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The social organisation of economic life plays a pivotal role in assembling many emerging and enduring health problems. Yet throughout the recent history of global health challenges, an emphasis on the influence of economic systems has frequently been sidelined in favour of research that interrogates the behavioural and/or cultural dimensions of these problems. The global crisis of antimicrobial resistance provides a striking example of this trend, with analysis frequently and increasingly focusing on behavioural or technological fixes – for example, the need for responsible use of remaining antimicrobial drugs, or for revived efforts to identify new antimicrobial agents – while at times glossing over the market logics that reproduce the problem itself. With a few notable exceptions, the economic headwinds that shape the current antimicrobial resistance (AMR) scene have been largely decentred in scholarly discussions. In this article, we argue for a critical sociology of economies of resistance, contributing to burgeoning efforts to understand how economic structures both shape the acceleration of AMR and undermine the development of drug and diagnostic solutions. [ABSTRACT FROM AUTHOR]

It is now well-recognised that antimicrobial resistance (AMR), or the ability of organisms to resist currently available antibiotics and other antimicrobial drugs, represents one of the greatest dangers to human health in the 21st Century. As of 2022, AMR is a top-10 global public health threat. Various national and transnational initiatives have been implemented to address accelerating AMR, and the pressure to find local and global solutions is increasing. Despite this urgency, surprisingly limited progress is being made in rolling back or even slowing resistance. A multitude of perspectives exist regarding why this is the case. Key concerns include an enduring dependency on market-driven drug development, the lacklustre governance and habitual over-prescribing of remaining antimicrobial resources, and rampant short-termism across societies. While rarely presented in such terms, these disparate issues all speak to the social production of vulnerability. Yet vulnerability is rarely discussed in the AMR literature, except in terms of 'disproportionate effects' of AMR. In this paper, we offer a reconceptualisation of vulnerability as manifest in the AMR scene, showing that vulnerability is both a predictable consequence of AMR and, critically, productive of AMR to begin with. We underline why comprehending vulnerability as embodied, assembled, multivalent and reproduced through surveillance matters for international efforts to combat resistance. [ABSTRACT FROM AUTHOR]

Harm is a recurring theme in the social sciences. Scholars in a range of empirical areas have documented the deleterious outcomes that at times emerge from social structures, institutions and systems of governance. Yet these harms have often been presented under the rubric of 'unintended consequences'. The outcomes of systems are designed to appear devoid of intentionality, in motion without any clear agency involved, and are thus particularly adept at evading accountability structures and forms of responsibility. Drawing insights from decades of social theory – as well as three illustrative examples from Australia's health, welfare and immigration systems – this article argues that many social structures are in fact intended to cause harm, but designed not to appear so. In presenting this argument, we offer a theoretical framework for conceptualising harm as actively administered. We also challenge scholars from across the social sciences to reconsider the partially depoliticising narrative of 'unintended consequences', and to be bolder in naming the intended harms that permeate social life, often serving powerful political and economic interests. [ABSTRACT FROM AUTHOR]

Men's emotions in intimate partner relationships have received little research attention. The current interpretive descriptive study included 30 Canadian‐based men to address the research question: What are the connections between masculinities and men's emotions in and after intimate partner relationships? Three inductively derived themes included emergent distressing emotions wherein participants' predominance for holding in abeyance their concerns about the relationship manifested varying levels of emotional stoicism. Within this context most men denied or downplayed and did not express their emotions. When the relationship broke, men were overwhelmed by mixed and weighty break‐up emotions comprising diverse and often‐times discordant emotions, including sadness, shame, anger, regret and guilt, calling into question men's rationality for deciphering and expressing what was concurrently but inexplicably felt. Shame and anger were prominent emotions demanding the participant's attention to all that happened in and at the end of the relationship. In the third theme, understanding and transitioning after‐burn emotions, participant's grief levered their efforts, including soliciting professional help for deconstructing, reframing and expressing their emotions in the aftermath of the partnership ending. The findings contextualise and in some instances counter claims about the utility of men's emotional stoicism by mapping participants' feelings in and after intimate partner relationships. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance (AMR) is one of the leading global public health threats of the 21st Century. Antimicrobial stewardship (AMS) programmes have been shown to improve antibiotic use and clinical outcomes in high-income settings, but context-specific evidence is lacking on the value and effectiveness of current AMS programmes in low-resource settings. This study sought to explore context-specific underlying barriers to AMS implementation in Indonesian hospitals with a focus on governance practices and structural vulnerabilities. Methods: We conducted semi-structured interviews with physicians, surgeons, clinical microbiologists, pharmacists, AMS team leaders, hospital managers, medical students, and national AMR stakeholders, and performed a thematic analysis. Results: Based on 51 interviews conducted between January and October 2020, four main barriers to AMS implementation were evident in the participants' experiences: (1) Ineffective resourcing and institutional buy-in regarding mandatory AMS under hospital accreditation; (2) Entangled priorities to generate profits and interprofessional relationships between doctors and hospital managers or AMS leaders; (3) Cost-prohibitive bacterial culture testing and thresholds of national health insurance coverage; (4) Unreliable infrastructures, including microbiology laboratory and surgical facilities, ensuring high antibiotic usage to cover structural vulnerabilities. Conclusions: Limited progress will be made with implementing AMS in Indonesian hospitals, and in settings with similar structural features, without addressing concerns around governance, competing interests, cost and structural vulnerabilities. [ABSTRACT FROM AUTHOR]

