Implementing palliative care education into primary care practice: a qualitative case study of the CAPACITI pilot program.

Background: CAPACITI is a virtual education program that teaches primary care teams how to provide an early palliative approach to care. After piloting its implementation, we conducted an in-depth qualitative study with CAPACITI participants to assess the effectiveness of the components and to understand the challenges and enablers to virtual palliative care education.

Methods: We applied a qualitative case study approach to assess and synthesize three sources of data collected from the teams that participated in CAPACITI: reflection survey data, open text survey data, and focus group transcriptions.

Gender and Trajectories of Marital Breakdown: Accounts of Chinese Immigrant Women in Canada.

The relatively sparse literature has documented various challenges international migration poses to martial stability, yet we know little about immigrant women's experiences with marital breakdown. Drawing data from a qualitative study of Chinese economic immigrants to Canada, this article explores women's experiences of navigating the processes of this life circumstance, and of how gender-including their senses of changing gender roles in post-immigration and postmarital contexts-plays out in these trajectories. The results of this exploratory study illustrate the value of transcending dichotomous conceptions of the relationship between gender and migration, and of opening spaces in which to better understand immigrant women's increasingly diversified life trajectories and the range of barriers they encounter along the way.

When 'Being There' Is Disallowed: Disruptions to Knowing and Caring During COVID-19 Visitor Restrictions.

This qualitative study explored the accounts of five health professionals working in hospitals in Hamilton, Ontario, Canada who provided end-of-life care during the COVID-19 pandemic. The study goal was to understand how palliative care providers experienced and responded to the significant change in family presence when visitors were restricted to slow the spread of the virus. Identified was the loss and disruption of important forms of knowing including observational and embodied knowing.

Intimacy, identity and relationship in the accounts of Chinese immigrants to Canada: the contribution of narrative analysis.

In this paper we use narrative analysis to consider how the discursive resources that come with living 'in between' countries and cultures unfold in personal stories. We do this by presenting a close analysis of two transcripts drawn from a study about the vulnerability to HIV faced by Chinese immigrants to Canada. Our goal is to illustrate the application of narrative analysis and highlight the contributions it can make to conceptualising how transnationalism becomes consequential in accounts of intimate life.

Research in cancer care disparities in countries with universal healthcare: mapping the field and its conceptual contours.

The paper reviews published studies focused on disparities in receipt of cancer treatments and supportive care services in countries where cancer care is free at the point of access. We map these studies in terms of the equity stratifiers they examined, the countries in which they took place, and the care settings and cancer populations they investigated. Based on this map, we reflect on patterns of scholarly attention to equity and disparity in cancer care.

Disparities in cancer care: perspectives from the front line.

Objective: The purpose of this qualitative study was to investigate how frontline healthcare professionals witness and understand disparity in cancer care.

Method: Six healthcare providers from a range of care settings, none with < 15 years of frontline experience, engaged with researchers in an iterative process of identifying and reflecting on equity and disparity in cancer care. This knowledge exchange began with formal interviews.

The ethics of engaged presence: a framework for health professionals in humanitarian assistance and development work.

In this article, we present an ethics framework for health practice in humanitarian and development work: the ethics of engaged presence. The ethics of engaged presence framework aims to articulate in a systematic fashion approaches and orientations that support the engagement of expatriate health care professionals in ways that align with diverse obligations and responsibilities, and promote respectful and effective action and relationships. Drawn from a range of sources, the framework provides a vocabulary and narrative structure for examining the moral dimensions of providing development or humanitarian health assistance to individuals and communities, and working with and alongside local and international actors.

Tragic choices in humanitarian health work.

Humanitarian healthcare work presents a range of ethical challenges for expatriate healthcare professionals, including tragic choices requiring the selection of a least-worst option. In this paper we examine a particular set of tragic choices related to the prioritization of care and allocation of scarce resources between individuals in situations of widespread and urgent health needs. Drawing on qualitative interviews with clinicians, we examine the nature of these choices.

Of time and troubles: patient involvement and the production of health care disparities.

Patient involvement in care practice has many and diverse proponents. It is endorsed by health care institutions and promoted by community agencies representing people with illness. A vast literature documents the benefits of patient involvement and describes ways to enable it.

Using institutional ethnography to understand the production of health care disparities.

