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Ayivi-Vinz G, Tremblay M, Gadio S, Dofara SG, Daniel SJ, Talbot D, Légaré F. Impact of Educational Activity Formats, Online or In-Person, on the Intention of Medical Specialists to Adopt a Clinical Behaviour: A Comparative Study. JOURNAL OF CME 2024; 13:2363550. [PMID: 38873619 PMCID: PMC11172255 DOI: 10.1080/28338073.2024.2363550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
COVID-19 accelerated continuing professional development (CPD) delivered online. We aimed to compare the impact of in-person versus online CPD courses on medical specialists' behavioural intentions and subsequent behaviour. In this comparative before-and-after study, medical specialists attended in-person courses on nine clinical topics. A second group attended an adapted online version of these courses. Behavioural intention and its psychosocial determinants were measured before and immediately after the courses. Behaviour change was measured six months later. Generalised estimating equation (GEE) models were used to compare the impact of course formats. A total of 82/206 in-person registrants (mean age: 52±10 years; 50% men) and 318/506 on-line registrants (mean age: 49±12 years; men: 63%) participated. Mean intention before in-person courses was 5.99±1.31 and 6.43±0.80 afterwards (average intention gain 0.44, CI: 0.16-0.74; p=0.003); mean intention before online courses was 5.53±1.62 and 5.98±1.40 afterwards (average intention gain of 0.45, CI: 0.30-0.58; p<0.0001). Difference in intention gain between groups was not statistically significant. Behaviour reported six months later was not significantly associated with post-course intention in either group. However, the intention difference increased significantly among those who said they had adopted the targeted behaviour (paired wilcoxon test: n = 40 and p-value=0.002) while it did not increase significantly in the group of those who had not adopted a targeted behaviour (paired wilcoxon test: n = 16 and p-value=0.223). In conclusion, the increase in intention of specialists after CPD courses was similar whether the course was in-person or online. Also, an increase in intention in both groups signalled more likelihood of adoption.
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Affiliation(s)
- Gloria Ayivi-Vinz
- Faculty of Medicine, Université Laval, Quebec, Canada
- Faculty of Science and Engineering, Université Laval, Quebec, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Quebec, Canada
| | - Martin Tremblay
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Souleymane Gadio
- VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Quebec, Canada
| | - Suélène Georgina Dofara
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Quebec, Canada
| | - Sam J Daniel
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Denis Talbot
- Faculty of Medicine, Université Laval, Quebec, Canada
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, Canada
| | - France Légaré
- Faculty of Medicine, Université Laval, Quebec, Canada
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, Canada
- VITAM - Centre de recherche en santé durable, CIUSSS de la Capitale-Nationale, Quebec, Canada
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, Canada
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Taqif H, Adisso L, Gomes Souza L, Dofara SG, Ghio SC, Rivest LP, Légaré F. Changes in intention to use an interprofessional approach to decision-making following training: a cluster before-and-after study. BMC Health Serv Res 2024; 24:437. [PMID: 38589863 PMCID: PMC11000315 DOI: 10.1186/s12913-024-10899-z] [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: 03/17/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Health professionals in home care work in interprofessional teams. Yet most training in decision support assumes a one-on-one relationship with patients. We assessed the impact of an in-person training session in interprofessional shared decision-making (IP-SDM) on home care professionals' intention to adopt this approach. METHODS We conducted a secondary analysis of a cluster stepped-wedge trial using a before-and-after study design. We collected data among home care professionals from November 2016 to February 2018 in 9 health and social services centers in Quebec, Canada. The intervention was an in-person IP-SDM training session. Intention to engage in IP-SDM pre- and post-session (dependent variable) was compared using a continuing professional development evaluation scale (CPD-Reaction) informed by the Godin's Integrated Behavioral Model for health professionals. We also assessed socio-demographic and psychosocial variables (beliefs about capabilities, beliefs about consequences, social influence and moral norm). We performed bivariate and multivariate analysis to identify factors influencing post-intervention intention. We used the STROBE reporting guidelines for observational studies to report our results. RESULTS Of 134 respondents who provided complete pairs of questionnaires (pre- and post-), most were female (90.9%), mean age was 42 (± 9.3) years and 66.9% were social workers. Mean intention scores decreased from 5.84 (± 1.19) to 5.54 (± 1.35) (Mean difference = -0.30 ± 1.16; p = 0.02). Factors associated with higher intention post-intervention were social influence (ß = 0.34, p = 0.01) and belief about capabilities (ß = 0.49, p < 0.01). CONCLUSION After in-person IP-SDM training, healthcare professionals' intention to engage in IP-SDM decreased. However, the scope of this decrease is probably not clinically significant. Due to their association with intention, beliefs about capabilities, which translate into having a sense of self-competency in the new clinical behavior, and social influences, which translate into what important others think one should be doing, could be targets for future research aiming to implement IP-SDM in home care settings.
