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Tremblay D, Turcotte A, Touati N, Poder TG, Kilpatrick K, Bilodeau K, Roy M, Richard PO, Lessard S, Giordano É. Development and use of research vignettes to collect qualitative data from healthcare professionals: a scoping review. BMJ Open 2022; 12:e057095. [PMID: 35105654 PMCID: PMC8804653 DOI: 10.1136/bmjopen-2021-057095] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies involving healthcare professionals. DESIGN Scoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. DATA SOURCES Electronic databases: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX (January 2000-December 2020). ELIGIBILITY CRITERIA Empirical studies in English or French with a qualitative design including an explicit methodological description of the development and/or use of vignettes to collect qualitative data from healthcare professionals. Titles and abstracts were screened, and full text was reviewed by pairs of researchers according to inclusion/exclusion criteria. DATA EXTRACTION AND SYNTHESIS Data extraction included study characteristics, definition, development and utilisation of a vignette, as well as strengths, limitations and recommendations from authors of the included articles. Systematic qualitative thematic analysis was performed, followed by data matrices to display the findings according to the scoping review questions. RESULTS Ten articles were included. An explicit definition of vignettes was provided in only half the studies. Variations of the development process (steps, expert consultation and pretesting), data collection and analysis demonstrate opportunities for improvement in rigour and transparency of the whole research process. Most studies failed to address quality criteria of the wider qualitative design and to discuss study limitations. CONCLUSIONS Vignette-based studies in qualitative research appear promising to deepen our understanding of sensitive and challenging situations lived by healthcare professionals. However, vignettes require conceptual clarification and robust methodological guidance so that researchers can systematically plan their study. Focusing on quality criteria of qualitative design can produce stronger evidence around measures that may help healthcare professionals reflect on and learn to cope with adversity.
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Affiliation(s)
- Dominique Tremblay
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Annie Turcotte
- School of Nursing, Université de Sherbrooke, Longueuil, Quebec, Canada
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Quebec, Canada
| | - Thomas G Poder
- School of Public Health, Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Centre intégré universitaire de santé et de services sociaux de l'Est-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Susan E. French Chair in Nursing Research and Innovative Practice, Montreal, Quebec, Canada
| | - Karine Bilodeau
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
| | - Mathieu Roy
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Patrick O Richard
- Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Sylvie Lessard
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
| | - Émilie Giordano
- Centre de recherche Charles-Le Moyne, Longueuil, Quebec, Canada
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Bottger C, Bernard L, Briand V, Bougouma C, Triendebeogo J, Ridde V. Primary healthcare providers' practices related to non-malarial acute febrile illness in Burkina Faso. Trans R Soc Trop Med Hyg 2019; 111:555-563. [PMID: 29509953 DOI: 10.1093/trstmh/try009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 01/19/2018] [Indexed: 11/13/2022] Open
Abstract
Background In Africa, fever is the main reason for consultation, with malaria playing a prominent role. Studies have reported that the widespread use of rapid diagnostic tests for malaria, implemented since 2010, has revealed an increasing proportion of non-malaria acute febrile illnesses (NMAFI). It is an important public health issue because evidence shows that mortality is higher among patients presenting with non-malarial fever than among those with malaria. Methods This cross-sectional study assessed the professional practices of healthcare providers in the management of NMAFI in urban and rural sites in Burkina Faso. Data was collected from 286 healthcare providers through a questionnaire based on the clinical situation in 2014. Factors have been associated using a hierarchical linear mixed model with random intercepts to model dependence of outcomes for healthcare providers working on the same site. Results Survey results showed limited knowledge about management of NMAFI, global survey score on General Practice Indicator being 60% (36.02/60.00). This gap was more evident at the admission and diagnosis level. The study's population from rural areas had better survey score than that of urban areas concerning the respect of adequacy diagnosis, treatment and use of antibiotics in NMAFI, 15.71 vs 13.93 mean score (p=0.01) (75 vs 66% on a 0 to 100% scale, with 100% being the best). Overall, more educated participants performed relatively better. A total of 46% (134/286) of participants felt that they needed training in at least one of the fever-related issues. Conclusions Increased awareness and knowledge of management for NMAFI are urgently required in Burkina Faso. This must be done through regular supervision and training courses targeted specifically at primary healthcare providers.