The SARS-CoV-2 pandemic has resulted in considerable consequences for many cancer patients, exacerbating pre-existing systemic health system limitations as well as creating new challenges. From socially distanced clinics and the widespread introduction of telehealth, to the halting of clinical trials and the reassessment of what constitutes "essential" treatment, care in oncology has abruptly changed. There is currently limited analysis of cancer patients' experiences of the pandemic and its impacts on illness, wellness, and everyday life. Through semi-structured interviews with 54 people living with cancer during the 2020 phase of the SARS-CoV-2 pandemic in Australia, we explore how patients experience illness and care in reflecting upon a range of pandemic challenges, including delay, distance, and vulnerability. We find that in some cases, these pandemic conditions redefined the meaning of essential cancer care, reconfigured expectations around clinical trials, constructed new affective distances, and amplified dread and fear for people living with cancer. [ABSTRACT FROM AUTHOR]

In the cultural imaginary of death and dying, the felt contours of grief are still often taken for granted. Grief is predominantly understood as sadness at loss; as melancholia at the finitude of relationships. Grief is conceived as a temporally-bound affective period in which one processes the pain of loss – that is, gets used to absence and works toward ‘moving on’. In this article, we centre the accounts of people caring for the dying, or recently having experienced the death of a loved one to cancer, to advance a sociological analysis of grief that untethers it from this normative environ. In the lives of those living with death, we argue, grief evades social conventions and temporal limits. It is a spectral presence that shows little concern for expected affective crescendos (being at death’s door/just departed). In its unruliness, grief reveals and resists the normative scene of death and dying, as collective pressure – for closure, for forgetting, for moving on – amplifies rather than ameliorates its felt experience. Centring the experiences of carers, we thus argue for an enlivened sociology of grief that illuminates its disruptive temporality, its haunting spectrality, and its propensity to instigate both affective refusals and (attempted) moments of collective catharsis. [ABSTRACT FROM AUTHOR]

The idea of 'precision medicine', which has gained increasing traction since the early 2000s, is now ubiquitous in health and medicine. Though varied in its implementation across fields, precision medicine has raised hopes of revolutionary treatments and has spurred the proliferation of novel therapeutics, the alteration of professional trajectories and various reconfigurations of health/care. Nowhere is the promise of precision medicine more apparent, nor further institutionalised, than in the field of oncology. While the transformative potential of precision medicine is widely taken for granted, there remains scant attention to how it is being experienced at the coalface of care. Here, drawing on the perspectives of 54 cancer care professionals gleaned through eight focus group discussions in two hospitals in Australia, we explore clinicians' experiences of the day‐to‐day dynamics of precision‐in‐practice. We illustrate some of the affective and temporal complexities, analysed here under the rubrics of enchantment, acceleration and distraction that are emerging alongside the uptake of precision medicine in the field of oncology. We argue that these complexities, and their dis/continuities with earlier iterations of cancer care, demonstrate the need for sociological analyses of precision medicine as it is being implemented in practice and its varied effects on 'routine' care. [ABSTRACT FROM AUTHOR]

What does migrancy mean for personhood, and how does this flow through caring relations? Drawing on life history interviews and photo elicitation with 43 people who identify as migrants and live with cancer, here we argue for the significance of recognising complex personhood as it inflects illness and care. Drawing on social science theory around temporalities, moralities and belonging, we assemble a series of cross-cutting themes at the intersection of personhood and care; relations that transcend cultural origins yet are vividly illustrated in relation to migrant pasts. In seeking a multidimensional view of personhood, we attend to the intersecting layers of complexity that make up care in this context vis-a-vis an emphasis on forms of difference, vulnerability and otherness. In this way, we develop an approach to personhood and care that broadens the lens on migrancy and cancer, but also, one that speaks to the importance of recognition of complexity and how it shapes care more generally. [ABSTRACT FROM AUTHOR]

Much has been written about the problem of antimicrobial resistance (AMR) and the action required to rein in this emerging global health threat. Addressing AMR is often operationalised as requiring 'behavior change' of clinicians and of patients, in combination with improving the drug development pipeline. Few have approached AMR as a challenge fundamentally embedded within the cultural fabric of modern societies and the (varied) ways they are organised economically, socially and politically. Here, drawing on a decade of work across a range of health contexts, we approach the problem of AMR as one of values and culture rather than of individual behavior. We reframe AMR as a social and political concern resulting from a confluence of factors and practices including: temporal myopia, individualisation, marketisation, and human exceptionalism. To effectively tackle AMR, we advocate solidaristic models that espouse collective responsibility and recognise relative opportunity to act rather than a continuation of the individualistic behavioural models that have, so far, proven largely ineffective. [ABSTRACT FROM AUTHOR]

Qualitative research is practiced across diverse disciplines and contexts, and this produces a wide range of perspectives on the role of conceptualization and theory development. It also results in a hugely varied mix of submissions to qualitative research journals in terms of their level of conceptual elevation. This editorial explores why we conceptualize qualitative data, and some common challenges evident in current qualitative practice. [ABSTRACT FROM AUTHOR]

India and the global community are facing a critical crisis of antimicrobial resistance (AMR), significantly contributed to by on-going and increasing antimicrobial misuse. Information as to what drives misuse of antimicrobials within India is essential to inform strategies to address the crisis. This papers aims to identify perceived influences on antimicrobial use in Hyderabad, India. We conducted semi-structured qualitative interviews conducted with thirty participants (15 doctors, 15 pharmacists) around their experiences of antimicrobials in Hyderabad, India. Thematic analysis was performed and four themes identified around (1) Perceptions of the problem of resistance and antimicrobial use; (2) Social pressures to prescribe/dispense; (3) Financial pressures driving antimicrobial over-use; and (4) Lack of regulation around training and qualifications. We conclude that antimicrobial use within India is embedded with, and occurs as a result of, complex social and economic factors including issues of resource limitation, structural/governance limitations and social relationships. Strategies to address misuse without acknowledging and addressing the critical driving forces of use will be unlikely to induce significant change. [ABSTRACT FROM AUTHOR]

