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Salwei ME, Reale C. Workflow analysis of breast cancer treatment decision-making: challenges and opportunities for informatics to support patient-centered cancer care. JAMIA Open 2024; 7:ooae053. [PMID: 38911330 PMCID: PMC11192055 DOI: 10.1093/jamiaopen/ooae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/19/2024] [Accepted: 06/13/2024] [Indexed: 06/25/2024] Open
Abstract
Objective Decision support can improve shared decision-making for breast cancer treatment, but workflow barriers have hindered widespread use of these tools. The goal of this study was to understand the workflow among breast cancer teams of clinicians, patients, and their family caregivers when making treatment decisions and identify design guidelines for informatics tools to better support treatment decision-making. Materials and Methods We conducted observations of breast cancer clinicians during routine clinical care from February to August 2022. Guided by the work system model, a human factors engineering model that describes the elements of work, we recorded all aspects of clinician workflow using a tablet and smart pencil. Observation notes were transcribed and uploaded into Dedoose. Two researchers inductively coded the observations. We identified themes relevant to the design of decision support that we classified into the 4 components of workflow (ie, flow of information, tasks, tools and technologies, and people). Results We conducted 20 observations of breast cancer clinicians (total: 79 hours). We identified 10 themes related to workflow that present challenges and opportunities for decision support design. We identified approximately 48 different decisions discussed during breast cancer visits. These decisions were often interdependent and involved collaboration across the large cancer treatment team. Numerous patient-specific factors (eg, work, hobbies, family situation) were discussed when making treatment decisions as well as complex risk and clinical information. Patients were frequently asked to remember and relay information across the large cancer team. Discussion and Conclusion Based on these findings, we proposed design guidelines for informatics tools to support the complex workflows involved in breast cancer care. These guidelines should inform the design of informatics solutions to better support breast cancer decision-making and improve patient-centered cancer care.
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Affiliation(s)
- Megan E Salwei
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37203, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37203, United States
| | - Carrie Reale
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37203, United States
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Long HA, Brooks JM, Maxwell AJ, Peters S, Harvie M, French DP. Healthcare professionals' experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme. Health Expect 2024; 27:e14023. [PMID: 38509776 PMCID: PMC10955228 DOI: 10.1111/hex.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Understanding healthcare professionals' (HCPs) experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme (NHSBSP) is important for reducing the impact of such results. METHODS Interviews were undertaken with 12 HCPs from a single NHSBSP unit, including advanced radiographer practitioners, breast radiographers, breast radiologists, clinical nurse specialists (CNSs), and a radiology healthcare assistant. Data were analysed thematically using Template Analysis. RESULTS Two themes were produced: (1) Gauging and navigating women's anxiety during screening assessment was an inevitable and necessary task for all participants. CNSs were perceived as particularly adept at this, while breast radiographers reported a lack of adequate formal training. (2) Controlling the delivery of information to women (including amount, type and timing of information). HCPs reported various communication strategies to facilitate women's information processing and retention during a distressing time. CONCLUSIONS Women's anxiety could be reduced through dedicated CNS support, but this should not replace support from other HCPs. Breast radiographers may benefit from more training to emotionally support recalled women. While HCPs emphasised taking a patient-centred communication approach, the use of other strategies (e.g., standardised scripts) and the constraints of the 'one-stop shop' model pose challenges to such an approach. PATIENT AND PUBLIC CONTRIBUTION During the study design, two Patient and Public Involvement members (women with false-positive-breast screening test results) were consulted to gain an understanding of patient perspectives and experiences of being recalled specifically in the NHSBSP. Their feedback informed the formulations of the research aim, objectives and the direction of the interview guide.
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Affiliation(s)
- Hannah A. Long
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Joanna M. Brooks
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Anthony J. Maxwell
- Wythenshawe HospitalThe Nightingale Centre, Manchester University NHS Foundation TrustManchesterUK
- Division of Informatics, Imaging and Data Sciences, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Sarah Peters
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Michelle Harvie
- Wythenshawe HospitalThe Nightingale Centre, Manchester University NHS Foundation TrustManchesterUK
| | - David P. French
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
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Long HA, Hindmarch S, Martindale JP, Brooks JM, Harvie M, French DP. Emotion constructs and outcome measures following false positive breast screening test results: A systematic review of reporting clarity and selection rationale. Psychooncology 2024; 33:e6334. [PMID: 38549216 DOI: 10.1002/pon.6334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE (i) To systematically identify constructs and outcome measures used to assess the emotional and mood impact of false positive breast screening test results; (ii) to appraise the reporting clarity and rationale for selecting constructs and outcome measures. METHODS Databases (MEDLINE, CINAHL, PsycINFO) were systematically searched from 1970. Studies using standardised and non-standardised outcome measures to evaluate the emotion or mood impact of false positive breast screening test results were eligible. A 15-item coding scheme was devised to appraise articles on clarity and rationale for selected constructs and measures. RESULTS Forty-seven articles were identified. The most investigated constructs were general anxiety and depression and disease-specific anxiety and worry. Twenty-two standardised general outcome questionnaire measures and three standardised disease-specific outcome questionnaire measures were identified. Twenty articles used non-standardised scales/items. Reporting of constructs and outcome measures was generally clear, but rationales for their selection were lacking. Anxiety was typically justified, but justification for depression was almost always absent. Practical and psychometric justification for selecting outcome measures was lacking, and theoretical rationale was absent. CONCLUSIONS Heterogeneity in constructs and measures, coupled with unclear rationale for these, impedes a thorough understanding of why there are emotional effects of false positive screening test results. This may explain the repeated practice of investigating less relevant outcomes such as depression. There is need to develop a consensual conceptual model of and standardised approach to measuring emotional impact from cancer screening test results, to address heterogeneity and other known issues of interpreting an inconsistent evidence base.
