Patients’ autonomy as a negotiated order: an ethnographic perspective on the clinical management of childhood obesity

The principle of patients’ autonomy has assumed a central place in healthcare. Patients are encouraged to play an active role in the management of their health, especially when they are affected by chronic illnesses that require long‐term follow‐up. In this article, we analyse patients’ and professionals’ conceptions of patients’ autonomy in the context of childhood obesity management. Based on the results of an ethnographic study that we conducted within a paediatric hospital in French‐speaking Switzerland, we put into perspective the discourses that professionals, parents and children construct around their experiences of the therapy. Our study reveals that the conceptions that these three different actors have of patients’ autonomy converge on several points, but they also diverge on many others. While the rise of autonomy in healthcare has mostly been analysed as a form of empowerment of patients, our results show that this principle also introduces new forms of social control over patients’ lives, and it creates new tensions for patients who are unable to match with the normative expectations of professionals in terms of self‐management and self‐care.     

从临终关怀的角度看预先指示

预先指示是指有决定能力的患者对自身将来丧失表意能力时接受何种医疗照护而事先做出的一种安排和指示。预先指示在国外随着临终关怀的发展而出现，在当前中国的文化背景下，其应用和发展也更具有现实意义。     

Trading autonomy for services: Perceptions of users and providers of services for disabled people in Iceland

This paper adopts a critical theory perspective, aligning itself with a growing body of critical disability research in Iceland. It draws attention to the importance of ensuring that the rights of disabled people to autonomy and independence enshrined in the CRPD are respected and upheld in the implementation of all service models, including “traditional” services. The paper draws on 22 interviews with disabled people and service providers in Iceland. Both groups reveal that they perceive there to be a limit to the autonomy of the user embedded in the concept of services provided by public authorities. The findings are examined in a theoretical context, concluding that the concept of services must be redefined to fully include the perspectives of disabled people if the autonomy and independence envisioned in the CRPD is to be achieved, particularly until such time that personalized services are realized for all.     

Parents with high levels of communicative and critical health literacy are less likely to vaccinate their children

ObjectiveTo investigate the relationship between parents’ health literacy and decision-making regarding child vaccinations.MethodsA cross-sectional survey was conducted among 731 parents of children aged 3–4 years. Functional, communicative, and critical health literacy (HL), knowledge, beliefs, reliability of the vaccine’s information resources, and vaccine's attitudes were measured. Attitudes included three types: pro-vaccine attitudes, anti-vaccine attitudes, and attitudes regarding mandatory vaccination. Path analysis was conducted to explore direct and indirect associations of compliance with childhood vaccinations and HL.ResultsCommunicative HL has a significant negative direct association with compliance with vaccinations (ß = − 0.06, p < 0.05). High functional and critical HL have significant negative indirect associations with vaccinations through parents’ attitudes regarding vaccines. Higher levels of perception of reliability of informal information resources are associated with non-compliance.ConclusionsThe results indicate that parents with high functional, communicative, and critical HL are more at risk of not vaccinating their children. The results are contrary to expectations in which people with high HL adopt more positive health behaviors.Practical implicationsPublic health professionals may need more sophisticated communication methods to transfer messages regarding vaccines to parents in order to prevent decline in vaccine coverage rates, taking into account levels of trust and health literacy.     

Prospective validation of the safety of a laparoscopic cholecystectomy training paradigm featuring incremental autonomy

Background

Surgical training is under scrutiny for the effect increased resident autonomy may have on patient outcomes. We hypothesize that as laparoscopic cholecystectomy (LC) difficulty increases, there will be increased involvement by senior residents and attending physicians with no differences in complications.

Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Objective

The Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making.