1
|
Ali A, Groot G, April M, MacPhee M, Witham S, Alimezelli H, Carr T. Understanding the impact of a residential housing program for people living with HIV/AIDS: results from a realist evaluation. BMJ Open 2024; 14:e075194. [PMID: 38740498 PMCID: PMC11097874 DOI: 10.1136/bmjopen-2023-075194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In Canada, the Public Health Agency surveillance of new HIV cases has demonstrated annual increasing rates since 2020. The rates of new HIV cases are highest in the province of Saskatchewan. OBJECTIVES The aim of the project was to conduct a resident-oriented realist evaluation of an innovative supportive housing programme, Sanctum, for people living with HIV/AIDS who also face social care issues, such as homelessness. This project took place in Saskatchewan, a province that is seeking innovative approaches to improve quality of life and HIV/AIDS management for its citizens. Our evaluation addressed how and why participants were successful (or not) within the Sanctum programme. DESIGN AND SETTING Sanctum is a housing programme located in an inner-city location within the province of Saskatchewan. A unique component of this evaluation was the inclusion of an individual with lived experience, a resident partner, as a member of the research team. PARTICIPANTS 11 recent Sanctum graduates, seven men and four women, were recruited for client partner-led in-depth, semistructured interviews. INTERVENTIONS Prior to the evaluation, we developed a realist programme theory with potential causal explanations, known as context-mechanism-outcomes (CMO) configurations. Interview data from the evaluation and ongoing discussions with Sanctum board members and our resident partner were used to test, refine and validate the final programme theory and CMO configurations. RESULTS CMO configurations at the micro (individual), meso (interpersonal) and macro (community) levels complement the over-arching programme theory. Key findings were the importance of Sanctum's harm reduction philosophy, accompanied by a non-judgmental and patient-oriented approach. Participants were supported to reduce risky behaviour, improve self-care management and develop healthier relationships within a 'safe' home-like setting. Underlying mechanisms that contributed to participants' success in the programme included: intrinsic motivation, self-worth, belongingness, empowerment and self-efficacy. Evidence-informed recommendations are offered to support Sanctum-like programme development for individuals with holistic health needs related to HIV/AIDS diagnoses and lack of access to necessary social determinants of health. CONCLUSIONS Stigma associated with HIV/AIDS and living circumstances, such as homelessness, were successfully addressed using harm reduction principles and judgement-free approaches within a family-like environment.
Collapse
Affiliation(s)
- Anum Ali
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Gary Groot
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Melissa April
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maura MacPhee
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Hubert Alimezelli
- Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tracey Carr
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
2
|
Zibrowski E, Carr T, McDonald S, Thiessen H, van Dusen R, Goodridge D, Haver C, Marciniuk D, Stobart C, Verrall T, Groot G. A rapid realist review of patient engagement in patient-oriented research and health care system impacts: part one. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:72. [PMID: 34629118 PMCID: PMC8504114 DOI: 10.1186/s40900-021-00299-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 05/16/2023]
Abstract
BACKGROUND Patient-oriented research affords individuals with opportunities to genuinely contribute to health care research as members of research teams. While checklists and frameworks can support academic researchers' awareness of patient engagement methods, less guidance appears available to support their understanding of how to develop and maintain collaborative relationships with their patient partners. This knowledge is essential as patient partners report that the social atmospheres of research teams significantly impacts the quality of their experiences. This study sought to develop theory regarding how academic researchers support and sustain patient engagement in patient-oriented research. METHODS A six-step, rapid realist review was conducted: (1) research question development, (2) preliminary theory development, (3) search strategy development; (4) study selection and appraisal, (4) data extraction, analysis and synthesis (5) identification of relevant formal theories, and (6) theory refinement with stakeholders. Findings were additionally distilled by collective competence theory. RESULTS A program theory was developed from 62 international studies which illuminated mechanisms supporting academic researchers to engage patient partners, contexts supporting these mechanisms, and resources that enabled mechanism activation. Interaction between seven contexts (patient-oriented research belief, prior interaction with a healthcare system, prior interaction with a particular academic researcher, educational background of patient partner, prior experience with patient-oriented research, study type, and time lived in a rural-urban setting) and seven mechanisms (deciding to become involved in patient-oriented research, recognizing valuable experiential knowledge, cultural competence, reducing power differentials, respectful team environment, supporting patient partners to feel valued, and readiness to research) resulted in an intermediate outcome (sense of trust). Trust then acted as an eighth mechanism which triggered the final-level outcome (empowered patient-centred lens). CONCLUSIONS Our theory posits that if patient partners trust they are a member of a supportive team working alongside academic researchers who authentically want to incorporate their input, then they are empowered to draw upon their experiential knowledge of health care systems and contribute as researchers in patient-oriented research. Our theory extends conceptual thinking regarding the importance of trust on patient-oriented research teams, how patient partners' trust is shaped by team interactions, and the role that academic researchers have within those interactions.