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Affiliation(s)
- Hajar Taqif
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Lionel Adisso
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Lucas Gomes Souza
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Suélène Georgina Dofara
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Sergio Cortez Ghio
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - France Légaré
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé Et de Services Sociaux de La Capitale-Nationale, Quebec City, QC, Canada.
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
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Sultan L, de Jong N, Alsaywid B, Khan MA, de Nooijer J. Exploring Perceptions and Practices of Interprofessional Shared Decision-Making Education in Palliative Care Settings. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:281-291. [PMID: 38600963 PMCID: PMC11005846 DOI: 10.2147/amep.s450166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/31/2024] [Indexed: 04/12/2024]
Abstract
Background Palliative care teams provide support to patients and their caregivers during terminal illness, which requires interprofessional collaboration. One of the foundational skills is to assist patients with decision-making. This can be facilitated through interprofessional shared decision-making (IP-SDM). So far, IP-SDM education frameworks have only been used to a limited extent in the area of palliative care. Aim This study aims to explore perceptions and practices of faculty members, health professionals, and students toward IP-SDM education in palliative care and to indicate associated factors to implement an IP-SDM in undergraduate health professions education in palliative care settings. Methods We used a cross-sectional study design in which the data was obtained via an online self-administered questionnaire adapted from existing validated tools. The questionnaire was distributed to faculty members and health professionals (n = 125) and students (n = 334) at King Abdulaziz Medical City in Jeddah, Saudi Arabia. The sampling technique was a non-probability convenience sampling. Bivariate statistics, such as independent sample t-tests, one-way ANOVA, correlation coefficient, and linear multiple regression were conducted. Findings The response rate was 54% (85 faculty members and health professionals and 164 students). Perceptions on IP-SDM did not differ between participants. From those who had previous experience with IP-SDM, the mean practices score was slightly higher for faculty members and health professionals (M = 83.1, SD = 15.9) than for students (M = 74.1, SD = 11.5), which was significant (p < 0.05). Factors such as gender, age, discipline, nationality, level of education, years of study, and previous experience that were associated with perceptions and practices were varied among participants. Conclusion The findings show high levels of perception with low levels of practice of IP-SDM in palliative care. Other factors that could be associated with the topic should be addressed in further studies.
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Affiliation(s)
- Lama Sultan
- Department of Clinical Nutrition, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, KSA, Saudi Arabia
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Nynke de Jong
- Department of Health Services Research, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, NL, Saudi Arabia
| | - Basim Alsaywid
- Urology Department, King Faisal Specialist Hospital & Research Center, Riyadh, KSA, Saudi Arabia
- Education and Research Skills Directory, Saudi National Institute of Health, Riyadh, KSA, Saudi Arabia
| | - Muhammad Anwar Khan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, KSA, Saudi Arabia
| | - Jascha de Nooijer
- Department of Health Promotion, School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
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Guay-Bélanger S, Aubin E, Cimon M, Archambault P, Blanchette V, Giguere A, Gogovor A, Morin M, Ben Charif A, Ben Gaied N, Bickerstaff J, Chénard N, Emond J, Gilbert J, Violet I, Légaré F. Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care. JMIR Res Protoc 2023; 12:e53150. [PMID: 37889512 PMCID: PMC10696497 DOI: 10.2196/53150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. OBJECTIVE This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. METHODS This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. RESULTS This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. CONCLUSIONS This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53150.