Questions of health care access and equity are often examined by researchers using quantitative approaches, describing patterns of service utilization. Articles based on such approaches often reveal relatively little about how health care services and resources come to be distributed as they are. Articles about qualitative research with marginalized people, although offering textured accounts of people's experiences of care, often do not systematically link felt troubles to specific features of health systems.

"I like to be an informed person but..." negotiating responsibility for treatment decisions in cancer care.

Social expectations surrounding sickness have undergone a transformation in Western welfare states. Emerging discourses about patients' roles and responsibilities do not however always map neatly onto patients' actions, experiences or desires. This paper emerges from a study in Ontario, Canada.

"Below their notice": exploring women's subjective experiences of cancer system exclusion.

Background: The experiences that marginalized breast cancer populations have in common are rarely considered.

Methods: The authors look across 3 qualitative studies to explore the experiences of older, lower-income, and Aboriginal women diagnosed with cancer and treated by the cancer care system in Ontario, Canada.

Results: The research examines critical moments in participants' narratives that parallel one another and are categorized within 2 themes: Not Getting Cancer Care and Not Getting Supportive Care.

Community support, community values:the experiences of lesbians diagnosed with cancer.

The study reported in this article was initiated in response to the paucity of literature focused on Canadian lesbians with cancer. The aims of the study were broadly defined: to increase understanding of Canadian lesbians' experiences with cancer and cancer care, and to suggest directions for change such that lesbians with cancer might be better supported by service providers and lesbian communities. The qualitative study, set in Ontario, Canada, employed a participatory action research model.

"Because you know there's an end to it": caring for a relative or friend with advanced breast cancer.

Objective: The aim of this paper is to delineate the particular nature of the end-of-life care experience from the perspective of family members and friends. Ideas drawn from feminist analyses of caring and the sociology of death and dying are used to illuminate study respondents' accounts.

Methods: Qualitative study with people who cared for a family member or friend who died of breast cancer.

Audience responses to a research-based drama about life after breast cancer.

This article explores audience reactions to the research-based drama Ladies in Waiting? Life After Breast Cancer. Quantitative findings indicate an overwhelmingly positive response, with approximately 90% of those who saw the production agreeing that they benefited from seeing it and indicating that they would recommend it to others. Qualitative data reveal a more complex picture of the range of reactions, allowing us to describe the most valued aspects of the production (mainly how it eased isolation and normalized the difficult aspects of survivorship) and to better understand the few reports of distress.

The experiences of men receiving androgen deprivation treatment for prostate cancer: a qualitative study.

Objective: This exploratory study was intended to investigate men's ways of integrating and understanding experiences with Androgen Deprivation Therapy (ADT), including how hormone treatment affected their sense of identity.

Patients And Methods: Twelve men, averaging 61 years of age and treated with ADT, participated in a single interview about their experiences with prostate cancer and hormone treatment. In keeping with a qualitative approach, questions were initially open-ended, with patients encouraged to describe experiences in their own words.

Homophobia and heterosexism in cancer care: the experiences of lesbians.

This participatory, qualitative study examines "what is lesbian" about lesbians' experiences of cancer and cancer care. Twenty-six lesbians were interviewed about their experiences of cancer diagnosis, treatment, and support, and their feelings and perceptions about shifts in identity, body, sexuality, and relationships. This paper highlights how homophobia and heterosexism, in contemporary nursing practice and as historical features of the health-care system, shape the experiences of lesbians with cancer.

Disarmed complaints: unpacking satisfaction with end-of-life care.

Difficult health care encounters often do not translate into expressions of dissatisfaction with care. This paper focuses on the 'non-expression' of dissatisfaction with care in the accounts of 12 people in Canada who provided care to a relative or friend who died of breast cancer. The analysis foregrounded in this paper began from the observation that as difficult health care experiences were elaborated, speakers located health professionals' actions in relation to various situational factors, including the fact of a (cancer) death and conditions of constraint in the health system.

Staging breast cancer, rehearsing metastatic disease.

Social science researchers have fruitfully used a range of conceptualizations of "performance": as a metaphor for social life, a way of vivifying research findings, and a form of scholarly representation. In this article, the researchers consider performance in its hermeneutic sense, as a way of generating meaning. The drama Handle With Care? Living With Metastatic Breast Cancer was created by a research team, a theater troupe, and women with breast cancer.