Collapse
Affiliation(s)
- Elaine Zibrowski
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | | | | | | | - Donna Goodridge
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Charlene Haver
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Darcy Marciniuk
- University of Saskatchewan, College of Medicine, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Christine Stobart
- Saskatchewan Centre for Patient-Oriented Research, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Tanya Verrall
- Saskatchewan Health Quality Council, Atrium Building, Innovation Place, 241 - 111 Research Drive, Saskatoon, SK, S7N 3R2, Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| |
Collapse
|
3
|
Azizian AR, Carr T, Muhajarine N, Verrall T, Hartness C, Vanstone J, Yasinian M, Skrapek C, Andreas B, Farthing G, Groot G. Developing a patient-oriented realist evaluation for COVID-19 vaccine implementation in Saskatchewan: a methodologic framework. CMAJ Open 2021; 9:E1034-E1039. [PMID: 34815258 PMCID: PMC8612651 DOI: 10.9778/cmajo.20210041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is an urgent need to inform decision-making and safe delivery of vaccines in a timely manner. Our objective is to describe the methods we used to perform a patient-oriented realist evaluation of COVID-19 vaccination implementation in Saskatchewan, Canada, in order to understand the underlying mechanisms and contexts of vaccination implementation and vaccine uptake. METHODS This methodology paper describes a patient-oriented, realist, mixed-method evaluation to assess COVID-19 vaccination implementation in Regina, Saskatoon and Prince Albert, Saskatchewan. The study comprised 3 iterative phases guided by Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II). In phase 1 (January-February 2021), we developed the initial program theory, in phase 2 (March-May 2021), we tested and refined the initial program theory, and in phase 3 (June-July 2021), we established the final program theory. Three patient and family partners with different backgrounds and experiences were selected purposively from various locations (urban and rural) in Saskatchewan to engage collaboratively in the evaluation. Data analysis and synthesis occurred at all 3 phases of the project. We analysed qualitative data from phases 2 and 3 using a "retroductive" approach. We used quantitative data to compare outcomes from the 3 sites. INTERPRETATION This protocol describes how we developed a final program theory for COVID-19 vaccination implementation with patient and family partners to show for whom, under what circumstances, how and why Saskatchewan's COVID-19 vaccination program has led to vaccine uptake. With patient and family partners' engagement, the evaluation findings will be shared with the Saskatchewan Health Authority and provincial government policy-makers and communications departments, published in peer-reviewed journals, presented at provincial or national conferences, and disseminated through any additional media identified by the patient and family partners.
