scholarly journals Implementation of a Meaning-Centered Psychotherapy training (MCPT) program for oncology clinicians: a qualitative analysis of facilitators and barriers

2019 ◽  
Author(s):  
Laura C Polacek ◽  
Sally Reisch ◽  
Rebecca M Saracino ◽  
Hayley Pessin ◽  
William Breitbart
Keyword(s):  
Psychotherapy Training ◽  
Psychosocial Treatment ◽  
Patient Treatment ◽  
Free Text ◽  
Care Providers ◽  
Psychosocial Needs ◽  
Clinical Implementation ◽  
Free Text Response ◽  
Text Response ◽  
Facilitators And Barriers

Abstract The Meaning-Centered Psychotherapy training program (MCPT) is a multimodal, intensive, in-person program that trains cancer care providers in the evidence-based psychosocial treatment Meaning-Centered Psychotherapy (MCP). This analysis aimed to identify barriers and facilitators to clinical implementation (CI) at 1 year post-training. Trainee feedback regarding CI was collected via a mixed-methods questionnaire, including rating the ease of CI and free-text response identifying facilitators and barriers to CI. Descriptive statistics and thematic content analysis of follow-up data from the first five MCPT training cohorts (n = 55) were performed to assess CI and its facilitators and barriers. One third of participants indicated that it was at least somewhat difficult to implement MCP in clinical practice. Trainee-identified facilitators and barriers to CI were characterized within four main categories: program, patient, treatment, and institution. Within each of these factors, clinicians reported a variety of components that contributed to or hindered their ability to implement MCP. MCPT itself was reported as a facilitator. Patient access and interest were simultaneously identified as facilitators for some and barriers for others. Some trainees found the MCP treatment structure helpful in addressing important patient psychosocial needs, while others felt it was too restrictive. Institutional support played an important role in whether trainees felt hindered or helped to implement MCP. These initial results provide important insight into the program’s strengths and have fostered improvements to the MCPT program to better facilitate CI. Further study of MCPT CI is warranted, and theme refinement will be possible with a larger sample.

Defining Legacy: The Perceptions of Pediatric Health Care Providers

2020 ◽  
Vol 59 (11) ◽  
pp. 1004-1010
Author(s):  
Jessika Boles ◽  
Maile Jones ◽  
Jenna Dunbar ◽  
Jessica Cook
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Family Relationships ◽  
Medical Center ◽  
Academic Medical Center ◽  
Free Text ◽  
Care Providers ◽  
Pediatric Health ◽  
Pediatric Health Care ◽  
Free Text Response

Legacy building interventions like plaster hand molds are offered in most children’s hospitals, yet little is known about how the concept of legacy is understood and described by pediatric health care providers. Therefore, this study explored pediatric health care providers’ perceptions of legacy at an academic medical center to ensure that future legacy interventions are evidence-informed and theoretically grounded. An electronic survey featuring three open-ended questions and two multiple-choice questions with an option for free text response was completed by 172 medical and psychosocial health care providers. Analysis yielded four themes: (1) legacy is intergenerational, enduring, and typically associated with end-of-life; (2) legacies articulate the impacts on others for which one is known and remembered; (3) legacies can be expressed through tangible items or intangible qualities; and (4) legacies are informed and generated by family relationships and work experiences. By understanding legacy as a personally and professionally contextualized experience, health care providers can better assess and meet the legacy needs of hospitalized pediatric patients and families.

scholarly journals P025: Improving senior resident engagement at academic core rounds

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S72
Author(s):  
M. Cortel-LeBlanc ◽  
J. Landreville ◽  
L. Thurgur
Keyword(s):  
Thematic Analysis ◽  
Senior Resident ◽  
Free Text ◽  
Core Content ◽  
Free Text Response ◽  
Recent Graduates ◽  
Text Response ◽  
On Line ◽  
Competency Based ◽  
The University

Introduction: Royal College Emergency Medicine (EM) trainees at the University of Ottawa participate in weekly Academic Full Days (AFD) that consist of didactic activities, simulation-based learning, and core content sessions referred to as Core Rounds (CR). Despite CR being intentioned for all EM trainees, an attendance attrition has been noted as trainees progress towards their senior (SR) years (PGY3-5). The objectives of this study were to (1) identify barriers to SR trainee CR attendance and (2) identify areas for CR improvement. Methods: An on-line survey was administered to SR EM trainees (PGY3-5, n = 28) and recent graduates from our program (practice year 1-2, n = 20) to explore perceptions of the value of AFDs, CR attendance barriers, and areas for CR improvement. The survey consisted of 5-point Likert scales and free-text responses. Quantitative responses were analyzed using Microsoft Excel. Free-text responses were analyzed qualitatively using thematic analysis. Each free-text response was reviewed independently by two investigators (JML, MCL) and underwent line-by-line coding. Through joint discussions, the codes from each response were synthesized and themes were identified. Results: Of the 48 trainees and attendings surveyed, 32 responded (response rate 67%). Most respondents (90%) stated they benefited from SR trainee attendance when they were at a junior (JR) level. The majority perceived they benefited less from CR as a SR trainee compared to when they were a JR trainee (85%). Further, 87% responded that CR were not tailored to a SR level, and that they would attend more frequently if sessions were geared to their level (81%). From our thematic analysis, three themes emerged relating to SR trainee absenteeism: 1) CR quality, 2) External Factors (eg. trainee fatigue) and 3) Malalignment with trainees’ own education plan. We also identified three themes relating to areas for CR improvement: 1) CR content, 2) CR format and 3) SR trainee involvement. Conclusion: Respondents indicated a benefit to having SR trainee presence at CR. This study identified barriers to SR resident attendance at CR and areas for improvement. With the transition to competency based medical education it is critical that trainees engage in effective educational experiences, especially as the RCPSC does not mandate AFDs for EM training in this new curriculum. A culture-change initiative and CR reformat is now underway at our institution with planned post-implementation analysis.

