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6 - Challenges for parents and clinicians discussing neuroprotective treatments
- from Section 2 - Clinical neural rescue
- Edited by A. David Edwards, Denis V. Azzopardi, Alistair J. Gunn
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- Book:
- Neonatal Neural Rescue
- Published online:
- 05 March 2013
- Print publication:
- 04 April 2013, pp 65-72
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- Chapter
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Summary
Introduction
Speaking to stressed parents in difficult circumstances about the care and prognosis for their very sick newborn baby is one of the challenges involved in providing neonatal intensive care. The regularity of the task can allow clinicians to develop their personal style and to refine their skills in communication, especially as many discussions have standard features such as explanations of a condition, an environment, a piece of equipment. Highly variable contextual and inter-personal elements can, however, add unpredictable dimensions to the discussions which can be demanding, professionally and personally. When a baby is a candidate for neural rescue, there are several additional issues which can increase these demands on clinicians.
The purpose of this chapter is to help clinicians who are thinking through issues involved with communication in these difficult situations. We draw upon accounts from parents of critically ill babies of their experiences of discussing hypothermic neural rescue with clinicians. These data are taken from our own research; we have conducted two studies of the views and experiences of parents and clinicians involved in studies of hypothermia and neuroprotection. Allmark and Mason carried out a qualitative study which focused on the continuous consent processes used in the TOBY trial [1,2]; data from their TOBY-QUAL study are indicated by [TQ]. Snowdon and Elbourne carried out a qualitative study of parent and clinician-researcher views of a pre-trial safety study of hypothermia and ECMO [3]; data from their Views of Hypothermia and ECMO study are indicated by [VHE].
five - The evaluation of public health education initiatives on smoking and lung cancer: an ethical critique
- Edited by Stephen Peckham, University of Kent, Alison Hann, Swansea University
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- Book:
- Public Health Ethics and Practice
- Published by:
- Bristol University Press
- Published online:
- 05 July 2022
- Print publication:
- 04 November 2009, pp 65-82
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Summary
The focus of this chapter is on ways in which public health information is communicated to the public. In particular it argues that the information concerning the relationship between smoking and lung cancer can convey the wrong messages. The authors’ research has shown that the lay public believe that cessation of smoking (or never smoking at all) is almost a guarantee that the individual will not contract lung cancer, and that if this is not the case, they feel in some way ‘cheated’. The empirical material demonstrates this very clearly. Their case is that, in order to be more ‘ethical’, the information given to the public should make it clear that smoking does not inevitably lead to lung cancer and that not smoking cannot guarantee freedom from the disease.
Introduction
This chapter considers the way in which public health education initiatives are evaluated. In particular, our concern is with such evaluation when it is done in terms of behavioural outcomes, such as how many people give up smoking. Our main claim is that this method of evaluation is scientifically and ethically flawed. We use the example of initiatives on smoking and lung cancer. This is because smoking is known to be a hugely important contributor to illness and to health inequality, and because there have been many such initiatives. However, the criticisms we make of initiatives relating to smoking and lung cancer apply equally to many other public health initiatives. Indeed, some criticisms might apply more forcefully to lung cancer initiatives, given that the epidemiological evidence for the link between smoking and lung cancer is stronger than that available for any other link between behaviour and an illness.
We begin the chapter by looking at how health education initiatives in the area of smoking and lung cancer are evaluated. We show that this is done primarily in terms of behaviour change, particularly rates of quitting. We suggest that this is because behaviour change is a good marker for future health benefits which might only accrue over many years: a drop in rates of smoking now could be expected to deliver significant health benefits in the future. However, we argue that looking at behaviour change alone is problematic, because it ignores the possibility of unwanted effects from a public health initiative. We give some evidence for such unwanted effects, based on our own empirical research.