Exploring reasons for overuse of contralateral prophylactic mastectomy in Canada

Background Contralateral prophylactic mastectomy (cpm) in women with known unilateral breast cancer (bca) has been increasing despite the lack of supportive evidence. The purpose of the present study was to identify the determinants of cpm in women with unilateral bca.Methods This qualitative descriptive study used semi-structured interviews informed by the Theoretical Domains Framework. We interviewed 74 key informants (surgical oncologists, plastic surgeons, medical oncologists, radiation oncologists, nurses, women with bca) across Canada. Interviews were analyzed using thematic analysis and an analysis for shared and discipline-specific beliefs.Results In total, 58 factors influencing the use of cpm were identified: 26 factors shared by various health care professional groups, 15 discipline-specific factors (identified by a single health care professional group), and 17 factors shared by women with unilateral bca. Health care professionals identified more factors discouraging the use of cpm (n = 26) than encouraging its use (n = 15); women with bca identified more factors encouraging use of cpm (n = 12) than discouraging its use (n = 5). The factor most commonly identified by health care professionals that encouraged cpm was lack of awareness of existing evidence or guidelines for the appropriate use of cpm (n = 44, 75%). For women with bca, the factor most likely influencing their decision for cpm was wanting a better esthetic outcome (n = 14, 93%).Conclusions Multiple factors discouraging and encouraging the use of cpm in unilateral bca were identified. Those factors identify potential individual, team, organization, and system targets for behaviour change interventions to reduce cpm.

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Patient decision aid for contralateral prophylactic mastectomy for use in the consultation: a feasibility study

Current Oncology ◽

10.3747/co.26.4689 ◽

2019 ◽

Vol 26 (2) ◽

Author(s):

J. E. Squires ◽

D. Stacey ◽

M. Coughlin ◽

M. Greenough ◽

A. Roberts ◽

...

Keyword(s):

Health Care ◽

Knowledge Translation ◽

Health Care Professionals ◽

Decision Aid ◽

Prophylactic Mastectomy ◽

Contralateral Prophylactic Mastectomy ◽

Shared Decision ◽

Patient Decision Aid ◽

Unilateral Breast Cancer ◽

Patient Decision

Background Rates of contralateral prophylactic mastectomy (cpm) continue to rise internationally despite evidence-based guidance strongly discouraging its use in most women with unilateral breast cancer. The purpose of the present study was to develop and assess the feasibility of a knowledge translation tool [a patient decision aid (da)] designed to enhance evidence-informed shared decision-making about cpm.Methods A consultation da was developed using the Ottawa Patient Decision Aid Development eTraining in consultation with clinicians and knowledge translation experts. The final da was then assessed for feasibility with health care professionals and patients across Canada. The assessment involved a survey completed online (health care professionals) or by telephone (patients). Survey data were analyzed using descriptive statistics for closed-ended questions and qualitative content analysis for open-ended questions.Results The 51 participants who completed the survey included 39 health care professionals and 12 patients. The da was acceptable; 88% of participants viewed it as having the right amount of information or slightly more or less information than they would like. Almost all participants (98%) felt that the da would prepare patients to make better decisions. The aid was perceived to be usable, with 73% of participants stating that they would be willing to use or share the da.Conclusions The cpm patient da developed for the present study was viewed by health care professionals and patients across Canada to be acceptable and usable during the clinical consultation. It holds promise as a knowledge translation tool to be used by clinicians in consultation with women who have unilateral breast cancer to enhance evidence-informed and shared decision-making with respect to undergoing cpm.

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Identity Matters- Perceptions of Inter-Professional Feedback in the Context of Workplace-based Assessment in Diabetology Training: A Qualitative Study

10.21203/rs.2.15505/v3 ◽

2020 ◽

Author(s):

