Thesis (Ph.D.)--University of Central Florida, 2008. / Advisers: Edward H. Robinson, III, Glenn Lambie. Includes bibliographical references (p. 134-155).

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Submitted in fulfilment of the requirements for the Degree Philosophiae Doctor in Health Sciences, Durban University of Technology, 2017. / Background Cancer is a global concern because it affects and kills millions of people worldwide. In South Africa, patients frequently move between traditional health practitioners and radiation oncologists to seek cure of cancer, yet these health practitioners do not communicate with each other. Consequently, the treatment is often disrupted and imcomplete therefore compromising the survival of patients. The future of the health system in effective treatment of patients with cancer is dependent on health practitioners’ changing fundamentally in their co-operative practice. The aim of this study was to explore the practice of traditional health practitioners in the treatment of patients with cancer in order to describe a viable co-operative practice between them and radiation oncologists and ultimately develop traditional health practitioners as a component in the health system in the treatment of patients with cancer. Methods An exploratory descriptive qualitative study using an interpretive phenomenological approach was employed to collect data from 28 traditional health practitioners and four radiation oncologists in KwaZulu-Natal utilising snowball and stratified purposive samplings for the former and latter, respectively. Semi-structured face-to-face and group interviews were employed to collect primary data from traditional health practitioners and data from the radiation oncologists were collected through face-to-face and email interviews. Data were transcribed verbatim and analysed using framework analysis. Results It emerged that the referral of patients, in addition to external conditions, individual attributes, trusting attitudes of participants as well as organisational dynamics and philosophy of practice, were the main categories used by participants in their understanding of co-operative practice in KwaZulu-Natal. The patient is the main player in the co-operation between parties, and coordinates the health practitioners’ activities during treatment. Effective co-operative practice is time consuming and requires commitment, co-operation and training of the participants. Conclusion Considering the problems associated with treatment of cancer when patients move freely between the traditional health practitioners and radiation oncologists, resulting in interruptions in treatment, co-operative practice between the two health practitioners is paramount. The development of traditional health practitioners could result in extending their role in the management of cancer and therefore increasing the accessibility of cancer services. It follows that a workable practice between traditional health practitioners and radiation oncologists in the treatment of patients with cancer could be an inclusive health system where the parties work in parallel with the patient being the main actor in the collaboration. There should be a healthy relationship between all those involved in the collaboration in order to facilitate referral of patients between the health practitioners. / D

O que acontece no encontro do médico com a morte do seu paciente diz de algo estruturante da condição humana que transcende a formação acadêmica e mobiliza por este estar na presença de outro ser humano. Trata-se de uma pesquisa qualitativa que teve como objetivo principal descrever e conhecer o que existe de estruturante no encontro do médico com a morte do seu paciente. Este estudo utiliza o método fenomenológico de pesquisa, entendido como um convite para o exercício reflexivo visando à construção de novos paradigmas na produção de conhecimento. O autor de base que fundamenta a análise teórica foi Maurice Merleau-Ponty (2006). Foram realizadas quatro entrevistas com médicos oncologistas clínicos, embasadas na pergunta norteadora: O que significa para você cuidar do paciente oncológico, sem possibilidade de cura, que vivencia o seu processo de morrer e posteriormente perdê-lo?. Após a realização das entrevistas, os relatos (ingênuos) foram literalizados, dos quais foram levantadas as unidades de análise e transformadas em categorias analisadas fenomenologicamente, que possibilitaram o diálogo intersubjetivo e objetivo com os pressupostos teóricos sobre o tema em pauta. Categorias estas denominadas de: 1. Relação médico e paciente: o desvelar das emoções e sentimentos; 2. Relação médico e paciente: um distanciamento da morte do paciente; 3. O encontro do médico com a morte: a morte imprevisível; 4. Construção da identidade do sujeito: a dimensão ética do ser médico. A partir da análise das categorias, observou-se que tal encontro ocorre de diversas formas, principalmente pelo distanciamento como os médicos em questão lidam com a morte de seus pacientes, vista como um acidente, com falta de diálogo que, necessariamente, esbarra nas questões éticas e de formação acadêmica. A estrutura do fenômeno reside na ausência de diálogo pela dificuldade de lidar com os próprios sentimentos e emoções emergidas do processo de perda por morte de seus pacientes / What happens in the doctors encounter with the death of his patient says about human condition structuring which transcends academic formation and mobilizes in the presence of another human being.This is a qualitative research which had as its principal aim to describe and know what exists of structuring in the doctors encounter with the death of his patient. This study uses the phenomenological method of research, understood as an invitation to the reflexive exercise which aims the construction of new paradigms in the knowledge production.The fundamental author who substantiates the theorical analysis is Maurice Merleau-Ponty (2006). Four interviews with clinical oncologist doctors were made, based on the guiding question: What means to you to take care of the cancer patient, without the possibility of healing, who experiences his dying process and eventually lose him?After the interviews were made, the narratives (literal) were literalized, from which the analysis units were raised and transformed into phenomenologically analyzed categories, which enabled the intersubjective and objective dialog with the theoretical presuppositions about the subject under discussion.These categories are named: 1. Relation between doctor and patient: the unveiling of emotions and feelings; 2. Relation between doctor and patient: a detachment from the patients death; 3. The doctors encounter with death: the unpredictable death; 4. Construction of the subjects identity: the ethical dimension of being a doctor. From the analysis of the categories it was possible to observe that such encounter occurs in several ways, mainly by the detachment which the doctors from this study deal with the death of their patients, seen as an accident, with lack of dialog that necessarily touches the ethical and academic formation questions. The structure of the phenomenon dwells in the lack of dialog due to the difficulty to deal with ones own feelings and emotions emerged from the process of losing ones patients by death