Collapse
Affiliation(s)
- Amir Reza Azizian
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Tracey Carr
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Tanya Verrall
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Collin Hartness
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Jason Vanstone
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Maryam Yasinian
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Candace Skrapek
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Brenda Andreas
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Gerald Farthing
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask
| | - Gary Groot
- Department of Community Health and Epidemiology (Azizian, Carr, Muhajarine, Yasinian, Groot), College of Medicine, University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.; Saskatchewan Health Authority (Azizian, Groot, Hartness, Vanstone), Regina, Sask.; patient partner (Skrapek), Saskatoon, Sask.; patient partner (Andreas), Maple Creek, Sask.; family partner (Farthing), Saskatoon, Sask.
| |
Collapse
|
4
|
McRae DN, Portela A, Waldron T, Bergen N, Muhajarine N. Understanding the implementation (including women's use) of maternity waiting homes in low-income and middle-income countries: a realist synthesis protocol. BMJ Open 2021; 11:e039531. [PMID: 33658257 PMCID: PMC7931758 DOI: 10.1136/bmjopen-2020-039531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes in low-income and middle-income countries provide accommodation near health facilities for pregnant women close to the time of birth to promote facility-based birth and birth with a skilled professional and to enable timely access to emergency obstetric services when needed. To date, no studies have provided a systematic, comprehensive synthesis explaining facilitators and barriers to successful maternity waiting home implementation and whether and how implementation strategies and recommendations vary by context. This synthesis will systematically consolidate the evidence, answering the question, 'How, why, for whom, and in what context are maternity waiting homes successfully implemented in low-income and middle-income countries?'. METHODS AND ANALYSIS Methods include standard steps for realist synthesis: determining the scope of the review, searching for evidence, appraising and extracting data, synthesising and analysing the data and developing recommendations for dissemination. Steps are iterative, repeating until theoretical saturation is achieved. Searching will be conducted in 13 electronic databases with results managed in Eppi-Reviewer V.4. There will be no language, study-type or document-type restrictions. Items documented prior to 1990 will be excluded. To ensure our initial and revised programme theories accurately reflect the experiences and knowledge of key stakeholders, most notably the beneficiaries, interviews will be conducted with maternity waiting home users/nonusers, healthcare staff, policymakers and programme designers. All data will be analysed using context-mechanism-outcome configurations, refined and synthesised to produce a final programme theory. ETHICS AND DISSEMINATION Ethics approval for the project will be obtained from the Mozambican National Bioethical Commission, Jimma University College of Health Sciences Institutional Review Board and the University of Saskatchewan Bioethical Research Ethics Board. To ensure results of the evaluation are available for uptake by a wide range of stakeholders, dissemination will include peer-reviewed journal publication, a plain-language brief, and conference presentations to stakeholders' practice audiences. PROSPERO REGISTRATION NUMBER CRD42020173595.
Collapse
Affiliation(s)
- Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Tamara Waldron
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Nicole Bergen
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
5
|
Zibrowski E, McDonald S, Thiessen H, VanDusen R, Boden C, Carr T, Goodridge D, Haver C, Marciniuk D, Stobart C, Verrall T, Groot G. Developing a program theory of patient engagement in patient-oriented research and the impacts on the health care system: protocol for a rapid realist review. CMAJ Open 2020; 8:E530-E534. [PMID: 32873581 PMCID: PMC7641165 DOI: 10.9778/cmajo.20190181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The patient-oriented research (POR) discourse has been criticized as being fragmented, lacking consistent terminology and having few evaluative studies. Our research team will use rapid realist review methodology to generate broad, process-based program theory regarding how partnering patients with researchers in POR generates an impact within a health care system. METHODS This protocol for a rapid realist review will involve multiple steps, including research question development; preliminary program theory and search strategy development; study selection and appraisal; data extraction, analysis and synthesis; and program theory refinement. We will be guided by the Realist and Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) publication standards for realist synthesis. Unlike traditional reviews, a realist review aims to discover and understand causal processes that exist within a complex environment, asking questions regarding what works for whom, under what circumstances, how and why. Our multidisciplinary team consists of patient partners, health care professionals, a health sciences librarian and health services researchers. Patient partners are full research partners, supporting development of our guiding research question and identifying community partners and stakeholder groups to disseminate our findings. Patient partners will be asked to recommend literature sources, to review and vet our set of search terms, and to review, evaluate and reflect on our initial program theory in light of their personal, lived expertise. INTERPRETATION We will share the results of our rapid realist review with community partners and stakeholder groups. We will also disseminate our program theory by means of publication in a peer-reviewed journal and presentation at scientific conferences.
