No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Decision-making about motherhood in Canadian women living with HIV: a negotiation of multidimensional risks
Abstract
Little research in Canada has examined the perspectives of women living with HIV on decision-making across the stages of motherhood. In 2004-2005, semi-structured interviews were conducted with 42 African, Caucasian and Haitian HIV-positive women recruited in Montreal. All were or wished to be biological mothers. Transcripts underwent thematic analysis organised by three culturally informed models of motherhood described by the participants, which influenced decision-making and perceived risks. For women who saw motherhood as 'self-fulfilment and completeness', vertical HIV transmission was a primary concern. It threatened their identity as a 'good mother', which also meant adhering to antiretrovirals. For women who viewed motherhood as a 'social realisation' (all African or Haitian), fears of compromised fertility dominated. Not becoming pregnant threatened their social status and presumed health within their community. Antiretrovirals were abandoned after delivery, fearing they would reveal their HIV status. For women endorsing a 'personal growth' model of motherhood (all Caucasian), threats to personal health were paramount. Pregnancy meant purifying body and soul. Antiretrovirals, seen as pollutants, were stopped after delivery. These findings can inform current research and sensitise health providers to the complex biological, psychological, social and spiritual risks that HIV-positive women negotiate in motherhood-related decision-making, towards more patient-centred care.
ResearchGate has not been able to resolve any citations for this publication.
Background:
Women comprise nearly one-quarter of people living with human immunodeficiency virus (HIV) in Canada. Compared with men, women living with HIV experience inequities in HIV care and health outcomes, prompting a need for gendered and tailored approaches to HIV care.
Method:
Peer and academic researchers from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study conducted focus groups to understand women's experience of seeking care, with the purpose of identifying key characteristics that define a women-centered approach to HIV care. Eleven focus groups were conducted with 77 women living with HIV across Quebec, Ontario, and British Columbia, Canada.
Results:
Women envisioned three central characteristics of women-centered HIV care, including i) coordinated and integrated services that address both HIV and women's health care priorities, and protect against exclusion from care due to HIV-related stigma, ii) care that recognizes and responds to structural barriers that limit women's access to care, such as violence, poverty, motherhood, HIV-related stigma, and challenges to safe disclosure, and iii) care that fosters peer support and peer leadership in its design and delivery to honor the diversity of women's experiences, overcome women's isolation, and prioritize women's ownership over the decisions that affect their lives.
Conclusion:
Despite advances in HIV treatment and care, the current care landscape is inadequate to meet women's comprehensive care needs. A women-centered approach to HIV care, as envisioned by women living with HIV, is central to guiding policy and practice to improve care and outcomes for women living with HIV in Canada.
The increased access to effective antiretroviral treatment (ART) has made HIV comparable to a chronic disease in terms of life expectancy. Needs related to sexuality and reproduction are central to overall health and well-being. An interpretative meta-synthesis was performed to synthesize and assess how HIV-positive women's experiences of sexuality and reproduction have been described in qualitative studies. A total of 18 peer-reviewed qualitative studies were included, which comprised a total of 588 HIV-positive interviewed women. The studies originated from resource-rich countries outside the Asian and African continents. The analysis, resulting in a lines-of-argument synthesis, shows that HIV infection was a burden in relation to sexuality and reproduction. The weight of the burden could be heavier or lighter. Conditions making the HIV burden heavier were: HIV as a barrier, feelings of fear and loss, whereas motherhood, spiritual beliefs, and supportive relationships made the HIV burden lighter. The findings are important in developing optimal health care by addressing conditions making the burden of HIV infection lighter to bear. In future research there is a need to focus not only on examining how HIV-positive women's sexual and relationships manifest themselves, but also on how health care professionals should provide adequate support to the women in relation to sexuality and reproduction.
Having children is a growing reality for women living with HIV in Canada. It is imperative to understand and respond to women's unique experiences and psychosocial challenges during pregnancy and as mothers including HIV-related stigma. This qualitative study used a narrative methodological approach to understand women's experiences of HIV-related stigma as they navigate health services in pregnancy (n = 66) and early postpartum (n = 64). Narratives of women living with HIV expose the spaces where stigmatizing practices emerge as women seek perinatal care and support, as well as highlight the relationship between HIV-related stigma and disclosure, and the impact this has on women's pregnancy and birthing experiences.
