (more often) negative experiences that patients reported in their quest to understand their symptoms and seek appropriate care. Candidacy usually considers how individuals negotiate healthcare access. We argue a crucial step preceding individual claims to candidacy is recognition of their condition through generation of collective candidacy. "Vanguard patients" collectively identified, named and fought for recognition of long Covid in the context of limited scientific knowledge and no established treatment pathways. This process was technologically accelerated via social media use. Patients commonly experienced "rejected" candidacy (feeling disbelieved, discounted/uncounted and abandoned, and that their suffering was invisible to the medical gaze and society). Patients who felt their candidacy was "validated" had more positive experiences; they appreciated being believed and recognition of their changed lives/bodies and uncertain futures. More positive healthcare encounters were described as a process of "co-experting" through which patient and healthcare professional collaborated in a joint quest towards a pathway to recovery. The findings underpin the importance of believing and learning from patient experience, particularly vanguard patients with new and emerging illnesses.

Talking about inequities: A comparative analysis of COVID-19 narratives in the UK, US, and Brazil.

Disproportionate mortality and morbidity burdens of the COVID-19 pandemic and coinciding media coverage of public acts of violence perpetrated against people of color in 2020 precipitated reckonings with structural inequities in global, national, and local contexts. This cross-country comparative analysis aims to describe how people voice and make sense race, racism, and privilege in their experiences with COVID-19 infection in the United States, United Kingdom, and Brazil. Anchored by continuous reflection on our individual and collective positionality, we conducted an inductive comparative analysis conceptually situated in intersectionality and critical race theory. Countries used a shared qualitative methodology to collect and analyze 166 narratives of people with experience of COVID-19 infection from 2020 to 2023. We selected 19 cases that illustrate cross-national differences in peoples' acknowledgment and narration of structural privilege and disadvantage in their observations of COVID-19 in their countries and in their personal experiences. People in the US had the most fluency with voicing race directly. In Brazil, while some respondents (especially younger people) demonstrated high racial consciousness, others struggled to identify and talk about racial relationships. In the UK, people voiced racial identifications, though often within white norms of politeness and an accompanying sense of discomfort. The findings overall illustrate moments the interview becomes or does not become a space for voicing social categories and systemic underpinnings of difference in COVID-19 infections and healthcare experiences. We reflect on cross-country differences in historical and contemporary racialized discourse and elaborate on implications of focusing on voicing in qualitative research.

Friendship in Adolescents and Young Adults With Experience of Cancer: A Dimensional Analysis.

BACKGROUND: Friendship is a complex social phenomenon important to human development, emotional health, and socialization. While making and maintaining peer friends are an emphasized task of adolescent and young adult development, the multidimensional experience of friendship is incompletely defined, particularly in the context of adolescents and young adults with cancer. OBJECTIVE: The aim of this study was to investigate the nature of friendship more deeply and completely by breaking down and then rebuilding meaning in this phenomenon. METHODS: The author searched 8 databases for relevant literature and conducted a dimensional analysis of the textual data from articles found in database searches and theoretical sampling. Dimensional analysis was an inductive process of determining all the components and attributes of the friendship concept. The author broke down and built up the meaningful units of friendship until a story of friendship in adolescents and young adults with experience of cancer emerged. RESULTS: Data from 80 empirical and theoretical articles published from 2013 to 2018 formed the literature base for this dimensional analysis. CONCLUSIONS: An explanatory matrix built from the perspective of "Time Marking" reveals contexts, conditions, processes, and consequences that together provide an explanation of the nature of friendship in this population. IMPLICATIONS FOR PRACTICE: This concept analysis, combined with the limitations of this inquiry, impels future empirical and theoretical research and implies preliminary clinical implications. In particular, the understanding of friendship as conceptually distinct from social support and the experience of friendships in narrative time suggest a need to reconceptualize supportive care services for adolescents and young adults who experience cancer.