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Affiliation(s)
- Hannah A Long
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Sarah Hindmarch
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - John-Paul Martindale
- School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Brooks
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Michelle Harvie
- The Prevent Breast Cancer Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
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Crubezy M, Corbin S, Hyvert S, Michel P, Haesebaert J. Studying both patient and staff experience to investigate their perceptions and to target key interactions to improve: a scoping review. BMJ Open 2022; 12:e061155. [PMID: 36216415 PMCID: PMC9557797 DOI: 10.1136/bmjopen-2022-061155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The improvement of patient experience (PE) is related to the experience of staff caring for them. Yet there is little evidence as to which interactions matter the most for both patients and staff, or how they are perceived by them. We aimed to summarise the interactions and the perceptions between patients and staff from studies by using both patient and staff experience data in healthcare institutions. DESIGN Scoping review. METHODS We conducted a scoping review, including studies dealing with PE and staff experience. Two authors independently reviewed each title/abstract and the selected full-text articles. A list of variables (objective, study design, data sources, tools used, results, interactions, perceptions and actions) was charted and summarised using a narrative approach including both qualitative and quantitative data. Studies were grouped according to their objective and the key interactions summarised according to this stratification. The perceptions of patients and staff were identified in the results of selected studies and were classified into four categories: commonalities and disagreements of perceptions, patients' perceptions not perceived by professionals and professional's perceptions not perceived by patients. RESULTS A total of 42 studies were included. The stratification of studies by type of objective resulted in six groups that allowed to classify the key interactions (n=154) identified in the results of the selected studies. A total of 128 perceptions related to interaction between patient and staff were reported with the following distribution: commonalities (n=35), disagreements (n=18), patients' perceptions not perceived by professionals (n=47) and professional's perceptions not perceived by patients (n=28). We separated positive and negative perceptions, which resulted in seven scenarios, each with actions that can be carried out for one or both populations to overcome barriers. CONCLUSION The study of both patient and staff experience allowed the identification of actions that can be taken to change the perceptions of patients and staff.
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Affiliation(s)
- Marion Crubezy
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Département des Études et de la Recherche, Institut d'études KPAM, Paris, France
| | - Sara Corbin
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
| | - Sophie Hyvert
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
| | - Philippe Michel
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Direction Qualité Usagers et Santé Populationnelle, Hospices Civils de Lyon, Lyon, France
| | - Julie Haesebaert
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Université Claude Bernard Lyon 1 - Domaine de Rockefeller, Lyon, France
- Pôle Santé Publique, Service Recherche et Epidémiologie Cliniques, Hospices Civils de Lyon, Lyon, France
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Eden JK, Borgen R. Exploring the perceptions of advanced practitioner radiographers at a single breast screening unit in extending their role from delivering benign to malignant biopsy results; a preliminary study. Br J Radiol 2021; 94:20200423. [PMID: 32976025 PMCID: PMC7774685 DOI: 10.1259/bjr.20200423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The study aims to explore the perceptions of advanced practice radiographers (APRs) currently giving benign biopsy results to extend their role to deliver NHS Breast Screening Programme (NHSBSP) malignant outcomes. In the UK, APRs are appropriately trained to deliver results, yet traditionally have been cultured not to. Increasing pressures on NHSBSP units are a key driver for APR evolvement. A significant lack of published research provides the rationale for the study, combined with an identified service need. METHODS Following ethical approval, a grounded theory design was applied to interview six APRs individually in a single breast screening unit. Extracted themes were considered during a subsequent focus group. RESULTS Five core themes identified; (i) role of the APR, (ii) patient experience, (iii) efficiency, (iv) role boundaries, and (v) delivering results.The findings indicate the ambiguity of radiographers delivering results within their profession, outlining the potential impact on themselves and patients. Mammography APRs are skilled to deliver results, and whilst enforced barriers may restrict extension a supportive environment can overcome these. Additional training is necessary to implement the role in the screening service. CONCLUSION Identified within their scope of practice; APRs have the ability with appropriate training and peer support to effectively deliver results with a patient-centred approach. ADVANCES IN KNOWLEDGE This study has identified important enabling factors and challenges concerning role extension in the delivery of breast biopsy results. The apparent suitability of APRs to communicate results may address breast service pressures, with benefit to patients and the radiology profession.