Research on pregnancy termination largely assumes HIV status is the only reason why HIV-positive women contemplate abortion. As antiretroviral treatment (ART) becomes increasingly available and women are living longer, healthier lives, the time has come to consider the influence of other factors on HIV-positive women's reproductive decision-making. Because ART has been free and universally available to Brazilians for more than two decades, Brazil provides a unique context in which to explore these issues. A total of 25 semi-structured interviews exploring women's pregnancy termination decision-making were conducted with women receiving care at the Reference Centre for HIV/AIDS in Salvador, Brazil. Interviews were transcribed, translated into English and coded for analysis. HIV played different roles in women's decision-making. In all, 13 HIV-positive women did not consider terminating their pregnancy. Influential factors described by those who did consider terminating their pregnancy included fear of HIV transmission, fear of HIV-related stigma, family size, economic constraints, partner and provider influence, as well as lack of access to pregnancy termination services and abortifacients. For some HIV-positive women in Brazil, HIV can be the only reason to consider terminating a pregnancy, but other factors are significant. A thorough understanding of all variables affecting reproductive decision-making is necessary for enhancing services and policies and better meeting the needs and rights of HIV-positive women.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Introduction
The increasing proportion of women living with HIV has evoked calls for tailored services that respond to women's specific needs. The objective of this investigation was to explore the concept of women-specific HIV/AIDS services to identify and define what key elements underlie this approach to care.
Methods
A comprehensive review was conducted using online databases (CSA Social Service Abstracts, OvidSP, Proquest, Psycinfo, PubMed, CINAHL), augmented with a search for grey literature. In total, 84 articles were retrieved and 30 were included for a full review. Of these 30, 15 were specific to HIV/AIDS, 11 for mental health and addictions and four stemmed from other disciplines.
Results and discussion
The review demonstrated the absence of a consensual definition of women-specific HIV/AIDS services in the literature. We distilled this concept into its defining features and 12 additional dimensions (1) creating an atmosphere of safety, respect and acceptance; (2) facilitating communication and interaction among peers; (3) involving women in the planning, delivery and evaluation of services; (4) providing self-determination opportunities; (5) providing tailored programming for women; (6) facilitating meaningful access to care through the provision of social and supportive services; (7) facilitating access to women-specific and culturally sensitive information; (8) considering family as the unit of intervention; (9) providing multidisciplinary integration and coordination of a comprehensive array of services; (10) meeting women “where they are”; (11) providing gender-, culture- and HIV-sensitive training to health and social care providers; and (12) conducting gendered HIV/AIDS research.
Conclusions
This review highlights that the concept of women-specific HIV/AIDS services is a complex and multidimensional one that has been shaped by diverse theoretical perspectives. Further research is needed to better understand this emerging concept and ultimately assess the effectiveness of women-specific services on HIV-positive women's health outcomes.
Prevention of vertical HIV transmission has evolved significantly in Canada over the last two decades. The aim of this analysis is to describe the surveillance programme used, rate of vertical HIV transmission and changing epidemiology of HIV-affected pregnancies in Canada.
National perinatal HIV surveillance programme.
From 1990, annual retrospective data was collected on demographic and clinical characteristics of HIV-infected mothers and their infants referred to 22 participating sites across Canada either before/during pregnancy or within 3 months after delivery. Factors impacting HIV transmission and demographic features were explored.
Two thousand, six hundred and ninety-two mother-infant pairs were identified. The overall rate of vertical HIV transmission was 5.2%, declining to 2.9% since 1997. The rate of transmission for mothers who received HAART was 1%, and 0.4% if more than 4 weeks of HAART was given. Forty percent of women delivered by caesarean section, with no difference in transmission rate compared with vaginal delivery for women treated with HAART (1.4 vs. 0.6%, P = 0.129) but significant risk reduction for those who did not receive HAART (3.8 vs. 10.3%, P = 0.016). Black women were the largest group; proportions of black and aboriginal women increased significantly over time (P < 0.001 for both). Heterosexual contact was the most common risk category for maternal infection (65%), followed by injection drug use (IDU) (25%).