Mental ill‐health is a serious and growing problem among university students in Australia. Within this cohort, international students are particularly vulnerable. International students in Australia have fewer social rights than domestic students and are at elevated risk of social isolation, exploitation in employment, precarious housing, financial insecurity, and racism and discrimination. When mental health challenges arise, international students are also less likely than their domestic counterparts to access support services. Against the backdrop of this escalating problem, this article presents a critical analysis of Australian universities' policy approaches to international student mental health. We ask: (a) How many universities have such policies publicly available, and (b) how do these policies understand and seek to address the problem of international student distress? Drawing on a documentary analysis of publicly available university mental health strategies, we find that—in the comparatively rare cases where such documents exist—international students' mental ill‐health is generally framed in these documents as an individual concern, placing the onus on individual students to develop “resilience” and/or seek out help. Leveraging theoretical insights concerning the collective production of (mental) health and illness, we caution that this individualisation of student distress naturalises and depoliticises the logics of financial exploitation and neglect that contribute to many international students' mental health problems to begin with. [ABSTRACT FROM AUTHOR]

More than a threat to embodied existence, cancer threatens various dimensions of social existence, including the general sense of inhabiting an ordered and moral universe. Here, we draw on sociological theory to interrogate the ontological politics of living with (and alongside) cancer. That is, how is cancer understood, made meaningful and enacted in relation to various others. Drawing on 130 interviews with people living with cancer and those close to them, we analyse people's attempts to make cancer make sense, as well as the disciplinary consequences of apprehending cancer in this way. We focus, in particular, on the centrality of serendipity, conviction and regret in the meaning-making of cancer, and how they interact to produce complex affective and intersubjective relations. Moreover, we unpack how these logics and affects are part of a broader moral and ethical order of cancer, which entangles people within particular sets of relations: to living, to dying, and to others. We argue that the origins of luck, the practice of conviction and the affect of regret are critical facets of the ontological construction of cancer, with important consequences for survivorship. [ABSTRACT FROM AUTHOR]

Serious illness has typically been explored as emergent within the relatively linear unfolding of the steady march of time. Here, focusing on cancer and drawing on the accounts of patient/carer dyads, we propose a relational ontology of the affective and temporal entanglements of living-with disease. Emphasising the iterative intra-activity of vital matter and social meaning as they are repatterned across time, we examine the enfolding of various temporal, affective and normative dis/continuities that become particularly meaningful – or are made to matter – in the context of living/dying-with cancer. We focus on the social practices of 'making memories', 'anticipating absence' and 'maintaining normal' which reveal the entanglement of seemingly discrete categories such as self and other, here and gone, and past, present and future. Living-with cancer thus emerges as more than an illness/caring experience, but rather as instructive in contributing to a relational understanding of everyday life. [ABSTRACT FROM AUTHOR]

An extensive body of scholarship focuses on cultural diversity in health care, and this has resulted in a plethora of strategies to "manage" cultural difference. This work has often been patient-oriented (i.e., focused on the differences of the person being cared for), rather than relational in character. In this study, we aimed to explore how the difference was relational and coproduced in the accounts of cancer care professionals and patients with cancer who were from migrant backgrounds. Drawing on eight focus groups with 57 cancer care professionals and one-on-one interviews with 43 cancer patients from migrant backgrounds, we explore social relations, including intrusion and feelings of discomfort, moral logics of rights and obligation, and the practice of defaulting to difference. We argue, on the basis of these accounts, for the importance of approaching difference as relational and that this could lead to a more reflexive means for overcoming "differences" in therapeutic settings. [ABSTRACT FROM AUTHOR]

India is considered the epicenter of the global antimicrobial resistance crisis, with unprecedented antimicrobial consumption, production, and "misuse." But the story of resistance in India is complicated—emerging from intersections of industrial pharmaceutical development, rationing/purchasing of health care, policy infrastructure, and dynamics of disadvantage. What looks like rampant, escalating antimicrobial misuse and a need for tighter controls over drugs and "prescribers," emerges as a complex social problem. These dimensions reach the bedside, although variously, with doctors in India dealing with precarious infectious disease landscapes, threats of multidrug-resistant organisms, and (pan) national imperatives for "more judicious" practices. Drawing on 24 semi-structured interviews with doctors in Hyderabad, we explore their perspectives on resistance (literal and figurative) in everyday practice, and how practices articulate intersections of power, influence, and governance. This offers broader context to reframe resistance in India as multifactorial, enacted through cultural/local practices, and irreducible to singular problems of control or regulation. [ABSTRACT FROM AUTHOR]

In this article, we focus on developing a critical sociology of 'cultural and linguistic diversity' as evident in cancer care praxis, drawing on the perspectives of cancer care health professionals. Set within the context of increasing efforts on the part of healthcare providers to 'accommodate difference' and 'incorporate diversity', we aimed to utilise participants' accounts of practice to ask: how do we and how should we think about and operationalise 'culture' (if at all) in cancer care settings. Drawing on eight focus groups with doctors, nurses, allied health staff and multicultural community workers, here we explore their accounts of: othering and over-simplification; the role of absences in biographical reciprocity; intimacy, care and carelessness; and entanglements of culture with other aspects of the person. Based on their accounts, we argue for a broadening of the examination of the nexus of culture and care, to focus on the problematics of othering, intimacy, reciprocity and complexity. [ABSTRACT FROM AUTHOR]

