scholarly journals Expertise, advocacy and activism: A qualitative study on the activities of prostate cancer peer support workers

2018 ◽  
Vol 24 (1) ◽  
pp. 21-37 ◽  
Author(s):  
Marjaana Jones ◽  
Ilkka Pietilä
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Health Policy ◽  
Clinical Practice ◽  
Peer Support ◽  
Health Professionals ◽  
Close Contact ◽  
Structured Interviews ◽  
Work Activities ◽  
Individual Level

Peer support workers are now working with patients in a variety of settings, coming into close contact and even work alongside health professionals. Despite the potentially influential position peer support workers hold in relation to those engaged in support activities, their role, duties and their relationship to peers and health professionals lack clarity and is often defined by other actors. This study explores how peer support workers interpret and define the activities, responsibilities and knowledge associated with their work. Using methods of membership categorisation analysis, we analysed interview materials generated by conducting individual semi-structured interviews during the autumn of 2016 with prostate cancer peer support workers ( n = 11) who currently volunteer as support workers in Finland. Although the peer support workers acknowledged the psychosocial aspects of the work, we argue that their interpretations extend far beyond this and encompass expertise, advocacy and activism as central features of their work. These can be used to strengthen their position as credible commentators and educators on issues relating to cancer and men’s health; raise awareness and represent the ‘patient’s voice’ and attempt to influence both policy and clinical practice. These findings suggest that by categorising their work activities in different ways, voluntary sector actors such as peer support workers can attempt to portray themselves as legitimate authorities on a range of issues and influence decision-making ranging from individual level treatment decisions all the way to health policy.

scholarly journals Early Mobilization After Stroke: Do Clinical Practice Guidelines Support Clinicians' Decision-Making?

2021 ◽  
Vol 12 ◽  
Author(s):  
Venesha Rethnam ◽  
Kathryn S. Hayward ◽  
Julie Bernhardt ◽  
Leonid Churilov
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Early Mobilization ◽  
Cross Sectional Study ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Delivery Of Care ◽  
Individual Patient Level

Importance: Early mobilization, out-of-bed activity, is a component of acute stroke unit care; however, stroke patient heterogeneity requires complex decision-making. Clinically credible and applicable CPGs are needed to support and optimize the delivery of care. In this study, we are specifically exploring the role of clinical practice guidelines to support individual patient-level decision-making by stroke clinicians about early mobilization post-stroke.Methods: Our study uses a novel, two-pronged approach. (1) A review of CPGs containing recommendations for early mobilization practices published after 2015 was appraised using purposely selected items from the Appraisal of Guidelines Research and Evaluation–Recommendations Excellence (AGREE-REX) tool relevant to decision-making for clinicians. (2) A cross-sectional study involving semi-structured interviews with Australian expert stroke clinicians representing content experts and CPG target users. Every CPG was independently assessed against the AGREE-REX standard by two reviewers. Expert stroke clinicians, invited via email, were recruited between June 2019 to March 2020.The main outcomes from the review was the proportion of criteria addressed for each AGREE-REX item by individual and all CPG(s). The main cross-sectional outcomes were the distributions of stroke clinicians' responses about the utility of CPGs, specific areas of uncertainty in early mobilization decision-making, and suggested parameters for inclusion in future early mobilization CPGs.Results: In 18 identified CPGs, many did not adequately address the “Evidence” and “Applicability to Patients” AGREE-REX items. Out of 30 expert stroke clinicians (11 physicians [37%], 11 physiotherapists [37%], 8 nurses [26%]; median [IQR] years of experience, 14 [10–25]), 47% found current CPGs “too broad or vague,” while 40% rely on individual clinical judgement and interpretation of the evidence to select an evidence-based choice of action. The areas of uncertainty in decision-making revealed four key suggestions: (1) more granular descriptions of patient and stroke characteristics for appropriate tailoring of decisions, (2) clear statements about when clinical flexibility is appropriate, (3) detailed description of the intervention dose, and (4) physical assessment criteria including safety parameters.Conclusions: The lack of specificity, clinical applicability, and adaptability of current CPGs to effectively respond to the heterogeneous clinical stroke context has provided a clear direction for improvement.