Collapse
Affiliation(s)
- Elaine Zibrowski
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Shelagh McDonald
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Heather Thiessen
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Ray VanDusen
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Catherine Boden
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Tracey Carr
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Donna Goodridge
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Charlene Haver
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Darcy Marciniuk
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Christine Stobart
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Tanya Verrall
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask
| | - Gary Groot
- Department of Community Health and Epidemiology (Zibrowski, Carr, Groot), University of Saskatchewan; Patient partner (McDonald, Thiessen), Saskatoon, Sask.; Patient partner (VanDusen), Regina, Sask.; Leslie and Irene Dube Health Sciences Library (Boden), and Department of Nursing (Goodridge), University of Saskatchewan; Saskatchewan Centre for Patient-Oriented Research (Haver, Stobart); College of Medicine (Marciniuk, Groot), University of Saskatchewan; Saskatchewan Health Quality Council (Verrall), Saskatoon, Sask.
| |
Collapse
|
6
|
Groot G, Waldron T, Barreno L, Cochran D, Carr T. Trust and world view in shared decision making with indigenous patients: A realist synthesis. J Eval Clin Pract 2020; 26:503-514. [PMID: 31750600 PMCID: PMC7154772 DOI: 10.1111/jep.13307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/07/2019] [Accepted: 10/09/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION How shared decision making (SDM) works with indigenous patient values and preferences is not well understood. Colonization has affected indigenous peoples' levels of trust with institutions, and their world view tends to be distinct from that of nonindigenous people. Building on a programme theory for SDM, the present research aims to refine the original programme theory to understand how the mechanisms of trust and world view might work differently for indigenous patients. DESIGN We used a six-step iterative process for realist synthesis: preliminary programme theory development, search strategy development, selection and appraisal of literature, data extraction, data analysis and synthesis, and formation of a revised programme theory. DATA SOURCES Searches were through Medline, CINAHL, and the University of Saskatchewan iPortal for grey literature. Medline and CINAHL searches included the University of Alberta Canada-wide indigenous peoples search filters. DATA SYNTHESIS Following screening 731 references, 90 documents were included for data extraction (53 peer reviewed and 37 grey literature). Documents from countries with similar colonization experiences were included. RESULTS A total of 518 context-mechanism-outcome (CMO) configurations were identified and synthesized into 21 CMOs for a revised programme theory. Demographics, indigenous world view, system and institutional support, language barriers, and the macro-context of discrimination and historical abuse provided the main contexts for the programme theory. These inspired mechanisms of reciprocal respect, perception of world view acceptance, and culturally appropriate knowledge translation. In turn, these mechanisms influenced the level of trust and anxiety experienced by indigenous patients. Trust and anxiety were both mechanisms and intermediate outcomes and determined the level of engagement in SDM. CONCLUSION This realist synthesis provides clinicians and policymakers a deeper understanding of the complex configurations that influence indigenous patient engagement in SDM and offers possible avenues for improvement.