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Affiliation(s)
- Joleen Kirsty Eden
- Department of Breast Imaging, East Lancashire Hospitals NHS Trust, England, United Kingdom
| | - Rita Borgen
- Department of Breast Imaging, East Lancashire Hospitals NHS Trust, England, United Kingdom
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Hayre CM, Blackman S. Ethnographic mosaic approach for health and rehabilitation practitioners: an ethno-radiographic perspective. Disabil Rehabil 2020; 43:3260-3263. [PMID: 32106722 DOI: 10.1080/09638288.2020.1730453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This methodological commentary focuses on the use of ethnography for health and rehabilitation practitioners. In recent years, ethnography has become a methodology of choice amongst diagnostic radiography researchers at uncovering phenomena pertinent to the clinical setting. This paper adds to the evidence base by providing not only a methodology account from two experienced researchers, but also offers a paradigmatic approach to ethnography that incorporates qualitative and quantitative approaches. It details an alternate ideological discourse in alignment with the role of a diagnostic radiographer, which can be replicated in other disciplines and thus offering an array of empirical opportunity for prospective health and rehabilitation practitioners.IMPLICATIONS FOR REHABILITATIONThis paper provides an introduction into the use of ethnography for health and rehabilitation practitioners.The authors reflect on the value of ethnography in order to satisfy a researcher's aims and objectives.The authors provide an "umbrella strategy" that can be used by other prospective health and rehabilitation researchers.It is argued here that this methodology offers an alternate strategy of uncovering new ideas and research data.
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Affiliation(s)
- Christopher M Hayre
- Faculty of Science, Department of Dentistry and Health Sciences, Charles Sturt University, Wagga Wagga, Australia.,University of Suffolk, School of Health Sciences, Ipswich, UK
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O'Regan T, Robinson L, Newton-Hughes A, Strudwick R. A review of visual ethnography: Radiography viewed through a different lens. Radiography (Lond) 2019; 25 Suppl 1:S9-S13. [PMID: 31481188 DOI: 10.1016/j.radi.2019.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The objective of this article is to provide a short review of the research methodology 'visual ethnography'. METHOD The review article will provide a summary of the foundations of visual ethnography, outline the key debates and refer to some of the main authors working in this field. RESULTS Visual Ethnography is both a methodology and a method of research. It should be selected for research in radiography when research questions seek to focus upon aspects or elements of a culture. A research plan that is designed using a visual ethnographic approach should be flexible and take into account the requirements of the researcher and research participants. Visual methods of research include the use of various images, for example, photographs, collage, film or drawings. Visual methods are commonly employed together with interviews, conversations and observation. The approach enables researchers to generate new and unique insights into cultures. CONCLUSION This review of visual ethnography provides background information that informs an introduction to the methodology. It demonstrates a methodology with the potential to explore culture and expand knowledge of radiography practice. IMPLICATIONS FOR PRACTICE The authors suggest that for future studies visual ethnography is a methodology that can expand the paradigm of radiography research.
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Affiliation(s)
- T O'Regan
- The Society and College of Radiographers, 207 Providence Square, Mill Street, London, SE1 2EW, UK.
| | - L Robinson
- University of Salford, Allerton Building, Salford, M5 4WT, UK.
| | - A Newton-Hughes
- University of Salford, Allerton Building, Salford, M5 4WT, UK.
| | - R Strudwick
- University of Suffolk, Waterfront Building, Neptune Quay, Ipswich, IP4 1QJ, UK.
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Hayre CM, Strudwick RM. Ethnography for Radiographers: A Methodological Insight for Prospective Researchers. J Med Imaging Radiat Sci 2019; 50:352-358. [PMID: 31377054 DOI: 10.1016/j.jmir.2019.06.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 06/12/2019] [Accepted: 06/17/2019] [Indexed: 11/17/2022]
Abstract
In recent years, ethnography has become a methodology of choice for exploring radiographic practices. This article adds to the existing evidence base by providing detailed methodological accounts of two experienced researchers. It aims to provide a critical methodological lens to prospective researchers who may also use ethnography as their methodology of choice. The author's reflect on their experiences of utilising ethnography as a methodological approach. Here, accounts of the original tools aligned to undertaking ethnographic research in radiography are discussed and how these can be used to uncover original phenomena. The article identifies the researchers' own positionality and reflexivity as researchers and how this impacted on data collection. In short, this article provides a detailed account of undertaking ethnography as a methodological approach within diagnostic radiography. The experiences documented can provide prospective researchers an insight of the researchers' position within the fieldwork.
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Affiliation(s)
- Christopher M Hayre
- Fatima College of Health Sciences, Institute of Applied Technology, Abu Dhabi, United Arab Emirates; University of Suffolk, Ipswich, UK.
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Challenges in mammography education and training today: The perspectives of radiography teachers/mentors and students in five European countries. Radiography (Lond) 2018; 24:41-46. [DOI: 10.1016/j.radi.2017.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/19/2017] [Accepted: 08/26/2017] [Indexed: 11/23/2022]
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