Co-designing a patient support portal with health professionals and men with prostate cancer: an action research study. (Preprint)

2021 ◽  
Author(s):  
Benjamin Shemesh ◽  
Jacinta Opie ◽  
Ellie Tsiamis ◽  
Darshini Ayton ◽  
Prassannah Satasivam ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Supportive Care ◽  
Health Professionals ◽  
Research Study ◽  
Treatment Decision ◽  
Patient Support ◽  
Practice Nurses ◽  
Treatment Decision Making ◽  
Barriers And Enablers

BACKGROUND The supportive care needs of men with prostate cancer (PCa) have been well documented, but little is known about how an online portal may address these. OBJECTIVE To determine priority issues facing men with PCa, barriers and enablers to accessing care, format and organisation of information on a portal and whether health professionals (HPs) and men would support the inclusion of a patient-reported outcome (PRO) comparator tool within the portal. METHODS A qualitative action research study was conducted. Data collection comprised four online focus groups with HPs recruited from four healthcare services in Victoria (3 metropolitan, 1 regional) and seven online co-design workshops with men with PCa, recruited through the Prostate Cancer Outcomes Registry – Victoria, Prostate Cancer Foundation Australia, and the Cancer Council Victoria. We invited men’s support persons to one workshop. Men were eligible to participate if they had lived experience of PCa and access to the internet. Focus groups were analysed thematically. Workshops were analysed using descriptive-content analysis. RESULTS HPs (n=39) highlighted that men had shifting priorities over time but noted the importance of providing information to men in lay terms and in a variety of formats to assist in treatment decision-making and side effect management. HPs identified key enablers to men accessing support services such as practice nurses, partners and having men share their stories with each other. HPs raised financial, cultural, geographic and emotional barriers to accessing supportive care. Inclusion of a PRO compactor tool received mixed support from HPs with 41% (n=16) supportive, 49% (n=19) unsure and 10% (n=4) not supportive. Men involved in workshops (n=28) ranged from 55 to 82 years of age. One workshop included five female support persons. Men identified informational needs to assist in treatment decision-making and side effect management as the top priority throughout care. Similar to HPs, support groups and practice nurses were described as key enablers. Short consultation times and complex information were described as barriers. Unlike HPs, all men supported the inclusion of a PRO comparator tool into a portal. Men reported a preference for video and audio stories to deliver portal content. CONCLUSIONS Our findings suggest that a patient support portal should provide information in lay terms that address the shifting priorities of men with PCa. While slight variations in the perspectives of HPs and men with PCa concerning the barriers and enablers to accessing care exist, these can be addressed in a portal. Men with PCa already use online support resources and would welcome the development of a portal to centralise support information and a PRO comparator tool to prompt health-seeking behaviour. Future research should implement these findings in the development of a portal, and pilot and evaluate the portal within a population-based sample.

scholarly journals Consumption of psychiatric drugs by patients of medical and surgical clinics in a general hospital

2013 ◽  
Vol 21 (4) ◽  
pp. 948-955 ◽  
Author(s):  
Flavio Hiroshi Shirama ◽  
Adriana Inocenti Miasso
Keyword(s):  
Clinical Practice ◽  
Quantitative Analysis ◽  
General Hospital ◽  
Health Professionals ◽  
Common Mental Disorders ◽  
Roman Catholicism ◽  
Structured Interviews ◽  
Psychiatric Drugs ◽  
High Prevalence ◽  
Benzodiazepine Drugs

PURPOSES: to identify the prevalence of the use of psychiatric drugs among patients admitted to medical and surgical clinics of a general hospital, and also the factors related to the consumption of this type of medication. METHOD: this is a transversal, descriptive, correlational study with quantitative analysis. For the collection of data, there was use of structured interviews and also reference to medical files. RESULTS: there was confirmation of a high prevalence of users of psychiatric drugs, which was associated to the female sex, to people who do not practice Roman Catholicism, and admittance to the clinic not covered by the Single Health System (Sistema Único de Saúde - SUS), as well as the presence of common mental disorders. Benzodiazepine drugs were the most commonly used psychiatric drugs. Among the total number of users, there has been the identification of patients who were not aware that they were receiving such medication. Doctors who are not psychiatrists were responsible for most prescriptions of psychiatric drugs. CONCLUSIONS: this signals the need to prepare health professionals to deal with psychological and social problems commonly found in clinical practice, in order to promote the rational use of psychiatric drugs.