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Affiliation(s)
- Sabrina Guay-Bélanger
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Emmanuelle Aubin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anik Giguere
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Michèle Morin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | | | | | - Nancy Chénard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Emond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Gilbert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Isabelle Violet
- Ministère de la santé et des services sociaux du Québec, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Dufour I, Arsenault-Lapierre G, Guillette M, Dame N, Poitras ME, Lussier MT, Fortier A, Brunet J, Martin J, Laverdure M, Brousseau G, Bergman H, Couturier Y, Quesnel-Vallée A, Vedel I. Research protocol of the Laval-ROSA Transilab: a living lab on transitions for people living with dementia. BMC Health Serv Res 2023; 23:1255. [PMID: 37964248 PMCID: PMC10647081 DOI: 10.1186/s12913-023-10248-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND The Laval-ROSA Transilab is a living lab that aims to support the Laval Integrated Health and Social Services Centres (Quebec, Canada) in consolidating the Quebec Alzheimer Plan. It aims to improve care transitions between different settings (Family Medicine Groups, home care, and community services) and as such improve the care of people living with dementia and their care partners. Four transition-oriented innovations are targeted. Two are already underway and will be co-evaluated: A) training of primary care professionals on dementia and interprofessional collaboration; B) early referral process to community services. Two will be co-developed and co-evaluated: C) developing a structured communication strategy around the dementia diagnosis disclosure; D) designation of a care navigator from the time of dementia diagnosis. The objectives are to: 1) co-develop a dashboard for monitoring transitions; 2) co-develop and 3) co-evaluate the four targeted innovations on transitions. In addition, we will 4) co-evaluate the impact and implementation process of the entire Laval-ROSA Transilab transformation, 5) support its sustainability, and 6) transfer it to other health organizations. METHODS Multi-methods living lab approach based on the principles of a learning health system. Living labs are open innovation systems that integrate research co-creation and knowledge exchange in real-life settings. Learning health systems centers care improvement on developing the organization's capacity to learn from their practices. We will conduct two learning cycles (data to knowledge, knowledge to practice, and practice to data) and involve various partners. We will use multiple data sources, including health administrative databases, electronic health records data, surveys, semi-structured interviews, focus groups, and observations. DISCUSSION Through its structuring actions, the Laval-ROSA Transilab will benefit people living with dementia, their care partners, and healthcare professionals. Its strategies will support sustainability and will thus allow for improvements throughout the care continuum so that people can receive the right services, at the right time, in the right place, and from the right staff.
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Affiliation(s)
- Isabelle Dufour
- School of Nursing, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12E Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
| | | | - Maxime Guillette
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathalie Dame
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Marie-Thérèse Lussier
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Annie Fortier
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Brunet
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Julie Martin
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Ginette Brousseau
- Integrated Health and Social Services Centre of Laval, Laval, Canada
| | - Howard Bergman
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Yves Couturier
- School of Social Work, Faculty of Letters and Humanities, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Isabelle Vedel
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Georg S, Genser B, Fischer J, Sachse S, De Bock F. Development and validation of a self-regulation scale within the German version of the Early Development Instrument. BMC Pediatr 2023; 23:509. [PMID: 37845613 PMCID: PMC10577983 DOI: 10.1186/s12887-023-04334-1] [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: 02/01/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Early childhood self-regulation (SR) is key for many health- and education-related outcomes across the life span. Kindergarten age is a crucial period for SR development, and within this developmental window, potential SR difficulties can still be compensated for (e.g., through interventions). However, efficient measurement of SR through brief, comprehensive, and easy-to-use instruments that identify SR difficulties are scarce. To address this need, we used items of an internationally applied kindergarten teacher questionnaire-the Early Development Instrument (EDI) - to develop and validate a specific SR measurement scale. METHODS The psychometric evaluation and validation of the selected SR-items was performed in data collected with the German version of the EDI (GEDI), in two independent data sets - (a) the development dataset, with 191 children, and b) the validation dataset, with 184 children. Both included three- to six-year-old children and contained retest and interrater reliability data. First, three independent raters-based on theory-selected items eligible to form a SR scale from the two SR-relevant GEDI domains "social competence" and "emotional maturity". Second, exploratory and confirmatory factor analysis using structural equation modeling examined the item structure across both data sets. This resulted in a defined SR scale, of which internal consistency, test-retest and interrater reliability, cross-validation, and concurrent validity using correlation and descriptive agreements (Bland-Altman (BA) plots) with an existing validated SR-measuring instrument (the Kindergarten Behavioral Scales) were assessed. RESULTS Confirmatory factor analysis across both data sets yielded the best fit indices with 13 of the GEDI 20 items initially deemed eligible for SR measurement, and a three-factor structure: a) behavioral response inhibition, b) cognitive inhibition, c) selective or focused attention (RMSEA: 0.019, CFI: 0.998). Psychometric evaluation of the resulting 13-item-GEDI-SR scale revealed good internal consistency (0.92), test-retest and interrater reliability (0.85 and 0.71, respectively), validity testing yielded stability across populations and good concurrent validity with the Kindergarten Behavioral Scales (Pearson correlation coefficient: mean 0.72, range 0.61 to 0.84). CONCLUSIONS The GEDI contains 13 items suitable to assess SR, either as part of regular EDI developmental monitoring or as a valid stand-alone scale. This short 13-item (G)EDI-SR scale may allow early detection of children with SR difficulties in the kindergarten setting in future and could be the basis for public health intervention planning. To attain this goal, future research should establish appropriate reference values using a representative standardization sample.
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Affiliation(s)
- Sabine Georg
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Old Brewery, Heidelberg University, Röntgenstraße 7, 68167, Mannheim, Germany.
- Department of Developmental Psychology, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany.
