Colorectal cancer survivors’ experience of continuity of care provided by different health professionals: A qualitative evidence synthesis

ObjectivesWe aimed to explore healthcare professionals’ experience of treating chronic non-malignant pain by conducting a qualitative evidence synthesis. Understanding this experience from the perspective of healthcare professionals will contribute to improvements in the provision of care.DesignQualitative evidence synthesis using meta-ethnography. We searched five electronic bibliographic databases from inception to November 2016. We included studies that explore healthcare professionals’ experience of treating adults with chronic non-malignant pain. We used the GRADE-CERQual framework to rate confidence in review findings.ResultsWe screened the 954 abstracts and 184 full texts and included 77 published studies reporting the experiences of over 1551 international healthcare professionals including doctors, nurses and other health professionals. We abstracted six themes: (1) a sceptical cultural lens, (2) navigating juxtaposed models of medicine, (3) navigating the geography between patient and clinician, (4) challenge of dual advocacy, (5) personal costs and (6) the craft of pain management. We rated confidence in review findings as moderate to high.ConclusionsThis is the first qualitative evidence synthesis of healthcare professionals’ experiences of treating people with chronic non-malignant pain. We have presented a model that we developed to help healthcare professionals to understand, think about and modify their experiences of treating patients with chronic pain. Our findings highlight scepticism about chronic pain that might explain why patients feel they are not believed. Findings also indicate a dualism in the biopsychosocial model and the complexity of navigating therapeutic relationships. Our model may be transferable to other patient groups or situations.

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Interventions targeted at health professionals to reduce unnecessary caesarean sections: a qualitative evidence synthesis

BMJ Open ◽

10.1136/bmjopen-2018-025073 ◽

2018 ◽

Vol 8 (12) ◽

pp. e025073 ◽

Cited By ~ 5

Author(s):

Carol Kingdon ◽

Soo Downe ◽

Ana Pilar Betran

Keyword(s):

Low Income ◽

Health Professionals ◽

Cultural Context ◽

Resistance To Change ◽

Evidence Synthesis ◽

High Income ◽

Primary Data ◽

Qualitative Evidence Synthesis ◽

Middle Income ◽

Qualitative Evidence

ObjectiveTo establish the views and experiences of healthcare professionals in relation to interventions targeted at them to reduce unnecessary caesareans.DesignQualitative evidence synthesis.SettingStudies undertaken in high-income, middle-income and low-income settings.Data sourcesSeven databases (CINAHL, MEDLINE, PsychINFO, Embase, Global Index Medicus, POPLINE and African Journals Online). Studies published between 1985 and June 2017, with no language or geographical restrictions. We hand-searched reference lists and key citations using Google Scholar.Study selectionQualitative or mixed-method studies reporting health professionals’ views.Data extraction and synthesisTwo authors independently assessed study quality prior to extraction of primary data and authors’ interpretations. The data were compared and contrasted, then grouped into summary of findings (SoFs) statements, themes and a line of argument synthesis. All SoFs were Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessed.Results17 papers were included, involving 483 health professionals from 17 countries (nine high-income, six middle-income and two low-income). Fourteen SoFs were identified, resulting in three core themes: philosophy of birth(four SoFs); (2)social and cultural context(five SoFs); and (3)negotiation within system(five SoFs). The resulting line of argument suggests three key mechanisms of effect for change or resistance to change: prior beliefs about birth; willingness or not to engage with change, especially where this entailed potential loss of income or status (including medicolegal barriers); and capacity or not to influence local community and healthcare service norms and values relating to caesarean provision.ConclusionFor maternity care health professionals, there is a synergistic relationship between their underpinning philosophy of birth, the social and cultural context they are working within and the extent to which they were prepared to negotiate within health system resources to reduce caesarean rates. These findings identify potential mechanisms of effect that could improve the design and efficacy of change programmes to reduce unnecessary caesareans.PROSPERO registration numberCRD42017059455.

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