Medical encounters – while often viewed as centred on conveying clinical knowledge – are also sites of emotion and for exerting emotional labour by healthcare professionals. The temptation to view these encounters as largely 'technical' – an exchange of knowledge or information – can marginalise the complex emotions often experienced by healthcare professionals, and negates the critical work done in these encounters. Drawing on in-depth interviews with 22 Australian medical oncologists, this article explores the experience and meaning of (their) emotions in medical encounters, and the manner in which emotional labour is performed by medical oncologists. Emotions, as it emerges, are central to the 'management' of encounters, ensuring professional sustainability and in 'achieving' clinical outcomes. Here, we broaden understandings of emotionality in oncological work, focusing on emotions as central to the production and enactment of professionalism, relationships and identities across professional careers. We illustrate how the performance of emotional labour reflects a dialectic between notions of 'professionalism' and 'feelings' – which in practice are co-existing and intermingling dimensions of oncology relations – manifested in the practice of 'bounded caring'. [ABSTRACT FROM AUTHOR]

Men are increasingly participating, and acknowledging their roles, as informal carers. Yet, there has been comparatively little exploration of their experiences therein, especially within the context of cancer care. Here, drawing on semi-structured qualitative interviews with 16 Australian male carers for a relative with cancer, and using constructivist grounded theory, we explore their experiences of informal caring. Our analysis highlights a series of tensions, including the following: the meanings and practicalities of care provision including notions of reciprocity, duty, autonomy, and interdependence; the discomforts of dependency and vulnerability; and the complicated moralities that inflect "caring well." Given the shifting dynamics around informal care, we argue for increased attention to the affective tensions that arise at the nexus of moralities and masculinities in informal caring relations, especially as they are articulated in the context of illness, affliction, and dependency. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is widely reported to be a rapidly escalating global health threat. Investigations into the social dimensions of AMR have tended to focus on economically wealthier nations, even though economically poorer countries are a site of considerable and often increasing antibiotic (mis)use. Understanding the global and local dynamics of antibiotic resistance, we propose, requires critical sociological investigation at the nexus of economic development, structural constraints, cultural norms, and infection-management practice. Here, to begin to unpack these intersections, we draw on qualitative interviews with physicians and pharmacists in Hyderabad to explore their accounts of the social dynamics of AMR in India. In particular, we focus on their accounts of practices of improvisation and self-medication with antibiotics; the nexus of informal and formal pharmaceutical economies and the vested interests therein; and the everyday brokering of antibiotics. We posit that responses to AMR need to be deeply embedded in the specificities of everyday practice, local market forces, and regulatory (im)possibilities with attention paid to the locally prevailing cultural norms. [ABSTRACT FROM AUTHOR]

Whether within an atmosphere of hope, or amidst relations of fear, the emotions of cancer are unavoidably collectively produced. Yet persistent individualistic paradigms continue to obscure how the emotions of cancer operate relationally – between bodies, subjects, discourses, and practices – and are intertwined with circulating beliefs, cultural desires, and various forms of normativity. Drawing on interviews with 80 people living with cancer in Australia, this paper illustrates why recognition of the collective enterprise of survivorship – and the collective production of emotion, more generally – is important in light of persistent, culturally dominant conceptions of the individual patient as the primary 'afflicted', 'feeling', and 'treated' subject. Building on previous work on affective relations and moral framings, we posit that the collective affects of survivorship inflect what people living with cancer can, and should, feel. We highlight how such things as hope, resignation, optimism, and dread are 'products' of the collective affects of cancer, with implications for how survivorship is lived, felt, and done. [ABSTRACT FROM AUTHOR]

Australia and the United Kingdom have introduced policies to protect employees who experience mental illness, including depression. However, a better understanding of the experiential issues workers face (e.g. sense of moral failure) is needed for the provision of appropriate and beneficial support. We analysed 73 interviews from the United Kingdom and Australia where narratives of depression and work intersected. Participants encountered difficulties in being (and performing as if) 'authentic' at work, with depression contributing to confusions about the self. The diffuse post-1960s imperative to 'be yourself' is experienced in conflicting ways: while some participants sought support from managers and colleagues (e.g. sick leave, back-to-work plans), many others put on a façade in an attempt to perform the 'well' and 'authentic' employee. We outline the contradictory forces at play for participants when authenticity and visibility are expected, yet, moral imperatives to be good (healthy) employees are normative. [ABSTRACT FROM AUTHOR]

Social isolation has featured as a significant and oftentimes all-encompassing risk factor for male suicide, yet, as an explanatory mechanism, it has not been unpacked in terms of what it constitutes in everyday life. The current photovoice study explores the various dimensions of the lived experience of social isolation, as embedded in accounts of suicidality drawn from 35 Canadian men. Study participants narrated the following factors as underpinning their social isolation: (a) family dysfunction and estrangement, (b) marginality and feeling like misfits at school and work, (c) alienation and provisional acceptance of health care, (d) ineffectual and self-harming management, (e) intrusive dislocating thoughts, and (f) society's burdensome and immoral subjects. These interwoven but discrete spheres provide a means for understanding the phenomenology of social isolation and a basis for melding ideas about connectedness, relationality, personal history, and care, along with strategies to support and reduce men's suicidality. [ABSTRACT FROM AUTHOR]

This article explores the experience and meaning of time from the perspective of caregivers who have recently been bereaved following the death of a family member. The study is situated within the broader cultural tendency to understand bereavement within the logic of stages, including the perception of bereavement as a somewhat predictable and certainly time-delimited ascent from a nadir in death to a 'new normal' once loss is accepted. Drawing on qualitative data from interviews with 15 bereaved family caregivers we challenge bereavement as a linear, temporally bound process, examining the multiple ways bereavement is experienced and how it variously resists ideas about the timeliness, desirability and even possibility of 'recovery'. We posit, on the basis of these accounts, that the lived experience of bereavement offers considerable challenges to normative understandings of the social ties between the living and the dead and requires a broader reconceptualization of bereavement as an enduring affective state. [ABSTRACT FROM AUTHOR]

