scholarly journals Barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people at end-of-life: a mixed methods systematic review protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e030566 ◽  
Author(s):  
Katie Greenfield ◽  
Simone Holley ◽  
Daniel Eric Schoth ◽  
Emily Harrop ◽  
Richard Howard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Young People ◽  
End Of Life ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Synthesis Methods ◽  
Children And Young People

IntroductionThis protocol describes the objective and methods of a systematic review of barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in infants, children and young people (ICYP) at end-of-life.Methods and analysisThe Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey will be electronically searched. Reference screening of relevant articles and inquiries to researchers in the field will be undertaken. Studies will be selected if they apply qualitative, quantitative or mixed-methods designs to explore barriers and facilitators experienced by patients, carers and healthcare professionals when managing symptoms in ICYP at end-of-life.Articles will be screened by title and abstract by one reviewer with a second reviewer assessing 10% of the articles. Both reviewers will read and screen all remaining potentially relevant articles. For included articles, one reviewer will extract study characteristics and one will check this.Both reviewers will undertake independent quality assessments of included studies using established and appropriate checklists including The Critical Appraisal Skills Programme Qualitative Checklist; The evaluative criteria of credibility, transferability, dependability and confirmability; The Quality Assessment Tool for Quantitative Studies, and The Mixed Methods Appraisal Tool. Data synthesis methods will be decided after data extraction and assessment.Ethics and disseminationThis review will inform our understanding of symptom management in ICYP at end-of-life. The findings will be reported in a peer-reviewed journal and presented at conferences. The study raises no ethical issues.PROSPERO registration numberCRD42019124797

scholarly journals Barriers and facilitators to implementing clinical imaging guidelines by healthcare professionals using theoretical domains framework: a mixed-methods systematic review protocol

BJR|Open ◽  
2021 ◽  
Vol 3 (1) ◽  
pp. 20210004
Author(s):  
Harriet Nalubega Kisembo ◽  
Ritah Nassanga ◽  
Faith Ameda Ameda ◽  
Moses Ocan ◽  
Alison A Kinengyere ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Systematic Reviews ◽  
Financial Incentives ◽  
Healthcare Professionals ◽  
Information Source ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Cochrane Library ◽  
Clinical Imaging

Objectives: To identify, categorize, and develop an aggregated synthesis of evidence using the theoretical domains framework (TDF) on barriers and facilitators that influence implementation of clinical imaging guidelines (CIGs) by healthcare professionals (HCPs) in diagnostic imaging Methods: The protocol will be guided by the Joanna Briggs Institute Reviewers’ Manual 2014. Methodology for JBI Mixed Methods Systematic Reviews and will adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA-P). Information source will include databases (MEDLINE, EMBASE and The Cochrane Library), internet search (https://www.google.com/scholar), experts’ opinion, professional societies/organizations websites and government bodies strategies/recommendations, and reference lists of included studies. Articles of any study design published in English from 1990 to date, having investigated factors operating as barriers and/or facilitators to the implementation CIGs by HCPs will be eligible. Selecting, appraising, and extracting data from the included studies will be independently performed by at least two reviewers using validated tools and Rayyan – Systematic Review web application. Disagreements will be resolved by consensus and a third reviewer as a tie breaker. The aggregated studies will be synthesized using thematic analysis guided by TDF. Results: Identified barriers will be defined a priori and mapped into 7 TDF domains including knowledge, awareness, effectiveness, time, litigationand financial incentives Conclusion: The results will provide an insight into a theory-based approach to predict behavior-related determinants for implementing CIGs and develop strategies/interventions to target the elicited behaviors. Recommendations will be made if the level of evidence is sufficient Advances in knowledge: Resource-constrained settings that are in the process of adopting CIGs may opt for this strategy to predict in advance likely impediments to achieving the goal of CIG implementation and develop tailored interventions during the planning phase. Systematic review Registration: PROSPERO ID = CRD42020136372 (https://www.crd.york.ac.uk/PROSPERO).

scholarly journals A mixed-methods systematic review and meta-analysis of barriers and facilitators to paediatric symptom management at end of life