scholarly journals Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program

2020 ◽  
Vol 17 (17) ◽  
pp. 6248
Author(s):  
Antonio Jesús Ramos-Morcillo ◽  
David Harillo-Acevedo ◽  
David Armero-Barranco ◽  
César Leal-Costa ◽  
José Enrique Moral-García ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Health Professionals ◽  
Best Practice ◽  
Research Study ◽  
Structured Interviews ◽  
Qualitative Research Study ◽  
Implementation Program

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

scholarly journals Patient aspects: A review of fifty-eight Danish HTA reports

2011 ◽  
Vol 27 (4) ◽  
pp. 330-336 ◽  
Author(s):  
Helle Ploug Hansen ◽  
Anne Lee ◽  
Christian Balslev van Randwijk
Keyword(s):  
Decision Making ◽  
Health Policy ◽  
Clinical Practice ◽  
Patient Information ◽  
Literature Search ◽  
Primary Research ◽  
Relevant Evidence ◽  
Literature Reviews ◽  
Theoretical Considerations ◽  
Improve Patient

Objectives: The objective of this study is to describe how patient aspects are assessed in Danish HTA reports, thereby contributing to the ongoing international debates concerning patient aspects in HTAs.Methods: Fifty-eight Danish HTA reports published from 1999 to 2010 were read systematically, focusing on the inclusion of patient aspects, the methods used to generate data, and if and how clinical recommendations concerning patient aspects were drawn.Results: Most of the fifty-eight HTA reports had a separate chapter about patient aspects. All reports included literature reviews for patient aspects. There was, however, much variation in the ways in which the authors presented and discussed their review methods. The most frequently used databases for the literature search were medical and HTA databases. More than half of the reports included primary research, either quantitative or qualitative methods, a few used both kinds of methods. Whereas some mentioned the importance of including patient aspects in daily clinical practice, others provided ideas on how to improve patient information or recommended changes in healthcare practices.Conclusions: Danish HTA reports do, to a large extent, include patient aspects in the assessment and in the final conclusions of the reports. If health policy and decision making is to be patient-focused, it is important that HTAs in the future integrate patient aspects in recommendations of HTA. Further improvement in assessments of patient aspects, in relation to use and description of methodologies and theoretical considerations, will assist producing the relevant evidence for these recommendations.

scholarly journals Patient, family and provider views of measurement-based care in an early-psychosis intervention programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Ari B. Cuperfain ◽  
Katrina Hui ◽  
Suze G. Berkhout ◽  
George Foussias ◽  
David Gratzer ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Shared Decision Making ◽  
Healthcare Delivery ◽  
Early Psychosis ◽  
Shared Decision ◽  
Structured Interviews ◽  
National Guidelines ◽  
Intervention Programme ◽  
Measurement Based Care

Background Measurement-based care (MBC) in mental health improves patient outcomes and is a component of many national guidelines for mental healthcare delivery. Nevertheless, MBC is not routinely integrated into clinical practice. Several known reasons for the lack of integration exist but one lesser explored variable is the subjective perspectives of providers and patients about MBC. Such perspectives are critical to understand facilitators and barriers to improve the integration of MBC into routine clinical practice. Aims This study aimed to uncover the perspectives of various stakeholders towards MBC within a single treatment centre. Method Researchers conducted qualitative semi-structured interviews with patients (n = 15), family members (n = 7), case managers (n = 8) and psychiatrists (n = 6) engaged in an early-psychosis intervention programme. Data were analysed using thematic analysis, informed by critical realist theory. Results Analysis converged on several themes. These include (a) implicit negative assumptions; (b) relevance and utility to practice; (c) equity versus flexibility; and (d) shared decision-making. Providers assumed patients’ perspectives of MBC were negative. Patients’ perspectives of MBC were actually favourable, particularly if MBC was used as an instrument to engage patients in shared decision-making and communication rather than as a dogmatic and rigid clinical decision tool. Conclusions This qualitative study presents the views of various stakeholders towards MBC, providing an in-depth examination of the barriers and facilitators to MBC through qualitative investigation. The findings from this study should be used to address the challenges organisations have experienced in implementing MBC.

scholarly journals Effectiveness of Technology-Enabled Knowledge Translation Strategies in Improving the Use of Research in Public Health: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Alison Brown ◽  
Courtney Barnes ◽  
Judith Byaruhanga ◽  
Matthew McLaughlin ◽  
Rebecca K Hodder ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health Policy ◽  
Knowledge Translation ◽  
Health Outcomes ◽  
Health Professionals ◽  
Public Health Policy ◽  
Randomized Trials ◽  
Policy Makers ◽  
Or Practice