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Affiliation(s)
- C Bottger
- School of Public Health, Université de Montréal (ESPUM), C.P. 6128, Succ. C.V., Montreal, Qc, H3C 3J7.,Université de Montréal Public Health Research Institute (IRSPUM), C.P. 6128, Succ. CV., Montréal, Qc., H3C 3J7, Canada
| | - L Bernard
- Faculty of Nursing, Université de Montréal, C.P. 6128, Succ. CV., Montreal, Qc, H3C 3J7, Canada
| | - V Briand
- UMR216-MERIT, French National Research Institute for Sustainable Development (IRD), Université Paris Descartes, Paris, France
| | - C Bougouma
- Ministère de la santé du Burkina Faso, Programme national de lutte contre les Maladies Tropicales Négligées, 03 BP: 7009 OUAGADOUGOU 03
| | - J Triendebeogo
- Jhpiego an affiliate of John Hopkins University, Burkina Faso
| | - V Ridde
- Université de Montréal Public Health Research Institute (IRSPUM), C.P. 6128, Succ. CV., Montréal, Qc., H3C 3J7, Canada.,IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, France
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Laliberté M, Mazer B, Orozco T, Chilingaryan G, Williams-Jones B, Hunt M, Feldman DE. Low Back Pain: Investigation of Biases in Outpatient Canadian Physical Therapy. Phys Ther 2017; 97:985-997. [PMID: 29029551 DOI: 10.1093/ptj/pzx055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/12/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Previous research suggested that physical therapy services can be influenced by patient characteristics (age, sex, socioeconomic status) or insurance status rather than their clinical need. OBJECTIVE The aim of this study was to determine whether patient-related factors (age, sex, SES) and the source of reimbursement for physical therapy services (insurance status) influence wait time for, frequency of, and duration of physical therapy for low back pain. DESIGN This study was an empirical cross-sectional online survey of Canadian physical therapy professionals (defined as including physical therapists and physical rehabilitation specialists). METHODS A total of 846 physical therapy professionals received 1 of 24 different (and randomly selected) clinical vignettes (ie, patient case scenarios) and completed a 40-item questionnaire about how they would treat the fictional patient in the vignette as well as their professional clinical practice. Each vignette described a patient with low back pain but with variations in patient characteristics (age, sex, socioeconomic status) and insurance status (no insurance, private insurance, Workers' Compensation Board insurance). RESULTS The age, sex, and socioeconomic status of the fictional vignette patients did not affect how participants would provide service. However, vignette patients with Workers' Compensation Board insurance would be seen more frequently than those with private insurance or no insurance. When asked explicitly, study participants stated that insurance status, age, and chronicity of the condition were not factors associated with wait time for, frequency of, or duration of treatment. LIMITATIONS This study used a standardized vignette patient and may not accurately represent physical therapy professionals' actual clinical practice. CONCLUSIONS There appears to be an implicit professional bias in relation to patients' insurance status; the resulting inequity in service provision highlights the need for further research as a basis for national guidelines to promote equity in access to and provision of quality physical therapy services.
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Affiliation(s)
- Maude Laliberté
- École de Réadaptation, Faculté de Médecine, Université de Montréal, C.P. 6128 Succursale Centre-ville, Montréal, Québec, Canada H3C 3J7; and Centre de Recherche Interdisciplinaire en Réadaptation du Montréal Métropolitain (CRIR), Montréal, Québec, Canada
| | - Barbara Mazer
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada; and CRIR
| | - Tatiana Orozco
- École de Réadaptation, Faculté de Médecine, Université de Montréal
| | - Gevorg Chilingaryan
- Centre Intégré de Santé et de Services Sociaux de Laval, Hôpital Juif de Réadaptation, Laval, Québec, Canada; School of Physical and Occupational Therapy, McGill University; and CRIR
| | - Bryn Williams-Jones
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Québec, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada; and CRIR
| | - Debbie Ehrmann Feldman
- École de Réadaptation, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada; and CRIR
