학술논문
Clinician perspectives on characteristics and care of traumatic brain injury among asylum seekers and refugees.
Document Type
Academic Journal
Author
Jahan N; Tufts University School of Medicine, Boston, MA, USA.; Velasco M; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.; Vranceanu AM; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Alegría M; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.; Saadi A; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.
Source
Publisher: Taylor & Francis Country of Publication: England NLM ID: 9207179 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1464-5165 (Electronic) Linking ISSN: 09638288 NLM ISO Abbreviation: Disabil Rehabil Subsets: MEDLINE
Subject
Language
English
Abstract
Purpose: Traumatic brain injury (TBI) disproportionately affects asylum-seekers and refugees (ASR), although underdiagnosed and undertreated. Our study assesses clinicians' perspectives on characteristics and management of TBI among ASR, with the hope of improving TBI management in this population.
Materials and Methods: We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach.
Results: Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population.
Conclusion: Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery.
Materials and Methods: We conducted six focus groups of 16 clinicians across two academic medical centers in Boston, Massachusetts, United States. Clinicians in our sample included primary care clinicians, nurse practitioners, social workers, psychologists, neurologists, psychiatrists, and neuropsychologists. We analyzed the qualitative data following a hybrid inductive-deductive thematic analytic approach.
Results: Clinicians characterized TBI among ASR as mostly mild and remote, involving head strikes, perpetrated predominantly by interpersonal violence and strangulation-related brain injury, and involving symptom overlap with mental health diagnoses, challenging diagnosis. Clinicians also described inadequate screening, the importance of connecting the physical and psychological symptoms of the brain injury rather than viewing them as distinct, and addressing diagnosis-related stigma and shame. Finally, they discussed lack of TBI-specific knowledge among providers and patients alike, and resource limitations affecting the continuum of care for this population.
Conclusion: Integrating clinicians' perspectives in caring for this population allows us to best meet their needs, including in TBI recovery.