scholarly journals The Notion of Presence in a Telematic Cross-Disciplinary Program for Music, Communication and Technology

2020 ◽  
pp. 77-101
Author(s):  
Robin Støckert ◽  
Andreas Bergsland ◽  
Anna Xambó
Keyword(s):  
Online Survey ◽  
Research Literature ◽  
Free Text ◽  
Learning Space ◽  
Sense Of Presence ◽  
Free Text Response ◽  
Text Response ◽  
Learning Scenarios ◽  
Communication And Technology ◽  
Communications System

This chapter examines how students in a two-campus, cross-disciplinary program in Music, Communication and Technology (MCT) experience the sense of presence of peer students and teachers, some physically co-localized while others are present via an audiovisual communications system. The chapter starts by briefly delineating the MCT program, the audiovisual communications system and the learning space built around it, named the Portal, and the research project SALTO which frames the current study. We then review research literature on presence relevant to this particular context and use this as a basis for the design of an online survey using a combination of Likert items and free text response. Our main findings, based on responses from the 16 students who participated in the survey, are that the mediating technologies of the Portal affect the experience of presence negatively, but that formal learning scenarios are less affected than informal scenarios that require social interaction.

scholarly journals Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fitriana Murriya Ekawati ◽  
Sharon Licqurish ◽  
Jane Gunn ◽  
Shaun Brennecke ◽  
Phyllis Lau
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Delphi Survey ◽  
Care Practice ◽  
Free Text ◽  
Care Providers ◽  
Hypertensive Disorders Of Pregnancy ◽  
Implementation Barriers ◽  
Primary Care Settings ◽  
Hypertensive Disorders

Abstract Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice.

scholarly journals Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

2020 ◽  
Vol 28 (1) ◽  
pp. 13-25
Author(s):  
Soleil Chahine ◽  
Gordon Walsh ◽  
Robin Urquhart
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Sociodemographic Factors ◽  
Patient Navigator ◽  
Care Providers ◽  
Psychosocial Needs ◽  
Factors Associated ◽  
Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

scholarly journals Quantitative Assessment of 3D Dose Rate for Proton Pencil Beam Scanning FLASH Radiotherapy and Its Application for Lung Hypofractionation Treatment Planning

Cancers ◽  
2021 ◽  
Vol 13 (14) ◽  
pp. 3549
Author(s):  
Minglei Kang ◽  
Shouyi Wei ◽  
J. Isabelle Choi ◽  
Charles B. Simone ◽  
Haibo Lin
Keyword(s):  
Dose Rate ◽  
Treatment Planning ◽  
Organs At Risk ◽  
Patient Treatment ◽  
Average Dose ◽  
Clinical Implementation ◽  
Flash Intensity ◽  
Dose Threshold ◽  
Rate Calculation ◽  
The Impact

To quantitatively assess target and organs-at-risk (OAR) dose rate based on three proposed proton PBS dose rate metrics and study FLASH intensity-modulated proton therapy (IMPT) treatment planning using transmission beams. An in-house FLASH planning platform was developed to optimize transmission (shoot-through) plans for nine consecutive lung cancer patients previously planned with proton SBRT. Dose and dose rate calculation codes were developed to quantify three types of dose rate calculation methods (dose-averaged dose rate (DADR), average dose rate (ADR), and dose-threshold dose rate (DTDR)) based on both phantom and patient treatment plans. Two different minimum MU/spot settings were used to optimize two different dose regimes, 34-Gy in one fraction and 45-Gy in three fractions. The OAR sparing and target coverage can be optimized with good uniformity (hotspot < 110% of prescription dose). ADR, accounting for the spot dwelling and scanning time, gives the lowest dose rate; DTDR, not considering this time but a dose-threshold, gives an intermediate dose rate, whereas DADR gives the highest dose rate without considering any time or dose-threshold. All three dose rates attenuate along the beam direction, and the highest dose rate regions often occur on the field edge for ADR and DTDR, whereas DADR has a better dose rate uniformity. The differences in dose rate metrics have led a large variation for OARs dose rate assessment, posing challenges to FLASH clinical implementation. This is the first attempt to study the impact of the dose rate models, and more investigations and evidence for the details of proton PBS FLASH parameters are needed to explore the correlation between FLASH efficacy and the dose rate metrics.