Vertical HIV transmission in Canada has decreased dramatically for women treated with HAART therapy. All pregnant women should be evaluated for HIV infection and programmes expanded to reach vulnerable populations including aboriginal, immigrant and IDU women.
We examined the variables associated with HIV stigma in HIV-positive women currently living in Ontario, Canada. Based on previous literature, we predicted that variables of social marginalization (e.g., ethnicity, income, education), medical variables (e.g., higher CD4 count, lower viral load), and increased psychological distress would be associated with higher perceived HIV stigma among HIV-positive women. One hundred fifty-nine HIV-positive women between the ages of 18 and 52 in Ontario completed self-report measures of the aforementioned variables. Women were recruited through 28 AIDS service organizations, eight HIV clinics, and two community health centers. In multiple regression analyses, for women born in Canada, lower educational level and higher anxiety were associated with higher HIV stigma. For women born outside of Canada, having been judged by a physician in Canada for trying to become pregnant was associated with higher HIV stigma. For HIV-positive women born outside of Canada, negative judgment by a physician regarding intentions to become pregnant should be addressed to reduce perceived HIV stigma and vice versa. Health care providers should be trained in the provision of sensitive and effective health care for women living with HIV, especially when providing reproductive health care.
The purpose of this study was to examine the self-reported reasons that people living with HIV (PLWH) provide to support their autonomous (i.e., against medical advice) decisions not to take, or to stop taking, highly active antiretroviral therapy (HAART). A further purpose of this study was to examine physicians' reactions to their patients' autonomous decisions and to examine physicians' conceptualization of compliance.
Semi structured interviews were conducted with 11 PLWH (5 male, 6 female) and their 8 HIV-care providers (4 male, 4 female). Interviews were analysed qualitatively using thematic coding. Patients also completed sociodemographic and medical information questionnaires. Interrater reliability was also calculated on patients' reasons supporting their decisions with coefficients ranging from .84 to 1.00 (all ps <.01).
For all 11 patients, preservation of quality of life and critical attitudes toward allopathic medicine were identified as reasons supporting autonomous decisions to refuse HAART. In addition, 10 patients cited the prior experience of, or the anticipated fear of, side-effects as central to their decision. Nine patients articulated their preference for alternative medicine and five patients expressed moral objections as significant reasons underlying their decisions. Gender differences emerged in care providers' conceptualization of compliance. Female care providers tended to view compliance as a collaboration between patient and care provider whereas male physicians tended to view compliance more as the patients' capacity to adhere to the prescribed HAART-regimen. Physician response strategies to patients' autonomous decision to refuse HAART were characterized as coercive or not. Neither the physicians' conceptualization of compliance nor their response strategies were consistent with the patients' perspective. In contrast, the central component of the patients' decision making was the patients' subjective view of the benefit they would derive from HAART.
The results of this study provide some initial evidence that health care providers integrate recommendations for HAART with patients concerns for their own quality of life and make these recommendations within the context of the patients' worldview. In addition, these results suggest that traditional views of compliance, that emphasize obedience to physician prescriptions, may be inadequate in this regard. Rather, these results suggest that a theory of compliance that is based upon collaboration between physician and patient will allow for a consideration of patients' subjective views, their worldview, and their health care beliefs.
Objective:
The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist Canadians affected by HIV with their fertility, preconception, and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible and take into account diverse and intersecting local/population needs based on the social determinants of health.
Intended outcomes:
EVIDENCE: Literature searches were conducted by a librarian using the Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase databases for published articles in English and French related to HIV and pregnancy and HIV and pregnancy planning for each section of the guidelines. The full search strategy is available upon request.
Values:
The evidence obtained was reviewed and evaluated by the Infectious Diseases Committee of the SOGC under the leadership of the principal authors, and recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines.