Katrin Feller ◽

Christoph Berendonk

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Professional ◽

Health Care Professionals ◽

Allied Health ◽

University Hospital ◽

Professional Collaboration ◽

Professional Groups ◽

Allied Health Care ◽

Workplace Based Assessment

Abstract Background: Inter-professional collaboration is acknowledged as essential for quality patient-care. However, little is known about receptiveness to inter-professional feedback in the postgraduate training. This study explores, in light of social identity theory, the perceptions of residents, supervising physicians and allied health care professionals regarding inter-professional feedback in the context of workplace-based assessment. Methods: For six months, residents in diabetology at the University Hospital of Bern performed formative workplace-based assessments under direct observation of a supervising physician and an allied health care professional. Feedback from both observers was given to the resident after every assessment. Subsequently, focus group discussions were conducted to collect the participants’ perceptions of inter- and intra-professional feedback. Transcripts were analyzed qualitatively using a thematic analysis approach. Results: We identified four main themes: (1) Identity and hierarchy; (2) Interdependence of feedback source and feedback content; (3) Impact on collaboration and patient-care; (4) Logistical and organizational requirements. While different social identities are the source of inter-professional hierarchies, they did not impede the receptiveness to feedback. Perceived trustworthiness of the feedback was attributed with more importance than professional affiliations, whereas intra-professional hierarchies between physicians led to the perception of a more summative nature of the feedback and rather impeded receptiveness. According to the participants, inter-professional feedback raised awareness of the working reality of other team members and had a positive impact on communication between the different professional groups. Moreover, participants reported positive response from patients regarding the inter-professional collaboration they experienced. Considerable organizational effort is required to enable the parallel observation of a resident’s consultation by a supervising physician and an allied health care professional. Conclusions: Feedback from allied health care professionals can be a valuable learning resource for residents, given its role outside the sometimes conflicting area of intra-professional hierarchies. Inter-professional feedback in the context of workplace-based assessment carries the potential to strengthen collaboration between the different professional groups.

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Identity Matters - Perceptions of Inter- and Intra-Professional Feedback in the Context of Workplace-based Assessment in Diabetology Training: A Qualitative Study

10.21203/rs.2.15505/v1 ◽

2019 ◽

Author(s):

Katrin Feller ◽

Christoph Berendonk

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Professional ◽

Health Care Professionals ◽

Allied Health ◽

University Hospital ◽

Professional Collaboration ◽

Professional Groups ◽

Allied Health Care ◽

Workplace Based Assessment

Abstract Background: Inter-professional collaboration is acknowledged as essential for quality patient-care. However, little is known about receptiveness to inter-professional feedback in the postgraduate training. This study explores, in light of social identity theory, the perceptions of residents, supervising physicians and allied health care professionals regarding inter- and intra-professional feedback in the context of workplace-based assessment. Methods: For six months, residents in diabetology at the University Hospital of Bern performed formative workplace-based assessments under direct observation of a supervising physician and an allied health care professional. Feedback from both observers was given to the resident after every assessment. Subsequently, focus group discussions were conducted to collect the participants’ perceptions of inter- and intra-professional feedback. Transcripts were analyzed qualitatively using a thematic analysis approach. Results: We identified four main themes: (1) Identity and hierarchy; (2) Interdependence of feedback source and feedback content; (3) Impact on collaboration and patient-care; (4) Logistical and organizational requirements. While different social identities are the source of inter-professional hierarchies, they did not impede the receptiveness to feedback. Perceived trustworthiness of the feedback was attributed with more importance than professional affiliations, whereas intra-professional hierarchies between physicians led to the perception of a more summative nature of the feedback and rather impeded receptiveness. According to the participants, inter-professional feedback raised awareness of the working reality of other team members and had a positive impact on communication between the different professional groups. Moreover, participants reported positive response from patients regarding the inter-professional collaboration they experienced. Considerable organizational effort is required to enable the parallel observation of a resident’s consultation by a supervising physician and an allied health care professional. Conclusions: Feedback from allied health care professionals can be a powerful learning resource for residents, given its role outside the sometimes conflicting area of intra-professional hierarchies. Inter-professional feedback in the context of workplace based assessment carries the potential to strengthen collaboration between the different professional groups and to improve patient care.

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Identity Matters- Perceptions of Inter-Professional Feedback in the Context of Workplace-based Assessment in Diabetology Training: A Qualitative Study

10.21203/rs.2.15505/v2 ◽

2019 ◽

Author(s):

Katrin Feller ◽

Christoph Berendonk

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Professional ◽

Health Care Professionals ◽

Allied Health ◽

University Hospital ◽

Professional Collaboration ◽

Professional Groups ◽

Allied Health Care ◽

Workplace Based Assessment

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Physiotherapy students’ perceptions of the dual role of the clinical educator as mentor and assessor: Influence on the teaching–learning relationship

South African Journal of Physiotherapy ◽

10.4102/sajp.v73i1.349 ◽

2017 ◽

Vol 73 (1) ◽

Author(s):

Ilse S. Meyer ◽

Alwyn Louw ◽

Dawn Ernstzen

Keyword(s):