The impact of a cancer diagnosis flows beyond the person, fundamentally shaping relationships with partners, family and friends. Living with cancer can change people’s needs considerably, often requiring additional care from loved ones, potentially disrupting existing relational expectations, capacities and dynamics. A relational ontological approach is needed to better understand how women’s cancer experiences are inter-subjectively shaped within relationships and by prevailing social scripts. Drawing on interviews with 81 women with cancer, we explore women’s accounts of living with cancer and their experience of ‘care’ within close relationships with others. The interviews revealed how women respond to their illness as an experience in relation to their (male) partners; how they navigate patterns of care in their lives; and how social scripts of gender, care and emotionality shape their experiences. This adds to the sociology of care, and the understanding of care as situated within gendered, relational and social expectations around illness, coping and caring. [ABSTRACT FROM AUTHOR]

Antibiotic resistance poses a significant global threat, yet clinically inappropriate antibiotic use within hospitals continues despite the implementation of abatement strategies. Antibiotic use and the viability of existing antibiotic options now sit precariously at the nexus of political will, institutional governance and clinical priorities ‘at the bedside’. Yet no study has hitherto explored the perspectives of managers, instead of focusing on clinicians. In this article, drawing on qualitative interviews with hospital managers, we explore accounts of responding to antimicrobial resistance, managing antibiotic governance and negotiating clinical and managerial priorities. We argue that the managers’ accounts articulate the problematic nexus of measurement and accountability, the downflow effects of political will, and core tensions within the hospital between moral, managerial and medical authority. We apply Bourdieu’s theory of practice to argue that an understanding of the logics of practice within the ‘hospital management classes’ will be critical in efforts to protect antibiotics for future generations. [ABSTRACT FROM AUTHOR]

Although male suicide has received research attention, the gendered experiences of men bereaved by male suicide are poorly understood. Addressing this knowledge gap, we share findings drawn from a photovoice study of Canadian-based men who had lost a male friend, partner, or family member to suicide. Two categories depicting the men’s overall account of the suicide were inductively derived: (a) unforeseen suicide and (b) rationalized suicide. The “unforeseen suicides” referred to deaths that occurred without warning wherein participants spoke to tensions between having no idea that the deceased was at risk while reflecting on what they might have done to prevent the suicide. In contrast, “rationalized suicides” detailed an array of preexisting risk factors including mental illness and/or substance overuse to discuss cause–effect scenarios. Commonalities in unforeseen and rationalized suicides are discussed in the overarching theme, “managing emotions” whereby participants distanced themselves, but also drew meaning from the suicide. [ABSTRACT FROM AUTHOR]

The ‘typical’ trajectory of a person with cancer has been from diagnosis, through treatment, and towards cure (life) or the end of life (death). Yet, cancer survivorship as a social practice is no longer contained by such neat categorisations. Much of the lived experience of cancer now centres on: living with, rather than beyond, disease; the perpetuity of treatment rather than the spectre of disease; and, making sense of incurability. Using a solicited diary methodology, in this article the authors seek to chronicle life with cancer for those living in the in-between – the often-overlooked lives of incurable survivors. In the analysis of survivors’ diaries, the authors argue for an emphasis on the phenomenology of waiting and sociological exploration of how clinical prognostications affectively haunt the present. This, they posit, will further sociological understandings of the lived experience of affliction and care, especially within relations of chronicity and perpetuity, in this case focusing on advanced cancer and the steadily changing oncological milieu. [ABSTRACT FROM AUTHOR]

India has undergone a considerable epidemiological transition in the past few decades. The rise of cancer and other chronic illnesses has, and will continue to have, a substantial impact on the overall burden of disease, as well as the lived experiences of illness in India. Little is known about the cultural inflection of cancer in the Indian medical, historical and religious/spiritual landscape, which is both highly varied and rapidly changing. Here, we explore some of the issues emergent from individuals’ experiences of illness including their understandings of cancer, its ‘origins’, its meanings and subsequent everyday experiences. Drawing on interviews with 40 people with cancer in Hyderabad, we focus on the cultural ontologies of cancer in India, the social moralities and evolving individual responsibilisation around cancer, and some of the affective dimensions of these interpretations of illness. [ABSTRACT FROM AUTHOR]

Narrative approaches within the social sciences have tended to privilege narrative coherence, with the thematic and sequential progression of one's story from beginning through middle to end often seen as a virtue and as a hallmark of strong narrative identity. Illness narratives, however, often disrupt this temporal order insofar as they render the future-and thus the narrative's end-uncertain. Advanced cancer calls the duration, even possibility, of one's future into question, challenging the normative construction of temporally coherent narratives. In this paper, we draw on recent work theorising contemporary orientations towards the future under the rubric of 'anticipation' to analyse the illness narratives and embodied experiences of people living with advanced cancer. We show how the lived experience of precarious selfhood produced in relation to uncertain futures resists coherent narrativisation. We argue that attending to the affective presence of the future in the present and challenging the normativity of narrative coherence are important dimensions of contemporary cancer narratives. [ABSTRACT FROM AUTHOR]

Given the global crisis of antimicrobial resistance, the continued misuse of antibiotics is perplexing, particularly despite persistent attempts to curb usage. This issue extends beyond traditional “wastage” areas, of livestock and community medicine, to hospitals, raising questions regarding the current principles of hospital practice. Drawing on five focus group discussions, we explore why doctors act in the ways they do regarding antibiotics, revealing how practices are done, justified, and perpetuated. We posit that antibiotic misuse is better understood in terms of social relations of fear, survival and a desire for autonomy; everyday rituals, performances, and forms of professional etiquette; and the mixed obligations evident in the health sector. Moreover, that antibiotic misuse presents as a case study of the broader problematic of defensive medicine. We argue that the impending global antibiotic crisis will involve understanding how medicine is built around certain logics of practice, many that are highly resistant to change. [ABSTRACT FROM AUTHOR]