2020 ◽  
Vol 34 (6) ◽  
pp. 689-707
Author(s):  
Katie Greenfield ◽  
Simone Holley ◽  
Daniel E Schoth ◽  
Emily Harrop ◽  
Richard F Howard ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mixed Methods ◽  
Side Effects ◽  
End Of Life ◽  
Treatment Efficacy ◽  
Symptom Management ◽  
Healthcare Professionals ◽  
Meta Analysis ◽  
Children And Young People ◽  
Treatment Side Effects

Background: Symptom management for infants, children and young people at end of life is complex and challenging due to the range of conditions and differing care needs of individuals of different ages. A greater understanding of these challenges could inform the development of effective interventions. Aim: To investigate the barriers and facilitators experienced by patients, carers and healthcare professionals managing symptoms in infants, children and young people at end of life. Design: A mixed-methods systematic review and meta-analysis was undertaken (PROSPERO ID: CRD42019124797). Data sources: The Cochrane Library, PROSPERO, CINAHL, MEDLINE, PsycINFO, Web of Science Core Collection, ProQuest Dissertations & Theses Database, Evidence Search and OpenGrey were electronically searched from the inception of each database for qualitative, quantitative or mixed-methods studies that included data from patients, carers or healthcare professionals referring to barriers or facilitators to paediatric end-of-life symptom management. Studies underwent data extraction, quality appraisal, narrative thematic synthesis and meta-analysis. Results: A total of 64 studies were included (32 quantitative, 18 qualitative and 14 mixed-methods) of medium-low quality. Themes were generated encompassing barriers/facilitators experienced by carers (treatment efficacy, treatment side effects, healthcare professionals’ attitudes, hospice care, home care, families’ symptom management strategies) and healthcare professionals (medicine access, treatment efficacy, healthcare professionals’ demographics, treatment side effects, specialist support, healthcare professionals’ training, health services delivery, home care). Only one study included patients’ views. Conclusion: There is a need for effective communication between healthcare professionals and families, more training for healthcare professionals, improved symptom management planning including anticipatory prescribing, and urgent attention paid to the patients’ perspective.

scholarly journals Clinical effectiveness and patient perspectives of different treatment strategies for tics in children and adolescents with Tourette syndrome: a systematic review and qualitative analysis

2016 ◽  
Vol 20 (4) ◽  
pp. 1-450 ◽  
Author(s):  
Chris Hollis ◽  
Mary Pennant ◽  
José Cuenca ◽  
Cris Glazebrook ◽  
Tim Kendall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Young People ◽  
Tourette Syndrome ◽  
Cochrane Library ◽  
Children And Young People ◽  
Behavioural Interventions ◽  
Qualitative Review ◽  
Habit Reversal Training ◽  
Depth Interviews