Benefits, harms, and costs:
Guideline implementation should assist the practitioner in developing an evidence-based approach for the prevention of unplanned pregnancy, preconception, fertility, and pregnancy planning counselling in the context of HIV infection.
Validation:
These guidelines have been reviewed and approved by the Infectious Disease Committee and the Executive and Council of the SOGC.
Sponsor:
Canadian Institutes of Health Research Grant Planning and Dissemination grant (Funding Reference # 137186), which funded a Development Team meeting in 2016.
Recommendations:
Aims and objectives:
To investigate the relationship between fertility decisions, to have already had a child or to desire to have one in the future, and the prognostic factors of; access to antiretrovirals, the time since these became widely available (year of the study) and relationship status.
Background:
There have been significant advances in the treatment of Human Immunodeficiency Virus (HIV) with the advent of antiretroviral therapy which has been used to successfully reduce the rate of mother to child transmission; leading researchers to hypothesise that HIV positive women may desire to have children more so now than in the past. However, this topic is often not discussed in healthcare consultations.
Methods:
A systematic search was conducted on CINAHL and Medline, using the key terms 'fertility decisions' and 'HIV positive'. A meta-analysis of proportions and a meta-regression were conducted using a random effects model and a logit transformation to normalise the data. Heterogeneity was assessed using Q, I(2) and R(2) values and p-values were produced for each regressed variable.
Findings:
There was no statistically significant relationship between a desire to have children in the future and any of the prognostic variables. Although, there were statistically significant relationships between already having had at least one child; being on antiretroviral therapy; wanting a child in the future; and being in a cohabiting partnership or marriage.
Conclusion:
There are no reliable prognostic variables which can be used to predict fertility intentions in HIV positive women. There are, however, a significant proportion of women who wish to have children or who have already had children and are in need of reproductive counselling from their healthcare providers.
Relevance to clinical practice:
A greater knowledge of factors which may influence reproductive decisions amongst HIV positive position will allow healthcare professionals to individualise the care they provide. This article is protected by copyright. All rights reserved.
HIV-related stigmatization is associated with a number of adverse consequences among HIV-positive individuals. Given the direct role healthcare providers play in promoting and maintaining the overall health of HIV-positive individuals, it is important to understand the extent to which stigmatization among healthcare providers exists and the potential effects that such negative attitudes and behavior may have on the well-being of HIV-positive patients. This chapter provides a review of the literature on stigmatization among healthcare providers, with a focus on studies that report information on stigmatizing healthcare experiences from the patient's perspective. We describe the potential effects of stigmatization on the well-being of HIV-positive patients, offer a methodological critique of the existing literature, and provide directions for future research and training interventions. Overall, findings confirm that HIV-positive patients experience stigmatization within healthcare settings in the form of negative demeanor from providers, as well as more overt examples, including patient avoidance, lowered quality of care, and treatment refusal. Review findings also confirm that provider stigmatization remains a concern for HIV-positive patients and may exert negative effects on medical care. In reviewing the literature, we suggest directions for research that informs the development of interventions to assist healthcare providers and HIV-positive patients in creating more positive treatment experiences and health outcomes. © Springer Science+Business Media Dordrecht 2013. All rights are reserved.
The social amplification of risk framework (SARF) is the most comprehensive tool available for the study of risk. Theories and frameworks are useful and effective only insofar as they conform to certain fundamental features of logic: clearly defined terms, coherence, internal consistency, sound organization explicated with parsimony, accompanied by a specification of scope conditions, and the generation of testable hypotheses. The first goal of this chapter is to evaluate critically key foundational concepts of the SARF and to strengthen its foundation with a set of metatheoretical principles that have been coherently structured. The second goal is to use these same metatheoretical principles to establish symmetry between SARF and risk policy. Such symmetry should enhance communication between experts and laypersons in the development of risk policy and, therefore, remove some of the obstacles to effective, democratic risk policy. Genesis of the social amplification of risk framework The SARF developed in the late 1980s in response to the emergence of multiple perspectives in the rapidly growing risk literature. The multiple perspectives that emerged led, according to Kasperson (1992) one of the leading architects of the SARF, to key disjunctures which came to dominate the field: disjunctures between technical and social analyses of risk; disjunctures within the social sciences themselves (e.g. between the rational actor perspective (RAP) of economics and engineering and the psychometric paradigm; see also Jaeger et al. 2001); disjunctures between the older natural hazards social science and the newer technological hazard social sciences; and disjunctures over scientific and other claims to knowledge.