Collapse
Affiliation(s)
- Gary Groot
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tamara Waldron
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Leonzo Barreno
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - David Cochran
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| | - Tracey Carr
- Department of Community Health and EpidemiologyUniversity of SaskatchewanSaskatoonSKCanada
| |
Collapse
|
7
|
Waldron T, Carr T, McMullen L, Westhorp G, Duncan V, Neufeld SM, Bandura LA, Groot G. Development of a program theory for shared decision-making: a realist synthesis. BMC Health Serv Res 2020; 20:59. [PMID: 31973754 PMCID: PMC6979294 DOI: 10.1186/s12913-019-4649-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 10/16/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Shared Decision-making (SDM), a medical decision-making model, was popularized in the late 1980s in reaction to then predominate paternalistic decision-making, aiming to better meet the needs of patients. Extensive research has been conducted internationally examining the benefits of SDM implementation; however, existing theory on how SDM works, for whom, in which circumstances, and why is limited. While literature has shown positive patient, health care provider, and system benefits (SDM outputs), further research is required to understand the nuances of this type of decision-making. As such, we set out to address: "In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved engagement in the Shared Decision-making process?" METHODS To achieve our study goals we conducted a seven-step realist synthesis process, which included: (1) preliminary program theory development, (2) search strategy development, (3) selection and appraisal of literature in accordance with realist methodology, (4) data extraction, (5) identification of relevant formal theories, (6) data analysis and synthesis, and (7) formation of a revised program theory with the input of stakeholders. This process was done in accordance with RAMESES guidelines and publication standards for a realist synthesis. Expert consultations were also held to ensure consistency within the SDM literature. RESULTS Through our realist synthesis, we developed a program theory of SDM which includes three contexts (pre-existing relationship, difficulty of decision, and system support), eight mechanism sets (anxiety, trust, perception of other party capacity, perception of time, self-efficacy, world view, perception of capacity to external support, and recognition of decision), and one outcome (engagement in SDM). CONCLUSIONS As far as the authors of this paper are aware, this paper is the first to begin unpacking how SDM works, for whom, in which circumstances, and why. By examining key mechanism sets and exploring how they facilitate or inhibit SDM, we have produced a program theory that may assist health care professionals, policy makers, and patients. While further research is suggested to further unpack the concepts identified within this paper, this provides an initial understanding into the theory behind SDM. REGISTRATION PROSPERO: CRD42017062609.
Collapse
Affiliation(s)
- Tamara Waldron
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Tracey Carr
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Linda McMullen
- Department of Psychology, University of Saskatchewan Arts, 154, 9 Campus Drive, Saskatoon, SK S7N 5A5 Canada
| | - Gill Westhorp
- Charles Darwin University, Ellengowan Drive, Casuarina, NT 0810 Australia
| | - Vicky Duncan
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Shelley-May Neufeld
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Lori-Ann Bandura
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| | - Gary Groot
- Department of Community Health and Epidemiology, Health Sciences Building, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
| |
Collapse
|
8
|
Lamb CC, Wang Y, Lyytinen K. Shared decision making: Does a physician's decision-making style affect patient participation in treatment choices for primary immunodeficiency? J Eval Clin Pract 2019; 25:1102-1110. [PMID: 31115958 PMCID: PMC6900116 DOI: 10.1111/jep.13162] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/01/2019] [Accepted: 04/08/2019] [Indexed: 12/22/2022]
Abstract
Overall health care spending in the United States is equivalent to more than 15% of GDP, yet outcomes rank below the top 25 in most quality categories when compared with other Organization for Economic Cooperation and Development (OECD) countries. The majority of spending is consumed by small patient populations with chronic diseases. Experts believe increased patient-physician shared decision making (SDM) should result in better overall longitudinal care but understanding the physician's role in facilitating SDM is limited. Structural equation modelling was applied to results of a 2016 questionnaire-based survey of 330 US physicians who treat approximately 55% of primary immune deficiency requiring immune globulin therapy; it tested the relationship between slow/rational vs fast/intuitive decision-making styles and SDM as mediated by patient-centric care and moderated by physician's trust in the patient. The results showed a statistically significant relationship between slow/rational decision making and SDM. The results also suggest differences related to age, gender, education, and race but no differences related to trust.
