Chrys Jaye

Purpose: This qualitative study investigates how Canadian physician-providers of medical assistance in dying (MAiD) perceived their role in making judgements when assessing patients for MAiD.

Methodology: 21 Canadian physician MAiD providers were interviewed about their experience as early-adopting providers. The data were analysed using a phenomenological approach to identify themes and thematic groupings regarding providers' perceptions of roles and reasoning while undertaking MAiD assessments.

Findings: Participants universally endorsed a focus on providing patient-centred care. They varied in how they approached decision-making for patients applying for MAiD and how they viewed their role within the doctor-patient relationship. Group 1 participants placed moral decision-making with the patient, indicating a limited role for the provider. They focused on guiding the competent patient through the statutory MAiD requirements to actualise patient autonomy. Some described their role as 'conduits'. Group 2 had intermediate views. Group 3 participants described their professional judgement as important to the moral calculus of approval for MAiD. Their role was like that of a train conductor in that they positioned themselves as responsible for wider patient interests as part of maintaining their own professional and moral integrity during MAiD.

Conclusions/significance: Participants' narratives indicate that decisions about MAiD assessments are strongly influenced by provider reasoning regarding the physician's role in MAiD assessment and provision. This divergence reflects unclear role expectations in the context of rapidly changing cultural expectations regarding MAiD.

Background: Chronic non-cancer pain is a major burden worldwide. Indigenous communities experience additional inequities in pain care and management influenced by long-standing impacts of colonization, including systemic racism, oppression, and marginalization. Traditional healing knowledges, practices and methods are valued by Indigenous people when managing their pain. However, mainstream health services often disregard this knowledge and fail to provide culturally safe management strategies.

Aim: To understand how Indigenous peoples across the globe make sense of pain when experiencing chronic non-cancer pain.

Methodology and methods: This integrative literature review is reported according to the PRISMA checklist and CONSIDER statement. We focused on qualitative data reported by Indigenous adults with chronic non-cancer pain in empirical and theoretical studies. Electronic searches were performed in databases from health and humanities scopes, in addition to grey literature, from 1990 to August 2023. We drew from critical theory approaches to thematically analyze data from the included studies, privileging Indigenous perspectives through a Western intellectual framework (Two-Eyed Seeing epistemology). Data extraction and thematic analysis were managed using NVivo. Primary data were mapped according to geography and theoretical framework.

Results: After removal of duplicates, 1352 studies were screened using title and abstract, from which 99 full texts were assessed and 29 studies and 3 dissertations/theses were included. Included studies reported lived experiences of chronic pain among Indigenous peoples from Oceania, North America, and South America. Thematic analysis derived four main themes that indicated pain is entwined with nature, Indigenous identity, historical trauma, and the collective. Our findings suggest that pain is interconnected to a broader scenario of feelings, thoughts, peoples and places.

Conclusion: Our findings highlight the layered and complex aspects of the lived experiences of chronic pain among Indigenous people. Indigenous-led alternatives focusing on culturally safe care can guide approaches to clinical pain practice and contribute to achieving health equity.

In contemporary society, where digital literacy is an essential skill, older adults can face disadvantages because they frequently have lower levels of digital literacy than younger cohorts. This research evaluated the effectiveness of a smartphone course developed by Age Concern Otago (a New Zealand non-government organization), with the aim of improving digital literacy among older adults. This was achieved using a pre- and post-course survey study design. A total of 98 participants, aged above 60, from thirteen courses (four two-hourly sessions) completed pre-surveys in the first session and post-surveys in the last session of each course. The results showed that participants' smartphone digital literacy was improved across all evaluated indices, and feedback for the courses was positive. These findings illustrate that the courses are an effective means of improving the digital literacy of older adults and thus fostering digital inclusion in New Zealand.

Background: Refugee health is an issue of global importance. Refugees have high and complex mental, physical and social needs and poor health outcomes. There is a clear need for more research prioritising refugees’ perspectives of health care in their settlement countries; however, a number of methodological and ethical challenges can make this process difficult.

Methods: This methodological paper is an analysis of our recent experience conducting qualitative research with former refugees in Southern New Zealand. We utilized our research team’s discussions, reflections and fieldnotes and the relevant literature to identify the key processes of our successful engagement with former refugees.

Results: Successful engagement with former refugees in qualitative health research entails: establishing relationships, recognising interpreters as cultural brokers, having a responsive suite of methods and finding meaningful ways to communicate.

Conclusions: This paper offers suggestions and guidance on conducting qualitative health research with former refugees.

