Repenser le handicap : leçons du passé, questions pour l’avenir. Apports et limites du modèle social,de la sociologie des sciences et des techniques,de l’éthique du care

In this article, I analyze one evolution in disability research over the past 30 years: the shift from an individual to a social approach to disability. While most disability research has currently “socialized” disability or at the least situates disabled people within a social context, not all do so in the same way nor based on the same assumptions. They lead to different concepts of the person and society and different concepts of disability and normalcy. I analyze this evolution by looking at three approaches to disability: the social model, the approach taken in the sociology of science and technology, and the ethics of care. I show how each, by renewing the analysis of disability, has brought about changes for disabled people and transformed ways of “living together” and “making society”. I also show the limits of these approaches and propose lines of thought for the continuation of our research, notably around the question of autonomy. I propose that we rethink autonomy from the standpoint of the notion of “recalcitrance”.     

Principles of effective communication with patients who have intellectual disability among primary care physicians

ObjectiveExamine physicians’ implementation of effective communication principles with patients with intellectual disabilities (ID) and its predictors.MethodsFocus groups helped construct a quantitative questionnaire. The questionnaire (completed by 440 physicians) examined utilization of effective communication principles, attitudes toward individuals with ID, subjective knowledge and number of patients with ID.ResultsSubjective knowledge of ID and more patients with ID increased utilization of effective communication principles. Provision of knowledge that allows patients to make their own medical decisions was predicted by more patients with ID, lower attitudes that treatment of this population group is not desirable, less negative affect and greater perception that treatment of this group is part of the physician's role. Effective preparation of patients with ID for treatment was predicted by higher perception of treatment of this group as part of the physician's role, lower perception of this field as undesirable and higher perception of these individuals as unable to make their own choice. Simplification of information was predicted by a greater perception of treatment of this group as part of the physician's role and more negative affect.ConclusionGreater familiarity may enhance care for these patients.Practice implicationsIncrease exposure to patients with ID within training.     

Communication behaviors and patient autonomy in hospital care: A qualitative study

BackgroundLittle is known about how hospitalized patients share decisions with physicians.MethodsWe conducted an observational study of patient-doctor communication on an inpatient medicine service among 18 hospitalized patients and 9 physicians. A research assistant (RA) approached newly hospitalized patients and their physicians before morning rounds and obtained consent. The RA audio recorded morning rounds, and then separately interviewed both patient and physician. Coding was done using integrated analysis.ResultsMost patients were white (61%) and half were female. Most physicians were male (66%) and of Southeast Asian descent (66%). All physicians explained the plan of care to the patients; most believed that their patient understood. However, many patients did not. Physicians rarely asked the patient for their opinion. In all those cases, the decision had been made previously by the doctors. No decisions were made with the patient. Patients sometimes disagreed.ConclusionsShared decision-making may not be the norm in hospital care. Although physicians do explain treatment plans, many hospitalized patients do not understand enough to share in decisions. When patients do assert their opinion, it can result in conflict.Practice implicationsSome hospitalized patients are interested in discussing treatment. Improving hospital communication can foster patient autonomy.     

Interacting institutional logics in general dental practice

We investigate the organisational field of general dental practice and how agents change or maintain the institution of values associated with the everyday work of health care provision. Our dataset comprise archival literature and policy documents, interview data from field level actors, as well as service delivery level interview data and secondary data gathered (2011–12) from 16 English dental practices. Our analysis provides a typology of institutional logics (prevailing systems of value) experienced in the field of dental practice. Confirming current literature, we find two logics dominate how care is assessed: business-like health care and medical professionalism. We advance the literature by finding the business-like health care logic further distinguished by values of commercialism on the one hand and those of accountability and procedural diligence on the other. The logic of professionalism we also find is further distinguished into a commitment to clinical expertise and independence in delivering patient care on the one hand, and concerns for the autonomy and sustainability of a business enterprise on the other.     

Les enjeux de l’autonomisation de jeunes adultes confrontés à des troubles psychiques

In this paper, we offer to describe and analyze the social uses of the notion of autonomy in the life courses of young adults facing psychic disorders. We will rely on a three-year long longitudinal survey that was conducted in the context of a sociology thesis with 21 young adults treated in psychiatric and medico-social institutions. We will describe in what manner issues relating to these young users’ commitment in the support put in place around them emerge amongst differentiated or shared representations of autonomy.     

Sociotropic and Autonomous Personality and Stressful Life Events as Predictors of Depressive Symptoms in the Postpartum Period

Measures of stressful life events, sociotropic and autonomous personality, and depressive symptoms were completed by 76 women in the last trimester of pregnancy and 8-weeks postpartum. During pregnancy, women with strong sociotropic or autonomous personality style, or high levels of negative life events (or perceived loss resulting from events) in sociotropic or autonomous domains, tended to report higher levels of depressive symptoms. Cross-sectionally, there was some support for the cognitive diathesis-stress model, but not a congruency model, of depression. Longitudinal results indicated that high levels of sociotropic personality style, sociotropic loss, or autonomous loss resulting from events significantly predicted increases in depressive symptoms from pregnancy to the postpartum period. The interaction between personality styles and life events did not predict depressive symptoms longitudinally, either congruently or incongruently. Negative automatic thoughts mediated the direct effects of personality and life events upon depressive symptoms.     

Perceived Participation and Its Correlates Among First-Stroke Survivors at Six Months After Discharge From a Tertiary Hospital in China

Objectives

To describe perceived participation of first-stroke survivors in mainland China, and to determine variables that may correlate with perceived participation 6 months after discharge.