Collapse
Affiliation(s)
- Christopher C. Lamb
- BioSolutions Services LLCCambridgeMassachusetts
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
| | - Yunmei Wang
- Case Cardiovascular Research Institute, Case Western Reserve University School of Medicine and Harrington Heart &Vascular InstituteUniversity Hospitals Cleveland Medical CenterClevelandOhio
| | - Kalle Lyytinen
- Weatherhead School of ManagementCase Western Reserve UniversityClevelandOhio
| |
Collapse
|
9
|
Floate HJ, Marks GC, Durham J. Cash transfer programmes in lower-income and middle-income countries: understanding pathways to nutritional change-a realist review protocol. BMJ Open 2019; 9:e028314. [PMID: 31133594 PMCID: PMC6537996 DOI: 10.1136/bmjopen-2018-028314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Child malnutrition continues to be a significant global public health concern. Nutrition-related interventions have changed and diversified over the last two decades, with increasing emphasis on nutrition-sensitive programmes that address underlying determinants of child malnutrition. Cash transfer programmes (CTPs) are used with increasing popularity in lower-income and middle-income countries to improve both food/nutrition insecurity and resilience. Available studies, however, provide mixed findings on the outcomes of CTPs for child nutritional status. This review is the first stage of a research project to develop evidence-informed theories of how CTPs affect child malnutrition. These will be empirically tested in the field and contribute to a better understanding of how, why, for whom and in what circumstances CTPs can be implemented to optimise impacts on child nutritional status. METHODS AND ANALYSIS This realist review is informed by available standards for realist reviews and follows a five-step process. In step 1, an initial scoping of literature identified potential contextual factors and underlying mechanisms that influence nutritional outcomes, and potential theories developed to address our research question. In step 2, a systematic literature search using multiple databases will be undertaken with papers screened using defined inclusion/exclusion criteria. In step 3, included studies will be appraised, data extracted into a bespoke data extraction tool and used to test and further refine our explanatory framework. The fourth step will synthesise, using a mix of inductive and deductive analytical processes to identify patterns, link chains of inference and tracking and linking of articles. The final step involves dissemination of a preliminary theory for feedback prior to empirically testing it in Kenya and Ethiopia where large-scale CTPs are being implemented. ETHICS AND DISSEMINATION This review will not involve primary data collection. Findings will be presented in accordance with Realist and Meta-Narrative Evidence Synthesis: Evolving Standards guidelines and published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER CRD42018110735.
Collapse
Affiliation(s)
- Hilary J Floate
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey C Marks
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Jo Durham
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
10
|
Gunn CM, Bokhour BG, Parker VA, Battaglia TA, Parker PA, Fagerlin A, McCaskill-Stevens W, Bandos H, Blakeslee SB, Holmberg C. Understanding Decision Making about Breast Cancer Prevention in Action: The Intersection of Perceived Risk, Perceived Control, and Social Context: NRG Oncology/NSABP DMP-1. Med Decis Making 2019; 39:217-227. [PMID: 30803311 PMCID: PMC6538065 DOI: 10.1177/0272989x19827258] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Literature on decision making about breast cancer prevention focuses on individual perceptions and attitudes that predict chemoprevention use, rather than the process by which women decide whether to take risk-reducing medications. This secondary analysis aimed to understand how women's perceptions of breast cancer risk and locus of control influence their decision making. METHODS Women were accrued as part of the NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project 1, a study aimed at understanding contributors to chemoprevention uptake. Thirty women participated in qualitative in-depth interviews after being counseled about chemoprevention. Deductive codes grouped women based on dimensions of risk perception and locus of control. We used a constant comparative method to make connections among inductive themes focused on decision making, deductive codes for perceived risk and perceived locus of control, and the influence of explanatory models within and across participants. RESULTS Participants were predominantly non-Hispanic white (63%), with an average age of 50.9 years. Decision making varied across groups: the high-perceived risk/high-perceived control group used "social evidence" to model the behaviors of others. High-perceived risk/low-perceived control women made decisions based on beliefs about treatment, rooted in the experiences of social contacts. The low-perceived risk/low-perceived control group interpreted signs of risk as part of the normal continuum of bodily changes in comparison to others. Low-perceived risk/high-perceived control women focused on maintaining a current healthy trajectory. CONCLUSION "Social evidence" plays an important role in the decision-making process that is distinct from emotional aspects. Attending to patients' perceptions of risk and control in conjunction with social context is key to caring for patients at high risk in a way that is evidence based and sensitive to patient preferences.
