Pernille Andreassen

To explore how formative assessment methods are used and perceived by second-year junior doctors in different clinical settings.

Objective: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decisions are addressed in concrete ACP discussions, with special focus on doctor–patient interactions.Method: Following a discourse-analysis approach, the study uses the concept of doctor and patient “voices” to analyze 10 directly observed and audiotaped ACP discussions among patients, relatives, and a physician, carried out in connection with a pilot study conducted in Denmark.Results: Previous studies of directly observed patient–physician discussions about end-of-life care show largely ineffective communication, where end-of-life issues are toned down by healthcare professionals, who also tend to dominate the discussions. In contrast, the observed ACP discussions in our study were successful in terms of addressing such sensitive issues as resuscitation and life-prolonging treatment. Our analysis shows that patients and relatives were encouraged to take the stage, to reflect, and to make informed choices. Patients actively explored different topics and asked questions about their current situation, but some also challenged the concept of ACP, especially the thought of being able to take control of end-of-life issues in advance.Significance of Results: Our analysis indicates that during discussions about sensitive end-of-life issues the healthcare professional will be able to pose and explore sensitive ACP questions in a straightforward manner, if the voices that express empathy and seek to empower the patient in different ways are emphasized.

Resumé Professional explanations for the causes of childhood overweight vary greatly and no particular weight loss methods have proved successful. Nevertheless, parents are generally regarded as primarily to blame for overweight children and also perceived as key to successful weight loss. Based on semi-structured interviews with twelve mothers and two fathers of overweight preschool children, we use a narrative approach to focus on parents’ own aetiological explanations as well as their hopes for a resolution. In their stories of how their children became overweight, parents draw on a number of explanations that refer to both natural and cultural causes which to a large extent mirror the available professional explanations, and in their stories of future possibilities, parents hope to develop a healthy second nature in their children. We argue that the parents employ these hopes and explanations as narrative devices to position themselves as moral actors in relation to the prevalent and widespread idea of childhood overweight as caused by parental failure. The parents’ narratives offer valuable insight into the exceptionally morally charged position of parenting within the social and cultural context of childhood overweight and weight loss.

In this study we investigated the moral dilemmas and strategies of a group of Danish parents who were trying to help their overweight children lose weight. Data were drawn from repeated semistructured interviews carried out over a period of 2 years with 12 families with overweight children. Using a narrative approach, we show the moral dilemmas parents found themselves in when trying to further the two seemingly incompatible goals of helping their children lose weight and simultaneously strengthening their self-worth. When the children were young, the parents tried to hide the fact that they needed to lose weight to protect them from feeling stigmatized. As the children grew older, the parents became more forthright about weight loss so the children would take on more responsibility. We suggest that for parents, weight loss is experienced as a risky undertaking because they perceive their children’s self-worth as being in jeopardy during the process.