BACKGROUND Knowledge translation (KT) aims to facilitate the use of research evidence in decision making. Changes in technology have provided considerable opportunities for KT strategies to improve access and use of evidence in decision making by public health policy makers and practitioners. Despite this opportunity, there have been no reviews that have assessed the effects of digital technology-enabled KT (TEKT) in the field of public health. OBJECTIVE This study aims to examine the effectiveness of digital TEKT strategies in (1) improving the capacity for evidence-based decision making by public health policy makers and practitioners, (2) changing public health policy or practice, and (3) changes in individual or population health outcomes. METHODS A search strategy was developed to identify randomized trials assessing the effectiveness of digital TEKT strategies in public health. Any primary research study with a randomized trial design was eligible. Searches for eligible studies were undertaken in multiple electronic bibliographic databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus) and the reference lists of included studies. A hand search of 2 journals (Implementation Science and Journal of Medical Internet Research) and a gray literature search were also conducted. Pairs of independent review authors screened studies, assessed the risk of bias, and extracted data from relevant studies. RESULTS Of the 6819 citations screened, 8 eligible randomized trials were included in the review. The studies examined the impact of digital TEKT strategies on health professionals, including nurses, child care health consultants, physiotherapists, primary health care workers, and public health practitioners. Overall, 5 of the interventions were web-training programs. The remaining 3 interventions included simulation games, access to digital resource materials and the use of tailored messaging, and a web-based registry. The findings suggest that digital TEKT interventions may be effective in improving the knowledge of public health professionals, relative to control, and may be as effective as a face-to-face KT approach. The effectiveness of digital TEKT strategies relative to a control or other digital KT interventions on measures of health professional self-efficacy to use evidence to enhance practice behavior or behavioral intention outcomes was mixed. The evidence regarding the effects on changes to health policy or practice following exposure to digital TEKT was mixed. No trials assessed the effects on individual or population-level health outcomes. CONCLUSIONS This review is the first to synthesize the effectiveness of digital TEKT interventions in a public health setting. Despite its potential, relatively few trials have been undertaken to investigate the impacts of digital TEKT interventions. The findings suggest that although a digital TEKT intervention may improve knowledge, the effects of such interventions on other outcomes are equivocal.

Clinical Judgment and the Influence of Screening on Decision Making

2009 ◽  
Author(s):  
Howard N. Garb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Judgment ◽  
Structured Interviews ◽  
Primary Care Settings ◽  
Broad Array ◽  
Clinically Depressed

How do clinicians arrive at diagnostic decisions? In most cases the decision is not made following formal criteria, but by intuition. In addition, routine interviews are often narrow and the feedback gleaned from patients is inadequate. Yet it is not clear if screening helps or hinders clinical judgment. It might be that only clinicians who have low confidence and interviewing and diagnostic skills are open to the use of and actually helped by diagnostic tools. To provide a theoretical framework for understanding why it is difficult for physicians to detect depression in primary care settings, a broad array of research in the mental health fields can be described. For example, more than 1,000 studies have been conducted on clinical judgment in the area of mental health practice, and the results from these studies can be used to illuminate the challenges physicians face in judging whether a patient is clinically depressed and can benefit from treatment. In this chapter, results on clinical judgment will be described. A second topic will also be briefly discussed. Results from research on clinical judgment would seem to indicate that screening should be of value. Yet, as noted in Chapter 7, stand-alone screening programs have added little or nothing to outcomes. Reasons for this unexpected result will be explored. Three topics will be discussed: (1) narrowness of interviews, (2) nature of patient feedback, and (3) the cognitive processes of clinicians. Depression goes undetected because in many cases physicians do not ask patients if they have symptoms of a depressive mood disorder.3 To place this in context, it can be noted that mental health professionals also often do not ask patients about important symptoms and behaviors. Failure to inquire about depression in primary care settings can be viewed in the broader context of failure to inquire about important symptoms and events in mental health settings. Research on clinical judgment has demonstrated that lack of comprehensiveness is often a problem for interviews made in clinical practice. For example, in one study,4 mental health professionals saw patients in routine clinical practice, and afterwards research investigators conducted semi-structured interviews with the patients. Remarkably, the mental health professionals had evaluated only about 50% of the symptoms that were recorded using the semi-structured interviews.

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