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Tremblay D, Roberge D, Touati N, Maunsell E, Berbiche D. Effects of interdisciplinary teamwork on patient-reported experience of cancer care. BMC Health Serv Res 2017; 17:218. [PMID: 28320372 PMCID: PMC5360056 DOI: 10.1186/s12913-017-2166-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Interdisciplinary teamwork (ITW) is deemed necessary for quality cancer care practices. Nevertheless, variation in ITW intensity among cancer teams is understudied, and quantitative evidence of the effect of different ITW intensities among cancer teams on patients’ perceived experience of care is limited. This study aims to compare patient-reported experience measures (PREMs) of cancer outpatients followed by teams characterized by high vs. low ITW intensity. Methods The study is designed as an ex post facto quasi-experimental study. Participants (n = 1379) were recruited in nine outpatient oncology clinics characterized by different ITW intensities. ITW intensities were evaluated using the characteristics of structure (team composition and size) and process (interactions among team members), as per West’s seminal work on team effectiveness. ITW intensity was dichotomized (high vs. low ITW intensity). PREMs were classified and measured using validated scales corresponding to six dimensions: Prompt access to care, Person-centred response, Quality of patient-professional communication, Quality of the care environment, Continuity of care, and Results of care. Dichotomous variables were created for each dimension (positive vs. less positive experience). Multiple logistic regression analyses were performed to assess the association between ITW intensities and the six PREMs dimensions, while controlling for patient and organizational characteristics. PROC GENMOD was used to fit logistic models for categorical variables. Results Outpatients treated by teams characterized by high ITW intensity reported almost four times more positive perceptions of Prompt access to care compared to patients treated by low ITW intensity teams (OR = 3.99; CI = 1.89–8.41). High ITW intensity also positively affected patients’ perceptions of Quality of patient-professional communication (OR = 2.37; CI = 1.25–4.51), Person-centred response (OR = 2.11; CI = 1.05–4.24], and Continuity of care (OR = 2.18; CI = 1.07–4.45). No significant association was found between ITW intensity and perceived Results of care (OR = 1.31; CI = 0.68–2.52) or Quality of the care environment (OR = 0.66; CI = 0.31–1.39). Conclusions This study provides empirical evidence, from the patient’s perspective, that ITW intensity affects some critical aspects of patient-reported quality of care. Future research will allow explaining how and why ITW structure and processes may contribute to positive cancer care experiences. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2166-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominique Tremblay
- Nursing School, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Quebec, Canada. .,Charles-Le Moyne Hospital Research Center, Greenfield Park, Quebec, Canada.
| | - Danièle Roberge
- Charles-Le Moyne Hospital Research Center, Greenfield Park, Quebec, Canada.,Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke (Longueuil Campus), Longueuil, Quebec, Canada
| | - Nassera Touati
- École nationale d'administration publique, Montreal, Quebec, Canada
| | - Elizabeth Maunsell
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec City, Quebec, Canada
| | - Djamal Berbiche
- Charles-Le Moyne Hospital Research Center, Greenfield Park, Quebec, Canada
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Orozco T, Feldman DE, Mazer B, Chilingaryan G, Hunt M, Williams-Jones B, Laliberté M. Low Back Pain: Current Patterns of Canadian Physiotherapy Service Delivery. Physiother Can 2017; 69:49-56. [PMID: 28154444 DOI: 10.3138/ptc.2015-72] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: The aim of this study was to describe the current patterns of service delivery of Canadian physiotherapy (PT) professionals working in adult musculoskeletal (MSK) outpatient practice. Methods: A total of 846 Canadian PT professionals working with an adult MSK outpatient clientele participated in an online survey about how they would treat a patient with low back pain (LBP). After reading an online clinical vignette about a fictional patient with varying insurance status, participants answered questions about how they would treat the patient (e.g., wait time, frequency and duration of treatment, time allotted for initial evaluation and treatment), about their actual practice (e.g., number of patients seen per day), and about their work setting. Results: The vignette patients with LBP would typically be seen within 2 weeks, especially in private practice, and most would receive care 2-3 times per week for 1-3 months. Initial evaluations and subsequent treatments would take 31-60 minutes. Two-thirds of participants reported treating 6-15 patients a day in their current practice setting. Differences were found between provinces and territories (with the longest wait time in Quebec), practice settings (with a longer wait time in the public sector), and insurance status (patients covered by workers' compensation are seen more frequently). Conclusion: This study adds to our knowledge of the accessibility of outpatient MSK PT services for patients with LBP in Canada, and it points to potential areas for improvement.