O que acontece no encontro do médico com a morte do seu paciente diz de algo estruturante da condição humana que transcende a formação acadêmica e mobiliza por este estar na presença de outro ser humano. Trata-se de uma pesquisa qualitativa que teve como objetivo principal descrever e conhecer o que existe de estruturante no encontro do médico com a morte do seu paciente. Este estudo utiliza o método fenomenológico de pesquisa, entendido como um convite para o exercício reflexivo visando à construção de novos paradigmas na produção de conhecimento. O autor de base que fundamenta a análise teórica foi Maurice Merleau-Ponty (2006). Foram realizadas quatro entrevistas com médicos oncologistas clínicos, embasadas na pergunta norteadora: O que significa para você cuidar do paciente oncológico, sem possibilidade de cura, que vivencia o seu processo de morrer e posteriormente perdê-lo?. Após a realização das entrevistas, os relatos (ingênuos) foram literalizados, dos quais foram levantadas as unidades de análise e transformadas em categorias analisadas fenomenologicamente, que possibilitaram o diálogo intersubjetivo e objetivo com os pressupostos teóricos sobre o tema em pauta. Categorias estas denominadas de: 1. Relação médico e paciente: o desvelar das emoções e sentimentos; 2. Relação médico e paciente: um distanciamento da morte do paciente; 3. O encontro do médico com a morte: a morte imprevisível; 4. Construção da identidade do sujeito: a dimensão ética do ser médico. A partir da análise das categorias, observou-se que tal encontro ocorre de diversas formas, principalmente pelo distanciamento como os médicos em questão lidam com a morte de seus pacientes, vista como um acidente, com falta de diálogo que, necessariamente, esbarra nas questões éticas e de formação acadêmica. A estrutura do fenômeno reside na ausência de diálogo pela dificuldade de lidar com os próprios sentimentos e emoções emergidas do processo de perda por morte de seus pacientes / What happens in the doctors encounter with the death of his patient says about human condition structuring which transcends academic formation and mobilizes in the presence of another human being.This is a qualitative research which had as its principal aim to describe and know what exists of structuring in the doctors encounter with the death of his patient. This study uses the phenomenological method of research, understood as an invitation to the reflexive exercise which aims the construction of new paradigms in the knowledge production.The fundamental author who substantiates the theorical analysis is Maurice Merleau-Ponty (2006). Four interviews with clinical oncologist doctors were made, based on the guiding question: What means to you to take care of the cancer patient, without the possibility of healing, who experiences his dying process and eventually lose him?After the interviews were made, the narratives (literal) were literalized, from which the analysis units were raised and transformed into phenomenologically analyzed categories, which enabled the intersubjective and objective dialog with the theoretical presuppositions about the subject under discussion.These categories are named: 1. Relation between doctor and patient: the unveiling of emotions and feelings; 2. Relation between doctor and patient: a detachment from the patients death; 3. The doctors encounter with death: the unpredictable death; 4. Construction of the subjects identity: the ethical dimension of being a doctor. From the analysis of the categories it was possible to observe that such encounter occurs in several ways, mainly by the detachment which the doctors from this study deal with the death of their patients, seen as an accident, with lack of dialog that necessarily touches the ethical and academic formation questions. The structure of the phenomenon dwells in the lack of dialog due to the difficulty to deal with ones own feelings and emotions emerged from the process of losing ones patients by death