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Bernd Genser
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Old Brewery, Heidelberg University, Röntgenstraße 7, 68167, Mannheim, Germany
- BGStats Consulting, Schleifmühlgasse 7, 1040, Vienna, Austria
| | - Joachim Fischer
- Medical Faculty Mannheim, Center for Preventive Medicine and Digital Health (CPD), Division of General Medicine, Old Brewery, Heidelberg University, Röntgenstraße 7, 68167, Mannheim, Germany
| | - Steffi Sachse
- Department of Developmental Psychology, Heidelberg University of Education, Keplerstraße 87, 69120, Heidelberg, Germany
| | - Freia De Bock
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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van de Water L, Kuijper S, Henselmans I, van Alphen E, Kooij E, Calff M, Beerepoot L, Buijsen J, Eshuis W, Geijsen E, Havenith S, Heesakkers F, Mook S, Muller K, Post H, Rütten H, Slingerland M, van Voorthuizen T, van Laarhoven H, Smets E. Effect of a prediction tool and communication skills training on communication of treatment outcomes: a multicenter stepped wedge clinical trial (the SOURCE trial). EClinicalMedicine 2023; 64:102244. [PMID: 37781156 PMCID: PMC10539636 DOI: 10.1016/j.eclinm.2023.102244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023] Open
Abstract
Background For cancer patients to effectively engage in decision making, they require comprehensive and understandable information regarding treatment options and their associated outcomes. We developed an online prediction tool and supporting communication skills training to assist healthcare providers (HCPs) in this complex task. This study aims to assess the impact of this combined intervention (prediction tool and training) on the communication practices of HCPs when discussing treatment options. Methods We conducted a multicenter intervention trial using a pragmatic stepped wedge design (NCT04232735). Standardized Patient Assessments (simulated consultations) using cases of esophageal and gastric cancer patients, were performed before and after the combined intervention (March 2020 to July 2022). Audio recordings were analyzed using an observational coding scale, rating all utterances of treatment outcome information on the primary outcome-precision of provided outcome information-and on secondary outcomes-such as: personalization, tailoring and use of visualizations. Pre vs. post measurements were compared in order to assess the effect of the intervention. Findings 31 HCPs of 11 different centers in the Netherlands participated. The tool and training significantly affected the precision of the overall communicated treatment outcome information (p = 0.001, median difference 6.93, IQR (-0.32 to 12.44)). In the curative setting, survival information was significantly more precise after the intervention (p = 0.029). In the palliative setting, information about side effects was more precise (p < 0.001). Interpretation A prediction tool and communication skills training for HCPs improves the precision of treatment information on outcomes in simulated consultations. The next step is to examine the effect of such interventions on communication in clinical practice and on patient-reported outcomes. Funding Financial support for this study was provided entirely by a grant from the Dutch Cancer Society (UVA 2014-7000).
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Affiliation(s)
- L.F. van de Water
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - S.C. Kuijper
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - I. Henselmans
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.N. van Alphen
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.S. Kooij
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - M.M. Calff
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - L.V. Beerepoot
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, the Netherlands
| | - J. Buijsen
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - W.J. Eshuis
- Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - E.D. Geijsen
- Department of Radiation Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - S.H.C. Havenith
- Department of Medical Oncology, Flevoziekenhuis, Almere, the Netherlands
| | - F.F.B.M. Heesakkers
- Department of Surgery, Department of Intensive Care Medicine, Catharina Ziekenhuis, Eindhoven, the Netherlands
| | - S. Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - K. Muller
- Department of Radiation Oncology, Radiotherapiegroep, Deventer, the Netherlands
| | - H.C. Post
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - H. Rütten
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - M. Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - H.W.M. van Laarhoven
- Department of Medical Oncology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - E.M.A. Smets
- Department of Medical Psychology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
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Christensen C, Bellows DM. 2022 APTA Pediatrics Knowledge Translation Lecture: Clinicians and Researchers Collaborate to Implement a Segmental Approach to Trunk Control. Pediatr Phys Ther 2023; 35:387-396. [PMID: 37747974 DOI: 10.1097/pep.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The aim of this special communication is to describe a clinician/researcher collaboration that supported implementation of the segmental approach to trunk control into physical therapy practice at a large, multisite, pediatric hospital. A 6-phase, multifaceted iterative process including use of educational strategies, the knowledge-to-action (KTA) cycle, the Consolidated Framework for Implementation Research, and the Theoretical Domains Framework was used. The total number of Segmental Assessments of Trunk Control (SATCos) completed increased from 0 to 57. Fifteen of 23 physical therapists representing 7 clinic locations referred a child for a SATCo. Using education alone or education plus the KTA cycle resulted in minimal uptake. Using more formal contextual assessments and mapping of barriers to strategies using implementation frameworks, collaborative goal setting, and planning resulted in more effective strategies and increase in uptake of the segmental approach in later phases.