Objective:
This guideline reviews the evidence relating to the care of pregnant women living with HIV and the prevention of perinatal HIV transmission. Prenatal care of pregnancies complicated by HIV infection should include monitoring by a multidisciplinary team with experts in this area.
Outcomes:
OUTCOMES evaluated include the impact of HIV on pregnancy outcome and the efficacy and safety of antiretroviral therapy and other measures to decrease the risk of vertical transmission.
Evidence:
Published literature was retrieved through searches of PubMed and The Cochrane Library in 2012 and 2013 using appropriate controlled vocabulary (HIV, anti-retroviral agents, pregnancy, delivery) and key words (HIV, pregnancy, antiretroviral agents, vertical transmission, perinatal transmission). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English or French. There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to June 2013. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
Values:
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table 1).
Background: Patient-centered care that encompasses informed decision making can improve treatment choice, quality of care and outcomes. Patient-centered care recognizes the need for major changes in the process of care that arranges health care system around the patient. Objective: Study objective was to evaluate and discuss the interplay of components of patient-centered care by developing a conceptual model of patient-centered care. Methods: Comprehensive literature review was conducted using Medline, CINAHL, and Cochrane databases. Included were English language studies addressing issues related to patient-centered-care and patient reported outcomes. Results: Though the concept of patient-centered care emerged in the early 50s, it exploded in the health care research policy arena exponentially in the late nineties. The conceptual model described here can aid objective and subjective evaluation of patient-centered care. As we strive to improve the quality of care, patient-centered care can play a pivotal role in this process. This however requires changes in our healthcare system so as to improve overall quality of care by minimizing wasteful health resource consumption. Conclusions: With healthcare costs projected to continue their rapid increase, the current paradigm of healthcare is unsustainable. More research is needed to explore the various attributes of patient-centered care, its acceptability, and comparative effectiveness in the healthcare arena.
Despite the growing number of women living with and affected by HIV, there is still insufficient attention to their pregnancy-related needs, rights, decisions and desires in research, policy and programs. We carried out a review of the literature to ascertain the current state of knowledge and highlight areas requiring further attention. We found that contraceptive options for pregnancy prevention by HIV-positive women are insufficient: condoms are not always available or acceptable, and other options are limited by affordability, availability or efficacy. Further, coerced sterilization of women living with HIV is widely reported. Information gaps persist in relation to effectiveness, safety and best practices regarding assisted reproductive technologies. Attention to neonatal outcomes generally outweighs attention to the health of women before, during and after pregnancy. Access to safe abortion and post-abortion care services, which are critical to women's ability to fulfill their sexual and reproductive rights, are often curtailed. There is inadequate attention to HIV-positive sex workers, injecting drug users and adolescents. The many challenges that women living with HIV encounter in their interactions with sexual and reproductive health services shape their pregnancy decisions. It is critical that HIV-positive women be more involved in the design and implementation of research, policies and programs related to their pregnancy-related needs and rights.
Objective:
Four main clinical issues need to be considered for HIV-positive individuals and couples with respect to pregnancy planning and counselling: (1) pre-conceptional health; (2) transmission from mother to infant, which has been significantly reduced by combined antiretroviral therapy; (3) transmission between partners during conception, which requires different prevention and treatment strategies depending on the status and needs of those involved; and (4) management of infertility issues. The objective of the Canadian HIV Pregnancy Planning Guidelines is to provide clinical information and recommendations for health care providers to assist HIV-positive individuals and couples with their fertility and pregnancy planning decisions. These guidelines are evidence- and community-based and flexible, and they take into account diverse and intersecting local/population needs and the social determinants of health.