Collapse
Affiliation(s)
- Christine M. Gunn
- Boston University School of Medicine, Section of General Internal Medicine, Women’s Health Unit, Boston, MA
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
| | - Barbara G. Bokhour
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
- Center for Healthcare Organization and Implementation Research Department of Veterans Affairs, Bedford, MA
| | - Victoria A. Parker
- Boston University School of Public Health, Department of Health Law, Policy, and Management, Boston, MA
- University of New Hampshire, Durham, NH
| | - Tracy A. Battaglia
- Boston University School of Medicine, Section of General Internal Medicine, Women’s Health Unit, Boston, MA
| | - Patricia A. Parker
- Memorial Sloan Kettering Cancer Center, Psychiatry & Behavioral Sciences, New York, NY
| | - Angela Fagerlin
- University of Michigan, Ann Arbor, MI
- University of Utah School of Medicine, Department of Population Health Sciences, Salt Lake City
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT
| | - Worta McCaskill-Stevens
- NRG Oncology, Pittsburgh, PA
- Community Oncology and Prevention Trials Research Group, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Hanna Bandos
- NRG Oncology, Pittsburgh, PA
- The University of Pittsburgh, Pittsburgh, PA
| | - Sarah B. Blakeslee
- Institute of Public Health, Charité – Universitätsmedizin, Brandenburg, Berlin, Germany
| | - Christine Holmberg
- NRG Oncology, Pittsburgh, PA
- Institute of Public Health, Charité – Universitätsmedizin, Brandenburg, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
| |
Collapse
|
11
|
Coutu MF, Légaré F, Durand MJ, Stacey D, Labrecque ME, Corbière M, Bainbridge L. Acceptability and Feasibility of a Shared Decision-Making Model in Work Rehabilitation: A Mixed-Methods Study of Stakeholders' Perspectives. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:128-139. [PMID: 29663111 DOI: 10.1007/s10926-018-9770-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose To establish the acceptability and feasibility of implementing a shared decision-making (SDM) model in work rehabilitation. Methods We used a sequential mixed-methods design with diverse stakeholder groups (representatives of private and public employers, insurers, and unions, as well as workers having participated in a work rehabilitation program). First, a survey using a self-administered questionnaire enabled stakeholders to rate their level of agreement with the model's acceptability and feasibility and propose modifications, if necessary. Second, eight focus groups representing key stakeholders (n = 34) and four one-on-one interviews with workers were conducted, based on the questionnaire results. For each stakeholder group, we computed the percentage of agreement with the model's acceptability and feasibility and performed thematic analyses of the transcripts. Results Less than 50% of each stakeholder group initially agreed with the overall acceptability and feasibility of the model. Stakeholders proposed 37 modifications to the objectives, 17 to the activities, and 39 to improve the model's feasibility. Based on in-depth analysis of the transcripts, indicators were added to one objective, an interview guide was added as proposed by insurers to ensure compliance of the SDM process with insurance contract requirements, and one objective was reformulated. Conclusion Despite initially low agreement with the model's acceptability on the survey, subsequent discussions led to three minor changes and contributed to the model's ultimate acceptability and feasibility. Later steps will involve assessing the extent of implementation of the model in real rehabilitation settings to see if other modifications are necessary before assessing its impact.
Collapse
Affiliation(s)
- Marie-France Coutu
- CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil, QC, Canada.