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Affiliation(s)
- Catie Christensen
- Nationwide Children's Hospital (Dr Christensen), Westerville, Ohio; Massachusetts College of Pharmacy and Health Sciences (Dr Bellows), Worcester, Massachusetts
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Sachidanandan G, Sud A. From Two Dimensions to Multidimensions: A Mechanistic Model to Support Deliberate CPD Development, Coordination, and Evaluation. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00099. [PMID: 37782259 DOI: 10.1097/ceh.0000000000000527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The effectiveness of continuing professional development as an intervention to improve health professional behavior and patient health is variable and contentious. To clarify the causal relationships underlying program outcomes and facilitate a necessary shift from outcomes-only-based approaches to outcome-based and theory-based approaches in program development and evaluation, we developed a model of mechanisms mapped to relevant outcomes. METHODS Mechanisms identified in a prior realist synthesis of opioid agonist therapy continuing professional development programs were iteratively tested and refined using purposive and opportunistic sampling and realist approaches against two systematic reviews of programs in analgesic prescribing and palliative care. Further testing involved practical application within programs in sustainable health care and pain management. RESULTS Ninety reports on 75 programs and practical application to multiple additional programs informed the final model consisting of five distinct mechanisms: motivation transformation, expert influence, confidence development, self-efficacy facilitation, and community of practice expansion. The mechanisms and related analysis emphasize that continuing professional development is heterogeneous, complex, and context dependent. DISCUSSION Shifting toward outcome-based and theory-based approaches facilitates further conceptual shifts at intraprogram and interprogram and interintervention levels toward more deliberate program development and evaluation, increased program complementarity and subsequent collaboration. It clarifies opportunities for intercalation of continuing professional development with other intervention sciences. The model presents a resource for practitioners, researchers, and policymakers to advance continuing professional development planning, coordination, and evaluation.
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Affiliation(s)
- Grahanya Sachidanandan
- Ms. Sachidanandan: Medical Student, Temerty Faculty of Medicine, University of Toronto. Dr. Sud: Research Chair, Primary Care & Population Health Systems, Humber River Hospital, and Assistant Professor, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto
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Bakwa Kanyinga F, Gogovor A, Dofara SG, Gadio S, Tremblay M, Daniel SJ, Rivest LP, Légaré F. Evaluating the impact of continuing professional development courses on physician behavioral intention: a pre-post study with follow-up at six months. BMC MEDICAL EDUCATION 2023; 23:629. [PMID: 37661265 PMCID: PMC10476392 DOI: 10.1186/s12909-023-04597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Continuing professional development (CPD) for health professionals includes educational activities to maintain or improve skills. We evaluated the impact of a series of CPD courses by identifying factors influencing physicians' intention to adopt targeted behaviors and assessing self-reported behavior adoption six months later. METHODS In this pre-post study, eligible participants attended at least one in-person course at the Fédération des Médecins Spécialistes du Québec annual meeting in November 2019. Before and afterwards, participants completed CPD-REACTION, a validated questionnaire based on Godin's integrated model for health professional behavior change that measures intention and psychosocial factors influencing intention. We used Wilcoxon signed-rank test to compare pre- and post-course intention scores and linear regression analyses to identify factors influencing intention. We also compared the post-course intention scores of participants reporting a behavior change six months later with the scores of those reporting no behavior change six months later. Qualitative data was collected only six months after courses and responses to open-ended questions were analyzed using the Theoretical Domains Framework. RESULTS A total of 205/329 course attendees completed CPD-REACTION (response rate 62.3%). Among these participants, 158/329 (48%) completed the questionnaire before CPD courses, 129/329 (39.2%) only after courses and 47/329 (14.3%) at 6 months. Study population included 192 physicians of whom 78/192(40.6%) were female; 59/192(30.7%) were between 50 and 59 years old; and 72/192 (37.5%) were surgical specialist physicians. Mean intention scores before (n = 158) and after (n = 129) courses were 5.74(SD = 1.52) and 6.35(SD = 0.93) respectively. Differences in mean (DM) intention before and afterwards ranged from - 0.31(p = 0.17) to 2.25(p = 0.50). Multivariate analysis showed that beliefs about capabilities (β = 0.15, p = 0.001), moral norm (β = 0.75, p < 0.0001), and beliefs about consequences (β = 0.11, p = 0.04) influenced post-course intention. Post-course intention was correlated with behavior six months later (DM = 0.63; p = 0.02). Qualitative analysis showed that facilitators to behavior adoption after six months were most often related to the TDF domains of beliefs about capabilities. Most frequent barriers to adoption related to lack of resources. CONCLUSIONS Overall, scores for intention to adopt targeted behaviors increased after the courses. CPD providers could increase participants' intention by including interventions that emphasize beliefs about capabilities, moral norm and beliefs about consequences.