Facilitators and Barriers to Clinical Pathway Uptake and Utilization among Primary Care Providers in Saskatchewan – A Qualitative Study

2021 ◽  
Author(s):  
Gary Groot ◽  
Shaliny Ollegasagrem ◽  
Mahasti Khakpour ◽  
Adel Panahi ◽  
Donna Goodridge ◽  
...  
Keyword(s):  
Wound Care ◽  
Clinical Pathways ◽  
Complex Interventions ◽  
Family Physicians ◽  
Standardize Patient ◽  
Primary Care Providers ◽  
System Level ◽  
It Services ◽  
Care Providers ◽  
Facilitators And Barriers

Abstract Background: Clinical Pathways (CPWs) are multidisciplinary, evidence based, complex interventions designed to standardize patient care. In Saskatchewan, development, implementation, and evaluation of seven provincial CPWs (Hip & Knee, Spine, Pelvic Floor, Prostate Assessment, Fertility Care, Lower Extremity Wound Care, and Acute Stroke) present significant challenges, leading to lower uptake and utilization. This study aimed to identify facilitators and barriers to CPW uptake and utilization by Family Physicians in Saskatchewan. Methods: A qualitative interpretive approach was used consisting of eight one-on-one key informant (KI) interviews and five focus groups (FG) in identifying the facilitators and barriers to CPWs. KIs had been involved in the design and implementation of CPWs. FGs were held with 30 Family Physicians in two urban and two rural Saskatchewan cities. All interviews were audio recorded and transcribed. Inductive, thematic analysis of the interviews based on the Theoretical Domain Framework (TDF) for behavioral changes was used to identify facilitators and barriers to CPW uptake and utilization by Family Physicians.Results: KI interviews informed the FG interview guide. From 5 FG discussions, 51 themes emerged and were mapped under 14 TDF domains. Family Physicians notably emphasized the barriers for utilizing CPWs. Major barriers were: system-level (knowledge & communication, social/professional identity, Family Physician engagement and education); objective clarification (goals, belief about consequences of implementing CPW) and technical and resource related (administrative, access to local specialists, enforcement and incentives). The most prominent barrier was lack of systematic CPW promotion and inconsistencies in communication between: organization to practitioner; organization to organization; and practitioner to practitioner. Facilitators were recognized to mitigate barriers and ranged from need for optimized and integrated IT services (i.e. Electronic Medical Records), to optimism towards CPW usage and patient outcomes. Conclusions: Informed by data from KIs and FGs, this exploratory study identified specific improvements required to promote uptake of CPWs based on perceived facilitators and barriers. Recommendations are provided to enhance uptake among FPs. These initial findings will inform the creation of a theory-based, province -wide survey instrument to further evaluate CPWs.

scholarly journals Perceptions, Facilitators And Barriers of Physical Activity Among People Living With HIV: A Qualitative Study

2021 ◽  
Author(s):  
Brenda Kitilya ◽  
Erica Sanga ◽  
George PrayGod ◽  
Robert Peck ◽  
Bazil B Kavishe ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Care Providers ◽  
Gender Stereotypes ◽  
Ecological Model ◽  
People Living With Hiv ◽  
Activity Levels ◽  
Care Providers ◽  
Middle Income ◽  
Facilitators And Barriers ◽  
Living With Hiv

Abstract BackgroundPeople Living with HIV (PLWH) have low levels of physical activity. Understanding of perceptions, facilitators and barriers of physical activity in this population is of importance for future perspectives in developing contextual based intervention to improve physical activity in PLWH. MethodThis study explored perceptions, facilitators and barriers of physical activity in PLWH using sixteen in-depth interviews and three focus group discussions conducted in Mwanza, Tanzania. The interviews and discussions were audio recorded, transcribed and translated into English. Transcripts were coded and analysed deductively using thematic content analysis. The themes were interpreted and presented using the social ecological model. ResultsForty-three PLWH age 23-61 years old participated in this study. The findings showed that, PLWH perceived physical activity was beneficial to their health and that their perceptions and practices were rooted within the existing gender stereotypes and roles in the community. In addition to that, house-chores and income generating activities were perceived as sufficient physical activity to achieve adequate levels of physical activity. As facilitators, social support and interactions from family and friends were appraised positively as motivating factors of physical activity in this population. Indeed, at individual to community/environmental levels, PLWH reported barriers of physical activity were lack of time, money, and availability of facilities, as well as lack of social groups participating in physical activity in the communities and inadequate information on physical activity from health care providers at ART clinics. HIV disease was not reported as a main barrier of physical activity but rather stipulated from family members as a reason not to support physical activity in PLWH. ConclusionThe findings demonstrated differing perceptions, facilitators and barriers of physical activity among PLWH. Interventions addressing physical activity awareness, gender stereotypes and roles relating to physical activity performances from individual to community level, building supportive environment and infrastructures are needed to elevate physical activity levels in PLWH particularly in low and -middle income countries.

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