Health Care ◽

Clinical Education ◽

Health Care Professionals ◽

Dual Role ◽

Structured Interviews ◽

Negative Effects ◽

Clinical Educator ◽

Qualitative Descriptive ◽

Teaching Learning

Background: Clinical education is widely considered to be the cornerstone of health care professionals’ education. Clinical educators (CEs) fulfil many roles and act as both mentors and assessors in the learning process of students’ undergraduate health care professions education. However, changing from being a mentor to being an assessor may present particular challenges for both the CE and the students.Objective: To explore students’ perceptions of how the dual role of a CE as mentor and assessor influenced the teaching–learning (T-L) relationship.Method: A qualitative descriptive study, involving seven individual semi-structured interviews and two focus group discussions, was conducted with students in the Division of Physiotherapy, Stellenbosch University. A contextualised interpretive content analysis was used to analyse the data. By following an iterative process, themes were identified and categories were reviewed and refined.Results: Challenges were experienced when CEs had to act and change as both mentors and assessors to the needs of the students. This influenced the T-L relationship and consequently impacted the learning of students. The expectations of students and CEs were often not fulfilled. Contradictions were disclosed regarding the dual role of CEs.Conclusion: The findings of the study, grounded in the perceptions and experiences of students on the dual role of the CE, are highlighted. It is important to consider the challenges that the students face in order to minimise any negative effects these challenges could have on students’ learning processes.

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Digital Diabetes Care System Observations from a market acceptance evaluation study in Vietnam (Preprint)

10.2196/preprints.16435 ◽

2019 ◽

Author(s):

Tran Quang Khanh ◽

Pham Nhu Hao ◽

Eytan Roitman ◽

Baruch Marganitt ◽

Avivit Cahn

Keyword(s):

Health Care ◽

Blood Glucose ◽

Health Care Professional ◽

Diabetes Care ◽

Health Care Professionals ◽

Mobile App ◽

Physician Satisfaction ◽

Diabetes Clinic ◽

Blood Glucose Monitor ◽

Hba1c Levels

BACKGROUND Digital technologies are gaining an important role in the management of patients with diabetes. The GlucoMe solution integrates multiple aspects of diabetes care: 1) Wireless blood glucose monitor - communicates glucose data automatically to any smartphone; 2) Mobile-app - securely transmits real-time blood glucose monitor data for cloud based analyses, and enables 2-way communication between patients and health care professionals; 3) Digital diabetes clinic – analyzes and presents data to the health care professional; and 4) Control tower software provides population management reports and sends individualized alerts. OBJECTIVE Assess clinical outcomes and user satisfaction of incorporating the GlucoMe digital solution in diabetes clinics of a developing country. METHODS Five hospital endocrinology clinics in Vietnam participated in a market acceptance evaluation pilot of the GlucoMe system. The clinics sequentially recruited all patients willing to join, so long as they had a smartphone and access to internet connectivity. Patients were provided with the GlucoMe app and blood glucose monitor and instructed in their use in individual or groups sessions. The digital diabetes clinic and control tower software were installed in the clinic computers. Face-to-face visits were conducted at baseline and at 12 weeks, with monthly digital visits scheduled in the interim and additional digital visits performed as needed. HbA1c levels were measured at baseline and at 12 weeks (±20 days). Treatment modification was at the discretion of the treating physician. Outcome measures included adherence to glucose monitoring, change in glycemic parameters and patient and physician satisfaction as assessed by questionnaires. Only patients completing the pilot were included in data analyses. RESULTS The study recruited 300 patients of whom 279 patients completed the evaluation. Dropout was due to change in internet access availability (18) or death (3). Adherence to glucose measurements gradually declined, yet, at study end 81% of the patients were measuring glucose at least once a week. Digital contact from the health care professional to the patient or vice-versa (excluding automated alerts) occurred in average every 6.2 days. Average glucose levels declined from 170.4±64.6 mg/dl in the first two weeks to 150.8±53.2 mg/dl in the last two weeks (P<0.001) (n=221). HbA1c levels at baseline and 12 weeks were available for only 126 of the patients and declined from 8.3±1.9% to 7.6±1.3 (P<0.001). Over 95% of the physicians and patients stated they would strongly support the broad usage of the GlucoMe platform in diabetes clinics across the country. CONCLUSIONS The GlucoMe digital solution was broadly accepted by both patients and health care professionals and improved glycemic outcomes. The digital platform yielded increased number of patient-health care professional interactions, yet of short duration, enabling judicious allocation of limited time resources. The durability, scalability and cost-effectiveness of this approach merit further study.

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Women, Exercise, and Eating Disorder Recovery: The Normal and the Pathological

Qualitative Health Research ◽

10.1177/1049732321992042 ◽

2021 ◽

pp. 104973232199204

Author(s):

Hester Hockin-Boyers ◽

Megan Warin

Keyword(s):

Health Care ◽

Eating Disorder ◽

Affect Regulation ◽

Health Care Professionals ◽

Value Systems ◽

Structured Interviews ◽

Data Set ◽

The United Kingdom ◽

Theoretical Frame ◽

Intensity Of Exercise

The appropriate form, regularity, and intensity of exercise for individuals recovering from eating disorders is not agreed upon among health care professionals or researchers. When exercise is permitted, it is that which is mindful, embodied, and non-competitive that is considered normative. Using Canguilhem’s concepts of “the normal and the pathological” as a theoretical frame, we examine the gendered assumptions that shape medical understandings of “healthy” and “dysfunctional” exercise in the context of recovery. The data set for this article comes from longitudinal semi-structured interviews with 19 women in the United Kingdom who engaged in weightlifting during their eating disorder recovery. We argue that women in recovery navigate multiple and conflicting value systems regarding exercise. Faced with aspects of exercise that are pathologized within the eating disorder literature (such as structure/routine, body transformations, and affect regulation), women re-inscribe positive value to these experiences, thus establishing exercise practices that serve them.