- Charles-Le Moyne Hospital Research Centre, 150 Place Charles-Le Moyne, Room 200, Longueuil, QC, J4K 0A8, Canada.
| | - France Légaré
- Research Center of Centre hospitalier universitaire de Québec, St-François d'Assise Hospital, Quebec, QC, Canada
| | - Marie-José Durand
- CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil, QC, Canada
- Charles-Le Moyne Hospital Research Centre, 150 Place Charles-Le Moyne, Room 200, Longueuil, QC, J4K 0A8, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marie-Elise Labrecque
- CAPRIT and School of Rehabilitation, Université de Sherbrooke, Longueuil, QC, Canada
| | - Marc Corbière
- Université du Québec à Montréal, Montreal, QC, Canada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
| | | |
Collapse
|
12
|
Power J, Gilmore B, Vallières F, Toomey E, Mannan H, McAuliffe E. Adapting health interventions for local fit when scaling-up: a realist review protocol. BMJ Open 2019; 9:e022084. [PMID: 30679286 PMCID: PMC6347947 DOI: 10.1136/bmjopen-2018-022084] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/21/2018] [Accepted: 10/23/2018] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Scaling-up is essential to ensure universal access of effective health interventions. Scaling-up is a complex process, which occurs across diverse systems and contexts with no one-size-fits-all approach. To date, little attention has been paid to the process of scaling-up in how to make adaptations for local fit. The aim of this research is to develop theory on what actions can be used to make adaptations to health interventions for local fit when scaling-up across diverse contexts that will have practical application for implementers involved in scaling-up. METHODS AND ANALYSIS Given the complexity of this subject, a realist review methodology was selected. Specifically, realist review emphasises an iterative, non-linear process, whereby the review is refined as it progresses. The identification of how the context may activate mechanisms to achieve outcomes is used to generate theories on what works for whom in what circumstances. This protocol will describe the first completed stage of development of an initial programme theory framework, which identified potential actions, contexts, mechanisms and outcomes that could be used to make adaptations when scaling-up. It will then outline the methods for future stages of the review which will focus on identifying case examples of scale-up and adaptation in practice. This realist review consists of six stages: (i) clarifying scope and development of a theoretical framework, (ii) developing a search strategy, (iii) selection and appraisal, (iv) data extraction, (v) data synthesis and analysis and (vi) further theory refinement with stakeholders. ETHICS AND DISSEMINATION This review will develop theory on how adaptations can be made when scaling-up. Findings will be disseminated in a peer-reviewed journal and through stakeholder engagement as part of the research process. Ethical approval has been received through Health Policy and Management/Centre for Global Health Research Ethics Committee of Trinity College Dublin.
Collapse
Affiliation(s)
- Jessica Power
- Centre for Global Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Brynne Gilmore
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Frédérique Vallières
- Centre for Global Health, School of Psychology, Trinity College, Dublin, Ireland
| | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Hasheem Mannan
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| |
Collapse
|
13
|
Dalkin S, Lhussier M, Jones D, Phillipson P, Cunningham W. Open communication strategies between a triad of 'experts' facilitates death in usual place of residence: A realist evaluation. Palliat Med 2018; 32:980-989. [PMID: 29400631 DOI: 10.1177/0269216318757132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. AIM To understand how, for whom and in which circumstances death in usual place of residence is facilitated. DESIGN A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. SETTING/PARTICIPANTS Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants' homes ( n = 5). RESULTS A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of 'experts' (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. CONCLUSION An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.
Collapse
Affiliation(s)
- Sonia Dalkin
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK.,4 Fuse (The Centre for Transaltional Research in Public Health)
| | - Monique Lhussier
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK.,4 Fuse (The Centre for Transaltional Research in Public Health)
| | - Diana Jones
- 1 Northumbria University, Coach Lane Campus, Newcastle Upon Tyne, UK
| | - Pete Phillipson
- 2 Northumbria University, Newcastle City Campus, Newcastle Upon Tyne, UK
| | | |
Collapse
|