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Affiliation(s)
| | - Debbie E Feldman
- School of Rehabilitation, Faculty of Medicine; Public Health Research Institute; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal
| | - Barbara Mazer
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; School of Physical and Occupational Therapy, McGill University, Montreal
| | - Gevorg Chilingaryan
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; School of Physical and Occupational Therapy, McGill University, Montreal
| | - Matthew Hunt
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; School of Physical and Occupational Therapy, McGill University, Montreal
| | - Bryn Williams-Jones
- Public Health Research Institute; Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal
| | - Maude Laliberté
- School of Rehabilitation, Faculty of Medicine; Public Health Research Institute; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal; Bioethics Program, Department of Social and Preventive Medicine, School of Public Health, Université de Montréal
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Tremblay D, Latreille J, Bilodeau K, Samson A, Roy L, L’Italien MF, Mimeault C. Improving the Transition From Oncology to Primary Care Teams: A Case for Shared Leadership. J Oncol Pract 2016; 12:1012-1019. [DOI: 10.1200/jop.2016.013771] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
This article discusses the case of a 47-year-old woman who underwent primary therapy with curative intent for breast cancer. The case illustrates a number of failure events in transferring information and responsibility from oncology to primary care teams. The article emphasizes the importance of shared leadership, as multiple team members, dispersed in time and space, pursue their own objectives while achieving the common goal of coordinating care for survivors of cancer transitioning across settings. Shared leadership is defined as a team property comprising shared responsibility and mutual influence between the patient and the patient’s family, primary care providers, and oncology teams, whereby they lead each other toward quality and safety of care. Teams, including the patient-family, should achieve leadership when their contribution is relevant in managing task interdependence during transition. Shared leadership fosters coordinated actions to enable functioning as an integrated team-of-teams. This article illustrates how shared leadership can make a difference to coordinate interfaces and pathways, from therapy with curative intent to the follow-up and management of survivors of breast cancer. The detailed case is elaborated as a clinical vignette. It can be used by care providers and researchers to consider the need for new models of care for survivors of cancer by addressing the following questions. Who accepts shared leadership, how, with whom, and under what conditions? What is the evidence that supports the answers to these questions? The detailed case is also valuable for medical and allied health professional education.
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Affiliation(s)
- Dominique Tremblay
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Jean Latreille
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Karine Bilodeau
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Arnaud Samson
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Linda Roy
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Marie-France L’Italien
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
| | - Christine Mimeault
- Université de Sherbrooke, Longueuil; Hôpital Charles-Le Moyne; Centre Intégré de Santé et Services Sociaux Montérégie-Centre, Greenfield Park; Ministère de la Santé et des Services Sociaux; Université Laval, Québec; Centre Intégré de Santé et de Services Sociaux de la Côte-Nord, Baie-Comeau; and Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Saguenay-Lac-Saint-Jean, Québec, Canada
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Bochaton N, Ramelet AS, Rimensberger P, Januel JM. Amélioration de la mesure d’extravasation des cathéters veineux périphériques par les infirmières en pédiatrie, grâce à l’utilisation d’un instrument d’évaluation spécifique. Rech Soins Infirm 2016. [DOI: 10.3917/rsi.126.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Tremblay D, Touati N, Roberge D, Breton M, Roch G, Denis JL, Candas B, Francoeur D. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implement Sci 2016; 11:39. [PMID: 27000152 PMCID: PMC4802906 DOI: 10.1186/s13012-016-0404-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/12/2016] [Indexed: 11/16/2022] Open
Abstract
Background Managed cancer networks are widely promoted in national cancer control programs as an organizational form that enables integrated care as well as enhanced patient outcomes. While national programs are set by policy-makers, the detailed implementation of networks is delegated at the service delivery and institutional levels. It is likely that the capacity to ensure more integrated cancer services requires multi-level governance processes responsive to the strengths and limitations of the contexts and capable of supporting network-based working. Based on an empirical case, this study aims to analyze the implementation of a mandated cancer network, focusing on governance and health services integration as core concepts in the study. Methods/design This nested multi-case study uses mixed methods to explore the implementation of a mandated cancer network in Quebec, a province of Canada. The case is the National Cancer Network (NCN) subdivided into three micro-cases, each defined by the geographic territory of a health and social services region. For each region, two local health services centers (LHSCs) are selected based on their differences with respect to determining characteristics. Qualitative data will be collected from various sources using three strategies: review of documents, focus groups, and semi-directed interviews with stakeholders. The qualitative data will be supplemented with a survey that will measure the degree of integration as a proxy for implementation of the NCN. A score will be constructed, and then triangulated with the qualitative data, which will have been subjected to content analysis. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify governance patterns similarities and differences and degree of integration in contexts. Discussion This study is designed to inform decision-making to develop more effective network implementation strategies by thoroughly describing multi-level governance processes of a sample of settings that provide cancer services. Although the study focuses on the implementation of a cancer network in Quebec, the rich descriptions of multiple nested cases will generate data with a degree of generalizability for health-care systems in developed countries. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0404-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada. .,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.