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Affiliation(s)
- Felly Bakwa Kanyinga
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, G1J 2G1, Canada
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec City, QC, G1J 2G1, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec City, QC, G1J 2G1, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, G1J 2G1, Canada
| | - Suélène Georgina Dofara
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec City, QC, G1J 2G1, Canada
| | - Souleymane Gadio
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec City, QC, G1J 2G1, Canada
| | - Martin Tremblay
- Continuing Professional Development Directorate, Fédération des Médecins Spécialistes du Québec, Montreal, QC, H5B 1G8, Canada
| | - Sam J Daniel
- Continuing Professional Development Directorate, Fédération des Médecins Spécialistes du Québec, Montreal, QC, H5B 1G8, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Faculty of Science and Engineering, Université Laval, Quebec City, QC, G1V 0A6, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 2480 Chemin de la Canardière, Quebec City, QC, G1J 2G1, Canada.
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, QC, G1J 2G1, Canada.
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Bos-van den Hoek DW, Smets EMA, Ali R, Baas-Thijssen MCM, Bomhof-Roordink H, Helsper CW, Stacey D, Tange D, van Laarhoven HWM, Henselmans I. A blended learning for general practitioners and nurses on skills to support shared decision-making with patients about palliative cancer treatment: A one-group pre-posttest study. PATIENT EDUCATION AND COUNSELING 2023; 112:107712. [PMID: 37004502 DOI: 10.1016/j.pec.2023.107712] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To evaluate a newly developed blended learning programme for general practitioners (GPs) and nurses in supporting shared decision making (SDM) about palliative cancer treatment in a simulated setting. METHODS In a pre-posttest study, healthcare professionals (HCPs) participated in the blended learning (i.e. e-learning and (online) training session). HCPs filled out surveys (T0 (baseline), T1 (after e-learning) and T2 (after full blended learning)) and engaged in simulated consultations at T0 and T2. The primary outcome was observed SDM support (Triple-S; DSAT-10 for validation). Secondary outcomes included satisfaction, knowledge about and attitude towards SDM support. Repeated measures General Linear Models were conducted. RESULTS 33 HCPs (17 GPs and 16 nurses) participated. SDM support significantly improved after training (Triple-S; medium effect). Observers' overall rating of SDM support (medium effect) as well as HCPs' knowledge (large effect) and beliefs about their capabilities (medium effect) improved after training. There was no difference in decision support skills (DSAT-10), HCPs' other clinical behavioural intentions and satisfaction. HCPs evaluated the training positively. CONCLUSION Blended learning for HCPs on supporting SDM in palliative cancer care improved their skills, knowledge and confidence in simulated consultations. PRACTICE IMPLICATIONS These first findings are promising for evaluating interprofessional SDM in clinical practice.
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Affiliation(s)
- Danique W Bos-van den Hoek
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Quality of Care program, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands.
| | - Ellen M A Smets
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Quality of Care program, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
| | - Rania Ali
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Hanna Bomhof-Roordink
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Boelelaan 1117, Amsterdam, the Netherlands
| | - Charles W Helsper
- Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada; Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dorien Tange
- Dutch Federation of Cancer Patient Organizations (NFK), Godebaldkwartier 365, Utrecht, the Netherlands
| | - Hanneke W M van Laarhoven
- Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, Department of Medical Oncology, Meibergdreef 9, Amsterdam, the Netherlands
| | - Inge Henselmans
- Amsterdam UMC location University of Amsterdam, department of Medical Psychology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Quality of Care program, Amsterdam, the Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands; Amsterdam UMC Location University of Amsterdam, department of General Practice, Meibergdreef 9, Amsterdam, the Netherlands
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Crawford A, Sockalingam S, Serhal E, Zhou C, Gambin A, de Oliveira C, Iwajomo T, Kurdyak P. Using "Big Data" to Provide Insights into Early Adopters of Continuing Professional Development: An Example from Project ECHO. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023:00005141-990000000-00066. [PMID: 37053580 DOI: 10.1097/ceh.0000000000000509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Mental health care is often managed in primary care with limited specialist support, particularly in rural and remote communities. Continuing professional development programs (CPD) can offer a potential solution to further mental health training; however, engaging primary care organizations (PCOs) can be challenging. The use of "big data" to identify factors influencing engagement in CPD programs has not been well studied. Therefore, the aim of this project was to use administrative health data from Ontario, Canada to identify characteristics of PCOs associated with early engagement in a virtual CPD program, Project Extension for Community Healthcare Outcomes (ECHO) Ontario Mental Health (ECHO ONMH) . METHODS Ontario health administrative data for fiscal year 2014 was used to compare the characteristics of ECHO ONMH-adopting PCOs, and their patients, to nonadopter organizations (N = 280 vs. N = 273 physicians). RESULTS ECHO-adopting PCOs did not differ with respect to physician age or years of practice, although PCOs with more female physicians were somewhat more likely to participate. ECHO ONMH adoption was more likely in regions with lower psychiatrist supply, among PCOs using partial salary payment models, and those with a greater interprofessional complement. Patients of ECHO-adopters did not differ on the basis of gender or health care utilization (physical or mental health); however, ECHO-adopting PCOs tended to have patients with less psychiatric comorbidity. DISCUSSION Models such as Project ECHO, which deliver CPD to primary care, are advanced to address lack of access to specialist health care. These findings support the use of administrative health data to assess the implementation, spread, and impact of CPD.
