Individuals in multiproblem situations frequently seek frontline legal support. The support by frontline legal professionals is limited by its focus on the legal issue instead of the underlying problems. A strong focus on client values – i.e. on the outcome that these services yield in the client’s perception – may lead to a more effective approach by targeting underlying problems. Through individual interviews with clients and professionals, the current study examines client values and services that may contribute to those client values. Besides functional client values that focus on resolving the problem situation, emotional client values, such as trust prove at least as important. Furthermore, client values are not only supported by the professional’s legal expertise, accessibility and ability to build a relationship, but also by the professional’s knowledge and skills relevant to multiproblem situations, such as his ability to empower the client, the willingness to work on concrete needs, and his ability to adopt an integrated approach. Research findings confirm the relevance of an integrated approach to multiproblem situations, with due attention to different client values. Similarly, it proves important to incorporate skills and knowledge that specifically address multiproblem situations in education and training programmes of frontline legal professionals. Nederlandse samenvatting: Mensen in multiprobleem situaties maken veelvuldig gebruik van eerstelijns rechtshulp. De ondersteuning door eerstelijns rechtshulp wordt beperkt door de focus op de voorliggende rechtsvraag, in plaats van de onderliggende problematiek. Een sterke focus op klantwaarden – de opbrengsten van de dienstverlening in de ogen van de cliënt – zou weleens tot een effectievere werkwijze kunnen leiden, omdat de achterliggende problemen worden aangepakt. Aan de hand van diepteinterviews onder cliënten en professionals is onderzocht welke klantwaarden voor deze doelgroep relevant zijn en welke dienstverleningsaspecten daaraan kunnen bijdragen. Naast functionele klantwaarden gericht op oplossingen voor de probleemsituatie, blijken emotionele klantwaarden als vertrouwen en ontzorging minstens zo relevant. Ook dragen niet alleen juridisch vakmanschap, bereikbaarheid en de vaardigheden om met de klant een relatie op te bouwen van de professional aan klantwaarden bij, maar ook specifieke kennis en vaardigheden gericht op multiproblematiek, zoals de vaardigheid om de klant te empoweren, de bereidheid om te werken aan concrete behoeften, en het werken met een geïntegreerde aanpak. De onderzoeksbevindingen onderstrepen de relevantie van een integrale aanpak bij multiproblematiek met aandacht voor diverse klantwaarden. Evenzo blijkt van belang dat vaardigheden en kennis die specifiek gericht zijn op multiproblematiek in de opleiding van eerstelijns rechtshulp professionals worden geïncorporeerd.
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Background: The majority of patients diagnosed with early-stage breast cancer are in a position to choose between having a mastectomy or lumpectomy with radiation therapy (breast-conserving therapy). Since the long-term survival rates for mastectomy and for lumpectomy with radiation therapy are comparable, patients’ informed preferences are important for decision-making. Although most clinicians believe that they do include patients in the decision-making process, the information that women with breast cancer receive regarding the surgical options is often rather subjective, and does not invite patients to express their preferences. Shared decision-making (SDM) is meant to help patients clarify their preferences, resulting in greater satisfaction with their final choice. Patient decision aids can be very supportive in SDM. We present the protocol of a study to β test a patient decision aid and optimise strategies for the implementation of SDM regarding the treatment of early-stage breast cancer in the actual clinical setting. Methods/design: This paper concerns a preimplementation and post-implementation study, lasting from October 2014 to June 2015. The intervention consists of implementing SDM using a patient decision aid. The intervention will be evaluated using qualitative and quantitative measures, acquired prior to, during and after the implementation of SDM. Outcome measures are knowledge about treatment, perceived SDM and decisional conflict. We will also conduct face-to-face interviews with a sample of these patients and their care providers, to assess their experiences with the implementation of SDM and the patient decision aid.