BackgroundTourette syndrome (TS) is a neurodevelopmental condition characterised by chronic motor and vocal tics affecting up to 1% of school-age children and young people and is associated with significant distress and psychosocial impairment.ObjectiveTo conduct a systematic review of the benefits and risks of pharmacological, behavioural and physical interventions for tics in children and young people with TS (part 1) and to explore the experience of treatment and services from the perspective of young people with TS and their parents (part 2).Data SourcesFor the systematic reviews (parts 1 and 2), mainstream bibliographic databases, The Cochrane Library, education, social care and grey literature databases were searched using subject headings and text words for tic* and Tourette* from database inception to January 2013.Review/research methodsFor part 1, randomised controlled trials and controlled before-and-after studies of pharmacological, behavioural or physical interventions in children or young people (aged < 18 years) with TS or chronic tic disorder were included. Mixed studies and studies in adults were considered as supporting evidence. Risk of bias associated with each study was evaluated using the Cochrane tool. When there was sufficient data, random-effects meta-analysis was used to synthesize the evidence and the quality of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. For part 2, qualitative studies and survey literature conducted in populations of children/young people with TS or their carers or in health professionals with experience of treating TS were included in the qualitative review. Results were synthesized narratively. In addition, a national parent/carer survey was conducted via the Tourettes Action website. Participants included parents of children and young people with TS aged under 18 years. Participants (young people with TS aged 10–17 years) for the in-depth interviews were recruited via a national survey and specialist Tourettes clinics in the UK.ResultsFor part 1, 70 studies were included in the quantitative systematic review. The evidence suggested that for treating tics in children and young people with TS, antipsychotic drugs [standardised mean difference (SMD) –0.74, 95% confidence interval (CI) –1.08 to –0.41;n = 75] and noradrenergic agents [clonidine (Dixarit®, Boehringer Ingelheim) and guanfacine: SMD –0.72, 95% CI –1.03 to –0.40;n = 164] are effective in the short term. There was little difference among antipsychotics in terms of benefits, but adverse effect profiles do differ. Habit reversal training (HRT)/comprehensive behavioural intervention for tics (CBIT) was also shown to be effective (SMD –0.64, 95% CI –0.99 to –0.29;n = 133). For part 2, 295 parents/carers of children and young people with TS contributed useable survey data. Forty young people with TS participated in in-depth interviews. Four studies were in the qualitative review. Key themes were difficulties in accessing specialist care and behavioural interventions, delay in diagnosis, importance of anxiety and emotional symptoms, lack of provision of information to schools and inadequate information regarding medication and adverse effects.LimitationsThe number and quality of clinical trials is low and this downgrades the strength of the evidence and conclusions.ConclusionsAntipsychotics, noradrenergic agents and HRT/CBIT are effective in reducing tics in children and young people with TS. The balance of benefits and harms favours the most commonly used medications: risperidone (Risperdal®, Janssen), clonidine and aripiprazole (Abilify®, Otsuka). Larger and better-conducted trials addressing important clinical uncertainties are required. Further research is needed into widening access to behavioural interventions through use of technology including mobile applications (‘apps’) and video consultation.Study registrationThis study is registered as PROSPERO CRD42012002059.FundingThe National Institute for Health Research Health Technology Assessment programme.

scholarly journals Effectiveness of personal letters to healthcare professionals in changing clinical practice behaviours: A Systematic Review protocol

2020 ◽  
Author(s):  
Aikaterini Grimani ◽  
Louis Goffe ◽  
Mei Yee Tang ◽  
Fiona Beyer ◽  
Falko F. Sniehotta ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Healthcare Professionals ◽  
Assessment Tool ◽  
Data Extraction ◽  
Meta Analysis ◽  
Grey Literature ◽  
Cochrane Library ◽  
Behaviour Change Techniques ◽  
Hand Search

Abstract Background: Letters are regularly sent by healthcare organisations to healthcare professionals to encourage them to take action, change practice or implement guidance. However, whether letters are an effective tool in delivering a change in clinical practice behaviour is currently uncertain. In addition, there are currently no evidence-based guidelines to support providers and health authorities with advice on how to formulate the communication, what information and behaviour change techniques to include in order to optimise the potential effect on the behaviour of the receivers. To address this research gap, we aim to inform such guidance through this systematic review.Methods/ Design: A systematic literature search of published and unpublished studies (the grey literature) in electronic databases will be conducted to identify studies that meet our inclusion criteria. The search will be conducted in five electronic databases: MEDLINE, EMBASE, PsycINFO, the Cochrane Library and CINAHL. We will also conduct supplementary searches in Google Scholar, hand search relevant journals, and conduct backward and forward citation searching for included studies and relevant reviews. A systematic approach to searching, screening, reviewing and data extraction will be applied based on Preferred Reporting Items for Systematic reviews and Meta-Analysis. Titles, abstracts, full-texts for eligibility will be examined independently by researchers. The quality of the included studies will be assessed using quality assessment tool for studies with diverse design and Cochrane risk of bias tool. Disagreements will be resolved by a consensus procedure.Discussion: This review aims to provide comprehensive evidence of the effectiveness of personal letters to healthcare professionals in changing clinical practice behaviours. Health policy makers across government will benefit from being able to increase compliance in clinical settings by applying theories of behaviour to design of policy communications. The synthesized findings will be disseminated through peer-reviewed publication.Systematic review registration: PROSPERO CRD42020167674

scholarly journals Conceptualising the social networks of vulnerable children and young people: a systematic review and narrative synthesis