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Affiliation(s)
- Allison Crawford
- Dr. Crawford, Medical Director, Outreach and Virtual Care; Chief Medical Officer, Canada Suicide Prevention Service, Co-Chair ECHO Ontario Superhub and ECHO Ontario Mental Health, Clinician Scientist, Centre for Addiction and Mental Health, and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON; Dr. Sockalingam, VP, Education at the Centre for Addiction and Mental Health, CAMH Clinician Scientist; Professor of Psychiatry, University of Toronto, Toronto, ON; Dr. Serhal, Senior Director of Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Dr. Zhou, Lecturer and Staff Psychiatrist, University of Toronto, Toronto, ON; Dr. Gambin, Research Coordinator, Virtual Mental Health, ECHO Ontario Mental Health, and Canadian Suicide Prevention Service, Centre for Addiction and Mental Health, Toronto, ON; Dr. de Oliveira, Independent Scientist and Senior Health Economist, Centre for Addiction and Mental Health, and Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON; Ms. Iwajomo, Research Coordinator, Institute for Mental Health Policy Research (CAMH), and Appointed Analyst, Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), Toronto, ON; and Dr. Kurdyak, Director of Health Outcomes and Performance Evaluation, Institute for Mental Health Policy Research, Medical Director of Performance Improvement at CAMH, Lead of the Mental Health and Addictions Research Program at the Institute for Clinical Evaluative Sciences (ICES), and Associate Professor, Department of Psychiatry, University of Toronto, Toronto, ON
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Blended online learning for oncologists to improve skills in shared decision making about palliative chemotherapy: a pre-posttest evaluation. Support Care Cancer 2023; 31:184. [PMID: 36820944 PMCID: PMC9947445 DOI: 10.1007/s00520-023-07625-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. METHODS A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists' self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. RESULTS Oncologists (n = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists' beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. CONCLUSION Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.
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Odom-Forren J, Brady JM, Wente S, Edwards JM, Rayens MK, Sloan PA. A Web-based Educational Intervention to Increase Perianesthesia Nurses' Knowledge, Attitude, and Intention to Promote Safe Use, Storage, and Disposal of Opioids. J Perianesth Nurs 2022; 37:795-801. [PMID: 35941006 DOI: 10.1016/j.jopan.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/25/2022] [Accepted: 04/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education. DESIGN A pre-test, post-test longitudinal design. METHODS An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling. FINDINGS The participants were invited to complete a pre-test survey (n = 672), the immediate post-test (n = 245), and the 4-week post-test (n = 172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant. CONCLUSIONS In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed.
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Affiliation(s)
| | - Joni M Brady
- Inova System Nursing Professional Development, Inova, Falls Church, VA
| | - Sarah Wente
- Department of Nursing Practice, Clinical and Patient Education, MHealth Fairview Minneapolis, Minneapolis, MN
| | - John M Edwards
- Department of Anesthesia/Acute Pain Management, Baptist Health Lexington, Lexington, KY
| | | | - Paul A Sloan
- Department of Anesthesiology, University of Kentucky, Lexington, KY
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McNamara L, Scott K, Boyd RN, Farmer E, Webb A, Bosanquet M, Nguyen K, Novak I. Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost-consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes. BMJ Open 2022; 12:e063558. [PMID: 36410832 PMCID: PMC9680174 DOI: 10.1136/bmjopen-2022-063558] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12-24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research-practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control. METHODS AND ANALYSIS This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost-consequence analysis from funders' and societal perspectives. ETHICS AND DISSEMINATION Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.
