‘A real fine balancing act’: a secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting
‘A real fine balancing act’: a secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting
Aims: Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer. Design: Secondary qualitative analysis of a focused ethnographic study. Data Sources: In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison. Results: The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals. Conclusion: The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making. Implications for the Profession and/or Patient Care: We recommend incorporating the principles of personalized care to achieve more equitable power relations, reduce health inequalities and ensure that cancer treatment offered to people with dementia is safe and appropriate. Reporting Method: EQUATOR (COREQ) guidelines have been used for reporting. Patient or Public Contribution: Patients and the public were involved in designing the original research questions and the study protocol including documentation such as interview topic guides and participant information sheets.
agency, cancer, dementia, discourse, power, shared decision making
2980-2991
Farrington, Naomi
c2b8ed92-eeb9-4f7b-9ca3-6beca26f8f19
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
August 2023
Farrington, Naomi
c2b8ed92-eeb9-4f7b-9ca3-6beca26f8f19
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Bridges, Jackie
57e80ebe-ee5f-4219-9bbc-43215e8363cd
Farrington, Naomi, Richardson, Alison and Bridges, Jackie
(2023)
‘A real fine balancing act’: a secondary qualitative analysis of power imbalance in comorbid cancer and dementia in an outpatient treatment setting.
Journal of Advanced Nursing, 79 (8), .
(doi:10.1111/jan.15629).
Abstract
Aims: Studies of health services reveal a focus on provision of scheduled care at the expense of patient need, placing the health service in a position of power and the patient as passive recipient. This secondary qualitative analysis of a focused ethnography draws on the Foucauldian concept of power as pervasive and relational, to examine how an imbalance of power is manifested in situations where people with both cancer and dementia are being treated for cancer. Design: Secondary qualitative analysis of a focused ethnographic study. Data Sources: In the original study, qualitative data were gathered from observation and interviews with people with cancer and dementia (n = 2), caregivers (n = 7) and staff (n = 20). The study was conducted in the outpatient departments of two teaching hospitals in England between January 2019 and July 2021. Data from all sources were analysed for this secondary analysis using constant comparison. Results: The principal theme was balance, encapsulating the competing priorities involved in delivering cancer treatment. There was tension between maintaining safety and ensuring an individual's right to treatment, and difficulty reconciling the needs of the system with the needs of individuals. Conclusion: The pervasive nature of power can be harnessed to enhance the agency of people with cancer and dementia by incorporating principles of shared decision making. Implications for the Profession and/or Patient Care: We recommend incorporating the principles of personalized care to achieve more equitable power relations, reduce health inequalities and ensure that cancer treatment offered to people with dementia is safe and appropriate. Reporting Method: EQUATOR (COREQ) guidelines have been used for reporting. Patient or Public Contribution: Patients and the public were involved in designing the original research questions and the study protocol including documentation such as interview topic guides and participant information sheets.
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Power_and_SDM_JAN Authors copy
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More information
Accepted/In Press date: 22 February 2023
e-pub ahead of print date: 16 March 2023
Published date: August 2023
Additional Information:
Funding Information:
Naomi Farrington is funded by a NIHR Clinical Lectureship (ICA‐CL‐2015–01‐003). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Publisher Copyright:
© 2023 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.
Keywords:
agency, cancer, dementia, discourse, power, shared decision making
Identifiers
Local EPrints ID: 476034
URI: http://eprints.soton.ac.uk/id/eprint/476034
ISSN: 0309-2402
PURE UUID: 4de65dbe-5041-4cc0-bcc1-31c9002b255d
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Date deposited: 04 Apr 2023 16:54
Last modified: 06 Jun 2024 01:49
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Naomi Farrington
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