We are likely moving rapidly toward a post-antibiotic era, as a result of escalating antimicrobial resistance, rapidly declining antibiotic production and profligate overuse. Hitherto research has almost exclusively focused on doctors’ prescribing, with nurses’ roles in antibiotic use remaining virtually invisible. Drawing on interviews with 30 nurses, we focus on nurses as brokers of doctors’ antibiotic decisions, nursing capacity to challenge doctors’ decisions, and, “back stage” strategies for circumnavigating organizational constraints. We argue that nurses occupy an essential and conscious position as brokers within the hospital; a subject position that is not neutral, facilitates (short-term) cohesion, and involves the pursuit of particular (preferred) nursing outcomes. Illustrating how authority can be diffuse, mediated by institutionalized praxis, and how professionals evade attempts to govern their practice, we challenge the reification of physician prescribing power, arguing that it may work against the utilization of nurses as important stakeholders in the future of antibiotics. [ABSTRACT FROM AUTHOR]

Aim Medical consultations focused on managing the transition to palliative care are interpersonally challenging and require high levels of communicative competence. In the context of non-English speaking patients, communication challenges are further complicated due to the requirement of interpreting; a process with the potential to add intense layers of complexity in the clinical encounter, such as misunderstanding, misrepresentation and power imbalances. The aim of the study was to explore the experiences and perspectives of professional interpreters in supporting the transition of culturally and linguistically diverse patients to specialist palliative care. Methods Qualitative, semistructured interviews with 20 professional interpreters working in oncology and palliative care settings in two metropolitan hospitals in Queensland, Australia. Results Four key themes emerged from the thematic analysis: the challenges of translating the meaning of 'palliative care'; managing interpreting in the presence of family care-givers; communicating and expressing sensitivity while remaining professional and interpreters' own emotional burden of difficult clinic encounters between doctor and patient negotiations. Conclusion The results suggest that interpreters face a range of often concealed interpersonal and interprofessional challenges and recognition of such dynamics will help provide necessary support for these key stakeholders in the transition to palliative care. Enriched understanding of interpreters' experiences has clinical implications on improving how health professionals interact and work with interpreters in this sensitive setting. [ABSTRACT FROM AUTHOR]

Social science scholarship on cancer has been almost exclusively focused on Organization for Economic Cooperation and Development (OECD) countries, despite a significant epidemiological transition taking place in many nonOECD contexts, with cancer emerging as a prominent, and strongly feared, illness experience. With cancer gaining an increasingly high profile in India, there is an urgent need to explore how experiences of cancer may be socially and culturally embedded, and in turn, how localized practices may shape the therapeutic encounter. Here, drawing on interviews with 40 people living with cancer in Hyderabad, India, we focus on some specific components of their therapeutic journeys, including diagnostic and prognostic disclosure, collective versus individual decision making, the dynamics of medical authority, and the reception of cancer within their social milieu. These participants' accounts provide insight into a range of cultural sensibilities around illness and care, and reinforce the importance of understanding the cultural inflections of communication, decisions, and illness experiences. [ABSTRACT FROM AUTHOR]

Experiences of cancer are enmeshed with cultural understandings and social discourses around responsibility and causation. A cancer diagnosis can raise questions about its causation -- including the role of the individual -- whereas the disease and its treatment provide various social markers of illness. We present a sociological study of 81 women's accounts of living with cancer, with a focus on how women interpret their illness, in light of their interpersonal interactions and accounts of social relations. Our analysis reveals women's experiences of cancer diagnosis and treatment, the varied sociocultural meanings of cancer and the responses it elicits, the presence of moral assessments within everyday interactions, and the implications for the support and care they receive. We argue that the experience of cancer should be seen as intimately interwoven with its social reception and cultural sense-making practices, including normative constructs which promote ideas about (in)justice, responsibilization, and shame. [ABSTRACT FROM AUTHOR]

Transitions to palliative care can involve a shift in philosophy from life-prolonging to life-enhancing care. People living with a life-limiting illness will often receive palliative care through specialist outpatient clinics, while also being cared for by another medical specialty. Experiences of this point of care have been described as being liminal in character, that is, somewhere between living and dying. Drawing on experiences of illness and care taken from semistructured interviews with 30 palliative care outpatients in Australia, we found that this phase was frequently understood as concurrently living and dying. We suggest that this is a “parallax experience” involving narratives of a coherent linear self that is able to understand both realities, in a way that acknowledges the benefits of being multiple. These findings have significant implications for the ways in which palliative care is understood and how the self and subjectivity might be conceptualized at the end of life. [ABSTRACT FROM AUTHOR]

Ebola has previously been predominantly isolated to African nations, with limited impact in OECD countries. In 2014 Ebola gained international visibility, based largely on the threat of it 'moving west'. Here we examine a group of Australian health professionals' accounts of the Ebola threat including their fears around exposure; the moralities underpinning their responses; the role of othering in framing the threat; and the significance of relations of mistrust. We posit that the threat of Ebola unsettled professional expectations (duty, sacrifice and exposure to risk), rights (choice and safety) and certainty (evidence or knowledge to guide practice). In making sense of the 2014 Ebola threat, the participants articulate dilemmas around human value, the contingency of professional duty and care, and transnational responsibility. [ABSTRACT FROM AUTHOR]