Outcomes:
Intended outcomes are (1) reduction of risk of vertical transmission and horizontal transmission of HIV, (2) improvement of maternal and infant health outcomes in the presence of HIV, (3) reduction of the stigma associated with pregnancy and HIV, and (4) increased access to pregnancy planning and fertility services.
Evidence:
PubMed and Medline were searched for articles published in English or French to December 20, 2010, using the following terms: "HIV" and "pregnancy" or "pregnancy planning" or "fertility" or "reproduction" or "infertility" or "parenthood" or "insemination" or "artificial insemination" or "sperm washing" or "IVF" or "ICSI" or "IUI." Other search terms included "HIV" and "horizontal transmission" or "sexual transmission" or "serodiscordant." The following conference databases were also searched: Conference on Retroviruses and Opportunistic Infections, International AIDS Conference, International AIDS Society, Interscience Conference on Antimicrobial Agents and Chemotherapy, the Canadian Association of HIV/AIDS Research, and the Ontario HIV Treatment Network Research Conference. Finally, a hand search of key journals and conferences was performed, and references of retrieved articles were reviewed for additional citations. Subsequently, abstracts were categorized according to their primary topic (based on an outline of the guidelines) into table format with the following headings: author, title, study purpose, participants, results and general comments. Finally, experts in the field were consulted for their opinions as to whether any articles were missed.
Values:
The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. Recommendations for practice were ranked according to the method described in that report (Table) and through use of the Appraisal of Guidelines Research and Evaluation instrument for the development of clinical guidelines.
Sponsors:
The Society of Obstetricians and Gynaecologists of Canada, Women and HIV Research Program, Women's College Research Institute, Women's College Hospital, University of Toronto, Abbott Laboratories Canada, the Ontario HIV Treatment Network, the Canadian Institutes of Health Research, and the Canadian HIV Trials Network. KEY POINTS AND RECOMMENDATIONS: HIV-positive people who are considering pregnancy should be counselled on the following issues so they can make an informed decision.
The number of women living with HIV continues to increase globally. With the availability of efficacious antiretroviral therapy, there is a pressing need to ensure women are treated effectively throughout their life course. This article reviews information on ways that HIV affects women and discusses recent treatment and prevention approaches.
Because women are at greater risk of heterosexual HIV acquisition than men, new data on biomedical approaches to prevention are of particular relevance. International guidelines for the treatment of pregnant women with HIV now place greater weight on the well being of the mother as well as the prevention of vertical transmission. Although effective HIV treatment for women is associated with better health, longer life, reduced infectiousness and prevention of acquisition of HIV, there is evidence that women experience more adverse effects, discontinue medication more frequently and have more problems with adherence than men.
Efficacious anti-HIV drugs exist, but the particular circumstances for women may compromise their effectiveness. Globally, women's access to therapy remains inadequate. More data are needed about the best approaches to HIV therapy for women to include the biological, psychological, social and cultural factors that influence the way women experience HIV infection.
La procréation dans le contexte du VIH s'est-elle banalisée depuis que le taux de transmission verticale est réduit à moins de 2% ? L'analyse des perceptions de couples montre que ce risque est toujours un objet d'inquiétude, d'autant plus qu'il semble multidimensionnel car souvent indissociable d'un risque horizontal de transmission au partenaire ; de plus, s'y est ajouté le risque iatrogène. Dans ce domaine, les médecins revendiquent un rôle d'information objective sans être directifs. Les femmes perçoivent clairement la distinction entre un jugement, qu'elles réfutent, et un avis, qu'elles acceptent ou parfois qu'elles recherchent. Certaines d'entre elles appliquent les propositions de leur médecin ; d'autres suivent partiellement l'avis et adaptent leur projet ; d'autres mettent en œuvre des stratégies diverses pour contourner l'avis médical. Dans tous les cas, la charge de rationalisation et d'inquiétude associée à la procréation et les enjeux qui lui sont associés laissent penser qu'elle n'est pas banalisée.
Medical literature has increasingly emphasized the need to observe patients' autonomy; however, not all experts agree with this principle. This discord is based on varying credence between the concepts of autonomy and beneficence. In critically ill patients, this conflict involves the patient's family and creates a particular family-physician relationship. The purpose of this review is to assess the evidence on medical decision making and the family-physician relationship.
