Voices from the Margin of the Family

Chronic childhood illnesses such as cancer create enormous stress for all family members. Siblings of ill children often are overlooked, both in the psychosocial literature and in normal medical, social service, and family practices. This article reports the views and experiences of a small sample of siblings of children with cancer gathered during open-ended interviews. A qualitative analysis presents and conceplualizcs the voices and experiences of three young people themselves. Constant worry about their ill brother or sister, reactions to differential treatment and lack of attention, and a commitment to "take care of" other family members emerge as major themes. The siblings' comments indicated some positive changes in family life and in their own maturity. The authors offer suggestions for making more informed and compassionate responses to the situations of young cancer patients' siblings.     

Advice,authority and autonomy in shared decision‐making in antenatal screening: the importance of context

Shared decision‐making (SDM) has been widely advocated across many branches of healthcare, yet there is considerable debate over both its practical application and how it should be examined or assessed. More recent discussions of SDM have highlighted the important of context, both internal and external to the consultation, with a recognition that decisions cannot be understood in isolation. This paper uses conversation analysis (CA) to examine how decision‐making is enacted in the context of antenatal screening consultations in Hong Kong. Building on previous CA work (Collins et al. 2005 , Toerien et al. 2013), we show that, whilst previously identified formats are used here to present the need for a decision, the overriding basis professionals suggest for actually making a decision in this context is the level of worry or concern a pregnant woman holds about potential foetal abnormality. Professionals take an unknowing ‘epistemic stance’ (Heritage 2012 ) towards this worry, and hence step back from involvement in decision‐making. We argue that this is linked to the non‐directive ethos that prevails in antenatal screening services, and suggest that more research is needed to understand how the enactment of SDM is affected by wider professional contexts and parameters.     

Parental weighting of seizure risks vs. fever risks in vaccination tradeoff decisions

As part of a survey of about vaccination beliefs, a nationally representative sample of parents of young children answered a series of tradeoff questions that asked them to choose between two vaccination approaches that differed in terms of risks of vaccine complications, number of injections, and/or vaccine effectiveness. Most parents were willing to have their children endure more injections, and many were willing to forgo disease protection, in order to reduce the rare chance of febrile seizures. Yet, most parents were unwilling to trade disease protection to reduce the risk of fever alone, even though this is correlated with the risk of febrile seizures. Vaccine risk communications need to address the heightened emotional weight that parents give to febrile seizure risk, even when the rarity of such events is explicit.