Misuse of antibiotics in hospitals in Australia and internationally is common. The combination of multi-resistant organisms and continued misuse of antibiotics is contributing to a predicted ‘antimicrobial perfect storm’ in the coming decades. Attempts to influence doctors’ use of antibiotics have seen limited success internationally, yet few studies have explored the potential social factors driving current practices within hospitals and the interpersonal processes that underpin persistent ‘suboptimal’ antibiotic use. In this qualitative study of hospital-based Australian doctors we explore some of these dynamics including: the role of clinical uncertainty and ambivalence; experiences of immediate risk; interpersonal and intra-professional pressure; and the role of localised norms and ‘craft groups’ in driving antibiotic practices. We argue that the development of a sociological understanding of antibiotic misuse in the hospital sector (and beyond) is vital for progress to be made in protecting antibiotics for future generations. [ABSTRACT FROM AUTHOR]

Background: Medical oncology is a steadily evolving field of medical practice and professional pathway for doctors, offering value, opportunity and challenge to those who chose this medical specialty. This study examines the experiences of a group of Australian medical oncologists, with an emphasis on their professional practice, career experiences, and existing and emerging challenges across career stages. Methods: In-depth qualitative interviews were conducted with 22 medical oncologists, including advanced trainees, early-career consultants and senior consultants, focusing on: professional values and experiences; career prospects and pathways; and, the nexus of the characteristics of the profession and delivery of care. Results: The following themes were emergent from the interviews: the need for professional reinvention and the pressure to perform; the importance, and often absence, of mentoring and feedback loops; the emotional labour of oncology; and, the impact of cascading workload volume on practice sustainability. Conclusions: Understanding professional experiences, career trajectories and challenges at the workforce level are crucial for understanding what drives the oncological care day-to-day. The results indicate that there are considerable potential tensions between the realities of professional, workforce demands and expectations for patient care. Such tensions have real and significant consequences on individual medical oncologists with respect to their futures, aspirations, satisfaction with work, caring practices, interactions with patients and potentially therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Caring for the dying presents perhaps the most challenging site of informal care. Participation in informal caring roles in such contexts has been prone to reification as a virtuous social practice, often without critical reflection as to the implications for caregivers. Here, drawing on interviews with carers who were providing care in the last few weeks or days of life, we develop an understanding of informal care in this setting as a morally ambiguous social practice, framed by social relations of duty, gift and virtue, but in turn encapsulating experiences of failure, shame and suffering. Such a contradictory understanding of caregiving is critical for understanding the tensions within end-of-life settings and also for countering the concealments produced by the valorization of informal care more broadly in modern societies. We present a critical analysis of informal care's contested character at the end of life, challenging normative understandings that are complicit in producing moral ambivalence, shame and suffering for individual carers. [ABSTRACT FROM AUTHOR]

The shift from life-prolonging and palliative care can be fraught with interpersonal complexities as patients face dilemmas around mortality and the dying process. Nurses can play a central role in managing these moments, often with a focus on promoting and enhancing communication around: the meaning of palliative care, the nature of futility and the dying process more broadly. These sites of nurse–patient communication can be highly charged and pose unique challenges to nurses including how to balance nursing perspectives versus those of other stakeholders including doctors. Here, drawing on interviews with nurses, we explore their accounts of communication about futility and the process of transitioning to palliative care. The interviews reveal nurses’ perspectives on the following: the art of conversing around futility and managing patient resistance, the influence of guilt and individual biographies in shaping communication, the importance of non-verbal and the informal in communication, the impact of conflicting organisational expectations on nurses and the process of learning to effectively communicate. We argue that these transitional moments articulate important, and at times problematic, aspects of contemporary nursing and nurse–medical relations. [ABSTRACT FROM AUTHOR]

Objectives: Escalating antimicrobial resistance worldwide necessitates urgent optimization of antimicrobial prescribing to preserve antibiotics for future generations. Early intravenous (iv) to oral switch campaigns are one strategy that hospital-based antimicrobial stewardship programmes can incorporate to minimize inappropriate antibiotic use. Yet, iv antibiotics continue to be offered for longer than is clinically indicated, increasing hospital length of stay, increasing costs and placing patients at risk (e.g. cannula-related infections). This study aims to identify why this inappropriate prescribing trend continues.Methods: Twenty doctors (9 females and 11 males) working at a teaching hospital in north-east England participated in semi-structured interviews about their experiences of antibiotic use. NVivo10 software was used to conduct a thematic content analysis of the full interview transcripts driven by the framework approach. Results are reported according to COREQ guidelines.Results: Decisions around the choice of iv over oral antibiotics were influenced by three key issues: (i) consumerism, i.e. participants were concerned about the risk of litigation or complaints if patient expectations were not met; (ii) hierarchy of the medical team structure limited opportunities for de-escalation of antibiotics; and (iii) iv antibiotics were perceived as more potent and having significant mythical qualities, which participants acknowledged were not necessarily evidence based.Conclusions: The iv to oral switch interventions should tailor strategies to demystify iv versus oral antibiotic efficacy, engage consumers around the negative effects of iv antibiotic overuse and examine strategies to streamline team decision-making. Addressing these issues has the potential to reduce inappropriate antibiotic use and resistance. [ABSTRACT FROM AUTHOR]

The antibiotic optimisation imperative is now ubiquitous, with national policy frameworks in Organisation for Economic Co‐operation and Development (OECD) countries incorporating the requirement for antimicrobial stewardship within healthcare services. Yet in practice, the optimisation agenda often raises complex ethical‐ and practice‐based dilemmas. Antibiotic use at the end of life is multidimensional. It includes balancing complex issues, such as accuracy of prognostic estimates, benevolence to the individual versus the broader public health, personalised value judgement of time and quality of life and the right to treatment versus the right to die. It also occurs in an emotional context where the clinician and patient (and their family) collectively confront mortality. This provides a scenario where amplification of the already strong social and behavioural forces that drive overuse of antibiotics in many other clinical settings may occur. It therefore offers an important case for illustrating how antibiotic optimisation may be limited by social, value‐based and ethical dilemmas. [ABSTRACT FROM AUTHOR]