The many studies published on this topic reveal that people's preferences around the medical decision-making process vary substantially. Although it is clear that a shared decision approach is popular and desirable to some, it is not universally favored; some patients prefer to leave final treatment decisions up to the doctor. This finding shows a robust moral pluralism, which requires special attention in multicultural societies. For critically ill patients, the diversity of opinion extends to the family, which creates a complex family-physician dynamic and necessitates utilization of particular interaction strategies.
Clinicians must understand the range of preferences in a society and should offer the opportunity to participate in treatment by sharing decision-making responsibility. This would involve assessing the preferences of patients and their families in order to provide care accordingly. Clinicians should then ensure proper information is provided for informed decision making and minimize factors that could have potential adverse effect.
This article considers some implications of the new health consciousness and movements--holistic health and self-care--for the definition of and solution to problems related to "health." Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being.
A 'patient-centred' approach is increasingly regarded as crucial for the delivery of high quality care by doctors. However, there is considerable ambiguity concerning the exact meaning of the term and the optimum method of measuring the process and outcomes of patient-centred care. This paper reviews the conceptual and empirical literature in order to develop a model of the various aspects of the doctor-patient relationship encompassed by the concept of 'patient-centredness' and to assess the advantages and disadvantages of alternative methods of measurement. Five conceptual dimensions are identified: biopsychosocial perspective; 'patient-as-person'; sharing power and responsibility; therapeutic alliance; and 'doctor-as-person'. Two main approaches to measurement are evaluated: self-report instruments and external observation methods. A number of recommendations concerning the measurement of patient-centredness are made.
La Fécondité En Milieu Agni Traditionnel Et Urbain
- Y Boa Asso
Boa Asso, Y. 1982. "La Fécondité En Milieu Agni Traditionnel Et Urbain. " Master diss., Université Abidjan.
HIV in Canada -Supplementary Tables
- A C Bourgeois
- M Edmunds
- A Awan
- L Jonah
- O Varsaneux
- W Siu
Bourgeois, A.C., M. Edmunds, A. Awan, L. Jonah, O. Varsaneux, and W. Siu. 2017. "HIV in Canada -Supplementary Tables, 2016. " Canada Communicable Disease Report 43 (12): 248-256.
L'institution de la maternité
- D Damant
- M.-E Chartré
- S Lapierre
Damant, D., M.-E. Chartré, and S. Lapierre. 2012. "L'institution de la maternité. " In Regards critiques sur la
maternité dans divers contextes sociaux, edited by S. Lapierre and D. Daman, 5-17. Montreal, Canada:
Presse de l'Université du Québec.
Motherhood and HIV: Stigma, Disclosure and Educational Opportunities
- L Hunter
- B Longhurst
Hunter, L., and B. Longhurst. 2013. "Motherhood and HIV: Stigma, Disclosure and Educational
Opportunities. " Journal of the Motherhood Initiative 4 (1): 168-184.
Supporting Mothers in Ways That Work: A Resource Toolkit for Service Providers Working with Mothers Living with HIV
- P Khosla
- A Ion
- S Greene
Khosla, P., A. Ion, and S. Greene. 2016. Supporting Mothers in Ways That Work: A Resource Toolkit for Service
Providers Working with Mothers Living with HIV. Hamilton, ON: The HIV Mothering Study Team and
the Ontario Women's HIV/AIDS Initiative.
Silent Voices of the HIV/AIDS Epidemic: African and Caribbean Women Research Study
- E Tharao
- N Massaquoi
- S Teclom
Tharao, E., N. Massaquoi, and S. Teclom. 2006. Silent Voices of the HIV/AIDS Epidemic: African and
Caribbean Women Research Study (2002-2004). Toronto ON: Women's Health in Women's Hands
Community Health Centre.
Contributions de la maternité à l'état de santé de femmes vivant avec le VIH
- I Toupin
Toupin, I. 2015. "Contributions de la maternité à l'état de santé de femmes vivant avec le VIH. " PhD
diss., Université de Montréal.