2020 ◽  
Author(s):  
Imogen Nevard ◽  
Chloe Green ◽  
Vicky Bell ◽  
Judith Gellatly ◽  
Helen Brooks ◽  
...  
Keyword(s):  
Systematic Review ◽  
Social Networks ◽  
Social Network ◽  
Mixed Methods ◽  
Young People ◽  
Narrative Synthesis ◽  
Vulnerable Children ◽  
Children And Young People ◽  
Vulnerable Child ◽  
Minority Ethnic

Abstract Purpose The relationship between social networks and health and wellbeing is increasingly demonstrated in vulnerable adult populations. This relationship for vulnerable children and young people has not hitherto been systematically reviewed. This narrative synthesis aims to consolidate research to provide a foundational basis for future health-related social network research and interventions for children and young people. Methods This mixed methods systematic review synthesises research investigating whole, egocentric social networks of 32 vulnerable child groups with a mean age below 18. There were no setting, language or date restrictions. The quality was assessed using the Mixed Methods Appraisal Tool. Of 6360 search results, 49 were included for narrative synthesis. Results The majority of pertinent research originates from the USA; the most frequently investigated vulnerabilities were minority ethnic status, homelessness and the presence of special educational needs. Research aims and methodologies varied significantly between studies. Key findings included (i) vulnerable (excluding minority ethnic) children and young people have impoverished networks (ii) access to networks is a protective factor against negative outcomes (iii) social ties, primarily immediate family, provide access to personal resources and (iv) network ties are to a degree substitutable. Conclusions Networks are associated with wellbeing and vulnerable children and young people commonly have impoverished networks, excluding cases where vulnerability classification relates to minority ethnic status. Network embeddedness is associated with positive outcomes, particularly for homeless children. Family are typically primary providers of support, but ties are substitutable when networks are restricted. Egocentric social network research is currently limited for vulnerable child populations. Further research could inform interventions that harness networks to improve health, wellbeing and functional outcomes for these child groups.

scholarly journals P1 “She used to be Tigger and then she was Eeyore”: A qualitative study with children and young people with CFS/ME, exploring predictors of recovery and future treatment needs

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Philippa Clery ◽  
Jennifer Starbuck ◽  
Amanda Laffan ◽  
Esther Crawley ◽  
Philippa Clery
Keyword(s):  
Young People ◽  
Healthcare Professionals ◽  
Holistic Approach ◽  
Chronic Fatigue ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Treatment Needs ◽  
Children And Young People ◽  
Children And Parents ◽  
Definition Of

Abstract Introduction Paediatric Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is relatively common and severely disabling. At least 15% of children do not recover by 12 months. We do not know why some children recover and others do not. This study aimed to explore the barriers to recovery experienced by adolescents with CFS/ME. Methods I recruited adolescents (aged 11-17 years old, with CFS/ME, who were still disabled by CFS/ME after 12 months of treatment), their parents and specialist healthcare professionals were recruited from a single specialist CFS/ME service in the UK. I conducted semi-structured interviews and focus groups to explore views on treatment received including barriers and facilitators, as well as views on their future. I used thematic analysis grounded in the views of the patients to identify patterns (themes) in the data. Results I recruited 12 children and young people, 11 parents and 7 specialist healthcare professionals. The following themes were identified (with barriers and facilitators apparent in each theme): 1. “awareness and support” from CFS/ME services, GPs, schools and family. Poor awareness resulted in increased time-to-diagnosis, school disengagement, stigmatising experiences, and significant stress for children and parents; family support, school understanding, and validation from the service was a ‘life saver’. 2. “CFS/ME is bigger than the fatigue” described the importance of managing CFS/ME as a ‘long and hard’ chronic illness with secondary health, social and educational consequences. Participants called for holistic therapies that focus on the broader definition of recovery and facilitate re-integration into ‘normal life’. 3. “Balancing routine and control in adolescents”: Children differed on whether routines and pacing were helpful or exacerbated low mood. 4. “Individualised” treatment was important: treatment combinations were helpful in different ‘phases of recovery’, which varied depending on social context, motivations, school input, and co-morbidities. Conclusion Adolescents identified common facilitators and barriers to recovery and a desire for treatment that takes social factors into account, with a holistic approach using a broader definition of recovery. Children and parents identified a need for better awareness, communication and integration within and between services, including GPs and schools.

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