Medical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients' inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants' perceptions of the emotional and moral impacts of this role.PURPOSEMedical assistance in dying (MAiD) in Canada places the medical provider at the centre of the process. The MAiD provider holds primary responsibility for determining eligibility and becomes acquainted with patients' inner desires and expressions of suffering. This is followed by the MAiD procedure of administering the lethal agent and being present at the death of eligible patients. We report participants' perceptions of the emotional and moral impacts of this role.Two years after MAiD was legalised in Canada, 22 early-adopting physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.METHODOLOGYTwo years after MAiD was legalised in Canada, 22 early-adopting physician providers were interviewed. Data were examined using both phenomenological analysis and a novel ChatGPT-enhanced analysis of an anonymised subset of interview excerpts.Participants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient's autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.FINDINGSParticipants described MAiD as emotionally provocative with both challenges and rewards. Providers expressed a positive moral impact when helping to optimise a patient's autonomy and moral comfort with their role in relieving suffering. Providers experienced tensions around professional duty and balancing self with service to others. Personal choice and patient gratitude enhanced the provider experience, while uncertainty and conflict added difficulty.Participants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers' experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society.CONCLUSIONSParticipants described MAiD provision as strongly aligned with a patient-centred ethos of practice. This study suggests that, despite challenges, providing MAiD can be a meaningful and satisfying practice for physicians. Understanding the emotional and moral impact and factors that enhance or detract from the providers' experience allows future stakeholders to design and regulate assisted dying in ways congruent with the interests of patients, providers, families and society.

This qualitative study explored the impact of the 2017 Mycoplasma bovis incursion and its management on farmers in southern New Zealand. Eighteen farmers and farming couples were interviewed about their experiences. Analysis of interview data evoked van Gennep's notion of liminality with its journey through distinct phases associated with ambiguity, confusion and uncertainty. Farmers described separation from usual farming practices during the incursion management process. The disruption to farming rhythms was characterised by long periods of waiting for test results, stand-down periods, and compensation claim outcomes. In emerging from the incursion, participants reflected on altered identities and relationships within rural communities and with the government, including greater awareness of biosecurity issues. The liminality of M. bovis was anchored upon the farm. However, the liminal space of M. bovis lingered long after the official exit of the farm from liminal status. •Southern New Zealand farms became liminal places and spaces under Mycoplasma bovis biosecurity restrictions.•The on-farm intervention was a liminal journey for affected farmers.•Affected farmers described being altered by their liminal experiences.•The post- M. bovis farmscape was distinct to the pre- M. bovis farmscape on affected farms.•The liminal space of M. bovis extended beyond the official exit of the farm from liminal status.

Healthcare systems can be considered moral economies in which moral capital in the form of expectations toward norms, values, and virtues are exchanged and traded. Moral capital, as a concept, is an extension of Bourdieu's forms of symbolic, and in particular, cultural capital. This research set out to identify forms of moral capital evident in the accounts of health professionals and patients within the distinctive healthcare systems of Germany, New Zealand, and the Unites States. Here, we provide an overview of 15 forms of moral capital that were identified. An important form of moral capital is equality. The global coronavirus pandemic has illuminated inequalities in healthcare systems across the world. We suggest considering moral capital as a useful tool to reform healthcare systems and make the provision of healthcare a more equitable enterprise.

This article explores the brokering work performed by frontline workers during the recent New Zealand Mycoplasma bovis biosecurity outbreak and the subsequent eradication programme. The parent programme of study utilised a qualitative research design within a pragmatic orientation, and the dataset supporting this article comprised a subset of individual and group interviews conducted with fifteen frontline workers. The analysis indicates that in the process of meeting their various operational briefs, frontline workers brokered knowledge and information, resources and materials, and relationships for the benefit of their clients. Their brokering work mitigated the limitations of the intervention's infrastructure and also mitigated dysfunction among stakeholder organisations. The embeddedness of frontline workers within their local communities meant that they already had credibility that worked to the advantage of the eradication programme. Participant accounts support the existence of a boundary space on the frontline of the M. bovis invention that, despite an overarching common purpose, was characterised by instability, chaos, and flux. The position of frontline workers as being 'in-between' their clientele (farmers impacted by M. bovis) and their employers conferred ambiguous status. Nevertheless, their accounts indicate that their brokering work improved the efficiency of the M. bovis eradication programme, and we suggest that organisations responsible for biosecurity can increase the effectiveness of future incursions by recognising, valuing, and supporting the brokering roles conducted by frontline workers.

Behind rural lives lurk several forms of latent precarity that are unique to rural dwellers and rural contexts. Latent precarities may never become actualised or experienced, and the expression of latent precarity can be mitigated by both individual and community resources. For older rural dwellers, the latent precarities associated with rural life intersect with those associated with ageing and when experienced or actualised, can impact on an individual's ability to successfully ‘age in place’ within their rural community. We interviewed adults across the lifespan who lived in a small rural southern New Zealand community, and this article explores the latent precarities of rurality and ageing that they identified. If community assets dwindle or become unavailable, and health capabilities decline, latent precarities may multiply, or become actual/experienced precarities. The experience of ageing well in rural places can be improved and older adults better supported through the identification of, and attention to, forms of latent precarity within these rural places. •Latent forms of precarity can become experienced precarity for rural dwellers as they age.•There is the potential for expression of latent precarity to be mitigated so it does not become experienced precarity.•The experience of ageing well in rural places might be improved by attending to forms of latent precarity within rural communities.

ObjectivesTo explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ).DesignQualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory—the Consolidated Framework for Implementation Research.SettingSouthern health region of NZ (Otago and Southland).ParticipantsEleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy.ResultsThe large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism.ConclusionsThis study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.