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Leadership assumptions on implementation of patient involvement methods

BMC Health Services Research ◽

10.1186/s12913-021-06497-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kathrine Håland Jeppesen ◽

Kirsten Frederiksen ◽

Marianne Johansson Joergensen ◽

Kirsten Beedholm

Keyword(s):

Health Care ◽

Organizational Learning ◽

Health Care Professionals ◽

Large Scale ◽

Patient Involvement ◽

Hospital Setting ◽

Implementation Process ◽

University Hospital ◽

Structured Interviews ◽

Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

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Surveillance, anticipation and firefighting: Perspectives of patient safety from a New Zealand case study

10.26686/wgtn.12470129.v1 ◽

2020 ◽

Author(s):

J Wailling ◽

Brian Robinson ◽

M Coombs

Keyword(s):

Health Care ◽

Patient Safety ◽

New Zealand ◽

Health Care Professionals ◽

Nuclear Power ◽

High Reliability ◽

Health Care Systems ◽

Tertiary Hospital ◽

Structured Interviews

© 2018 John Wiley & Sons Ltd Aim: This study explored how doctors, nurses and managers working in a New Zealand tertiary hospital understand patient safety. Background: Despite health care systems implementing proven safety strategies from high reliability organisations, such as aviation and nuclear power, these have not been uniformly adopted by health care professionals with concerns raised about clinician engagement. Design: Instrumental, embedded case study design using qualitative methods. Methods: The study used purposeful sampling, and data was collected using focus groups and semi-structured interviews with doctors (n = 31); registered nurses (n = 19); and senior organisational managers (n = 3) in a New Zealand tertiary hospital. Results: Safety was described as a core organisational value. Clinicians appreciated proactive safety approaches characterized by anticipation and vigilance, where they expertly recognized and adapted to safety risks. Managers trusted evidence-based safety rules and approaches that recorded, categorized and measured safety. Conclusion and Implications for Nursing Management: It is important that nurse managers hold a more refined understanding about safety. Organisations are more likely to support safe patient care if cultural complexity is accounted for. Recognizing how different occupational groups perceive and respond to safety, rather than attempting to reinforce a uniform set of safety actions and responsibilities, is likely to bring together a shared understanding of safety, build trust and nurture safety culture.

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Making the Transition to Insulin Therapy: The Experiences of Samoan People with Type 2 Diabetes in New Zealand

10.26686/wgtn.16985230.v1 ◽

2021 ◽

Author(s):

◽

Sera Tapu-Ta'ala

Keyword(s):

Type 2 Diabetes ◽

Health Care ◽

New Zealand ◽

Insulin Therapy ◽

Health Care Professionals ◽

Pacific People ◽

Qualitative Descriptive

<p>Background Pacific people are dying younger compared to other New Zealanders because of complications resulting from uncontrolled type 2 diabetes mellitus. Good diabetes control is achievable with early use of insulin because of its effectiveness, and proven long term benefits to quality of life. An understanding of how Samoan people with type 2 diabetes make their transition to insulin therapy will assist in understanding how insulin is perceived, which will inform health care professionals in their work with those diagnosed with diabetes. Aim of Research The aim of the research is to explore and describe how Samoan people with type 2 diabetes in New Zealand made the transition to insulin therapy for better glycaemic control. Design The Fonofale Model was used as the theoretical framework, from which to understand Samoan peoples' experiences. This research used a qualitative descriptive methodology. In-depth interviews were used to gather the stories of four Samoan participants over the age of 18 years diagnosed with type 2 diabetes. The data was analysed using thematic analysis. Findings Three major themes emerged from the analysis of the participants' stories. These were: living with diabetes, making the transition to insulin therapy and realisation. The findings led to the creation of the Ia Malu model, which describes the experiences of the participants in this study. Conclusion This study confirmed that there are immense challenges and struggles encountered by people with diabetes. Their adjustment to the illness as well as making the transition to using insulin takes time. As a result of this, it is fundamental for nurses/health care professionals to understand that this is the reality for these people, and they must therefore provide time for people to adjust.</p>

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