| | - Nassera Touati
- École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada
| | - Danièle Roberge
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada
| | - Mylaine Breton
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada.,Campus de Longueuil - Université de Sherbrooke, 150 Place Charles-Le Moyne, J4K 0A8, Longueuil, Quebec, Canada
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, G1V 0A6, Quebec, Quebec, Canada.,Centre de recherche du CHU de Québec - Université Laval, 11 Côte du Palais, Quebec, G1R 2J6, Quebec, Canada
| | - Jean-Louis Denis
- École nationale d'administration publique, 4750 Henri-Julien Avenue, 5th Floor, H2T 3E5, Montreal, Quebec, Canada
| | - Bernard Candas
- Institut national d'excellence en santé et en services sociaux, 2535, boulevard Laurier, 5e étage, Quebec, G1V 4M3, Quebec, Canada
| | - Danièle Francoeur
- Institut national de santé publique du Québec, 190 Crémazie Blvd. East, 2nd Floor, H2P 1E2, Montreal, Quebec, Canada
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Tremblay D, Touati N, Roberge D, Denis JL, Turcotte A, Samson B. Conditions for production of interdisciplinary teamwork outcomes in oncology teams: protocol for a realist evaluation. Implement Sci 2014; 9:76. [PMID: 24938443 PMCID: PMC4074333 DOI: 10.1186/1748-5908-9-76] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 06/11/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Interdisciplinary teamwork (ITW) is designed to promote the active participation of several disciplines in delivering comprehensive cancer care to patients. ITW provides mechanisms to support continuous communication among care providers, optimize professionals' participation in clinical decision-making within and across disciplines, and foster care coordination along the cancer trajectory. However, ITW mechanisms are not activated optimally by all teams, resulting in a gap between desired outcomes of ITW and actual outcomes observed. The aim of the present study is to identify the conditions underlying outcome production by ITW in local oncology teams. METHODS This retrospective multiple case study will draw upon realist evaluation principles to explore associations among context, mechanisms and outcomes (CMO). The cases are nine interdisciplinary cancer teams that participated in a previous study evaluating ITW outcomes. Qualitative data sources will be used to construct a picture of CMO associations in each case. For data collection, reflexive focus groups will be held to capture patients' and professionals' perspectives on ITW, using the guiding question, 'What works, for whom, and under what circumstances?' Intra-case analysis will be used to trace associations between context, ITW mechanisms, and patient outcomes. Inter-case analysis will be used to compare the different cases' CMO associations for a better understanding of the phenomenon under study. DISCUSSION This multiple case study will use realist evaluation principles to draw lessons about how certain contexts are more or less likely to produce particular outcomes. The results will make it possible to target more specifically the actions required to optimize structures and to activate the best mechanisms to meet the needs of cancer patients. This project could also contribute significantly to the development of improved research methods for conducting realist evaluations of complex healthcare interventions. To our knowledge, this study is the first to use CMO associations to improved empirical and theoretical understanding of interdisciplinary teamwork in oncology, and its results could foster more effective implementation in clinical practice.
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Affiliation(s)
- Dominique Tremblay
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Nassera Touati
- École Nationale d’Administration Publique, Montréal, QC G1K 9E5, Canada
| | - Danièle Roberge
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Jean-Louis Denis
- École Nationale d’Administration Publique, Montréal, QC G1K 9E5, Canada
| | - Annie Turcotte
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
| | - Benoît Samson
- Charles-Le Moyne Hospital Research Centre, Greenfield Park, QC J4K 0A8, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke-Campus Longueuil, Longueuil, QC J4K 0A8, Canada
- CSSS Champlain–Charles-Le Moyne, Longueuil, QC J4V 2H1, Canada
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Stacey D, Brière N, Robitaille H, Fraser K, Desroches S, Légaré F. A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making. J Interprof Care 2014; 28:453-9. [PMID: 24766619 DOI: 10.3109/13561820.2014.911157] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n = 6), good (n = 20), fair (n = 0) or weak (n = 3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p < 0.0001). Our video vignette development process resulted in a product that was true-to-life and as part of a multifaceted workshop it appears to improve knowledge among health professionals. This could be used to create and appraise vignettes targeting IP-SDM in other contexts.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, Ottawa Hospital Research Institute, University of Ottawa , Ontario , Canada
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