Home is frequently idealised as the preferred location for end-of-life care, while in-patient hospital care is viewed with suspicion and fear. Yet many people with a terminal illness spend their final days in some form of medicalised institutional setting, such as a specialist palliative care in-patient unit. Drawing on semi-structured interviews with in-patients at a specialist palliative care unit, we focus on their difficulties in finding a better place of care at the end of their life. We found that participants came to conceptualise home though a sense of bodily vulnerabilities and that they frequently understood institutional care to be more about protecting their family from the social, emotional and relational burdens of dying. For a significant number of participants the experience of dying came to be understood through what could be practically accomplished in different locales. The different locales were therefore framed around providing the best care for the patient and their family. [ABSTRACT FROM AUTHOR]

Background: Antibiotic treatment options for common infections are diminishing due to the proliferation of antimicrobial resistance (AMR). The impact of Antimicrobial Stewardship (AMS) programs seeking to preserve viable antibiotic drugs by governing their use in hospitals has hitherto been limited. Pharmacists have been delegated a critical role in antibiotic governance in AMS teams within hospitals but the experience of pharmacists in influencing antibiotic use has received limited attention. In this study we explore the experiences of pharmacists in antibiotic decision-making in two Australian hospitals.Methods: We conducted 19 semi-structured interviews to explore hospital-based pharmacists' perceptions and experiences of antibiotic use and governance. The analysis was conducted with NVivo10 software, utilising the framework approach.Results: Three major themes emerged in the pharmacist interviews including (1) the responsibilities of pharmacy in optimising antibiotic use and the interprofessional challenges therein; (2) the importance of antibiotic streamlining and the constraints placed on pharmacists in achieving this; and (3) the potential, but often under-utilised expertise, pharmacists bring to antibiotic optimisation.Conclusions: Pharmacists have a critical role in AMS teams but their capacity to enact change is limited by entrenched interprofessional dynamics. Identifying how hospital pharmacy's antibiotic gatekeeping is embedded in the interprofessional nature of clinical decision-making and limited by organisational environment has important implications for the implementation of hospital policies seeking to streamline antibiotic use. Resource constraints (i.e. time limitation and task prioritisation) in particular limit the capacity of pharmacists to overcome the interprofessional barriers through development of stronger collaborative relationships. The results of this study suggest that to enact change in antibiotic use in hospitals, pharmacists must be supported in their negotiations with doctors, have increased presence on hospital wards, and must be given opportunities to pass on specialist knowledge within multidisciplinary clinical teams. [ABSTRACT FROM AUTHOR]

The misuse of antibiotics has become a major public health problem given the global threat of multi-resistant organisms and an anticipated ‘antimicrobial perfect storm’ within the next few decades. Despite recent attempts by health service providers to optimise antibiotic usage, widespread inappropriate use of antibiotics continues in hospitals internationally. In this study, drawing on qualitative interviews with Australian pharmacists, we explore how they engage in antibiotic decisions in the hospital environment. We develop a sociological understanding of pharmacy as situated within evolving interprofessional power relations, inflected by an emerging milieu whereby antibiotic optimisation is organisationally desired but interprofessionally constrained. We argue that the case of antibiotics articulates important interprofessional asymmetries, positioning pharmacists as delimited negotiators within the context of medical prescribing power. We conclude that jurisdictional uncertainties, and the resultant interprofessional dynamics between pharmacy and medicine, are vital delimiting factors in the emerging role of pharmacists as ‘antimicrobial stewards’ in the hospital environment. Moreover, we argue that a nuanced understanding of the character of interprofessional negotiations is key to improving the use of antibiotics within and beyond the hospital. [ABSTRACT FROM AUTHOR]

Chronic back pain is a major health and social problem in Australia, often concealed and given limited credibility vis-a-vis other health conditions. Care practices are diversified with allied health, biomedical and complementary and alternative medicine (CAM) practitioners regularly being consulted for help and care, often concurrently. While this differentiated ‘healthcare market’ may on one level be viewed as positive in terms of diverse therapeutic choices, there is also potential for difficulties with regard to care practices and negotiating competing therapeutic modalities. Drawing on qualitative interviews with 50 women aged 60–65 from the Australian Longitudinal Study on Women’s Health living with chronic back pain, this article explores their accounts of suffering and the experiences of engaging in pluralistic healthcare choices, with a particular focus on CAM. The findings reveal the ways by which healthcare pluralism is connected to the dynamics of suffering and relations of recognition. [ABSTRACT FROM AUTHOR]

Chronic back pain affects a significant proportion of older women, often with severe implications for their social lives, relationships and families. It is often characterized by intractability and causative ambiguity, challenging a range of medical and moral boundaries around sickness and wellness. In this study, we utilize solicited diaries with women to capture the day-to-day undulations of living with chronic back pain. These diaries provide rich insight into issues around: disrupted roles and social lives; experiences of perpetuality and isolation; acts of pretense and withdrawal; and, its perceived illegitimacy as an illness experience. Situated within gendered and life-stage cultural scripts, these women’s diaries illustrate how ideas about legitimacy and worthiness circulate within and around the social milieu of chronic back pain. We posit that individualized shame and dynamics of recognition are central to women’s suffering, reflecting persistent and disruptive social hierarchies of illness. [ABSTRACT FROM AUTHOR]