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Affiliation(s)
- Lynda McNamara
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Karen Scott
- Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Elizabeth Farmer
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Annabel Webb
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Paediatric Department, Townsville Hospital and Health Service District (THHS), Townsville, Queensland, Australia
| | - Kim Nguyen
- Faculty of Medicine, Centre for Health Service Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Jackson AC, Grande MRL, Rogerson MC, Ski CF, Amerena J, Smith JA, Hoover V, Alvarenga ME, Higgins RO, Thompson DR, Murphy BM. The cardiac distress inventory: A new measure of psychosocial distress associated with an acute cardiac event. BMC Cardiovasc Disord 2022; 22:460. [PMID: 36329396 PMCID: PMC9633013 DOI: 10.1186/s12872-022-02897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many challenges are posed by the experience of a heart attack or heart surgery which can be characterised as ‘cardiac distress’. It spans multiple psychosocial domains incorporating patients’ responses to physical, affective, cognitive, behavioural and social symptoms and experiences related to their cardiac event and their recovery. Although some measures of the psychological and emotional impacts of a cardiac event exist, none provides a comprehensive assessment of cardiac distress. To address this gap, the study aimed to develop a Cardiac Distress Inventory (CDI) using best practice in instrument design. Method An item pool was generated through analysis of cognate measures, mostly in relation to other health conditions and through focus group and individual review by a multidisciplinary development team, cardiac patients, and end-users including cardiac rehabilitation co-ordinators. The resulting 144 items were reduced through further reviews to 74 for testing. The testing was carried out with 405 people recruited from three hospitals, through social media and by direct enrolment on the study website. A two-stage psychometric evaluation of the 74 items used exploratory factor analysis to extract the factors followed by Rasch analysis to confirm dimensionality within factors. Results Psychometric analysis resulted in the identification of 55 items comprising eight subscales, to form the CDI. The subscales assess fear and uncertainty, disconnection and hopelessness, changes to roles and relationships, overwhelm and depletion, cognitive challenges, physical challenges, health system challenges, and death concerns. Validation against the Kessler 6 supports the criterion validity of the CDI. Conclusion The CDI reflects a nuanced understanding of cardiac distress and should prove to be a useful clinical assessment tool, as well as a research instrument. Individual subscales or the complete CDI could be used to assess or monitor specific areas of distress in clinical practice. Development of a short form screening version for use in primary care, cardiac rehabilitation and counselling services is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02897-y.
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Affiliation(s)
- Alun C Jackson
- Australian Centre for Heart Health, Melbourne, VIC, Australia. .,Centre on Behavioral Health, University of Hong Kong, Hong Kong SAR, China.
| | - Michael R Le Grande
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | | | - Chantal F Ski
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Integrated Care Academy, University of Suffolk, Ipswich, UK.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - John Amerena
- Barwon Health, Geelong, VIC, Australia.,Deakin School of Medicine, University Hospital Geelong, Geelong, VIC, Australia
| | - Julian A Smith
- Department of Cardiothoracic Surgery, Monash Health, Clayton, VIC, Australia.,Department of Surgery, School of Clinical Sciences at Monash Health), Monash University, Clayton, VIC, Australia
| | - Valerie Hoover
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Marlies E Alvarenga
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Institute of Health and Wellbeing, Federation University, Berwick, VIC, Australia.,Victorian Heart Institute, Clayton, VIC, Australia.,Monash Health & Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Rosemary O Higgins
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Physiotherapy, University of Melbourne, Parkville, VIC, Australia
| | - David R Thompson
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Barbara M Murphy
- Australian Centre for Heart Health, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia
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Laberge M, Chadoin M, Inigo M, Messing K, Lefrançois M, Sultan-Taïeb H, Chatigny C, Riel J, Webb J, Fillion M, Vaillancourt C, Bellemare M. Integration of sex and gender in interventions by students in ergonomics. ERGONOMICS 2022; 65:1578-1591. [PMID: 35232328 DOI: 10.1080/00140139.2022.2048898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
This article aims to analyse the integration of sex and gender (s/g) by ergonomics students during their internship at the master's degree level, following training sessions on s/g issues in the workplace. This exploratory research used a descriptive mixed-methods design, encompassing evaluation of students' intention to use the content from the training (n = 13 students), and a multiple case study (n = 5 ergonomics interventions). The results show that while students found the training relevant, they only minimally integrated s/g in their interventions and when they did, it was primarily from an anthropometric and physiological perspective. In addition to discussing the training format limitations, the article discusses barriers to this integration: combining learning about s/g issues with learning about activity analysis is challenging; employers' and workers' organisations may be reluctant to approach s/g issues; and it is difficult for an ergonomist to integrate these issues when the employer's request does not specify it.Practitioner summary: This article aims to analyse the integration of s/g by ergonomics students during their internships. Findings show that they only minimally considered s/g. The discussion examines s/g training, organisational obstacles to inclusion of s/g during interventions, and how ergonomists can consider s/g in their practice.
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Affiliation(s)
- Marie Laberge
- School of Rehabilitation, Faculty of Medicine, University of Montreal (UdeM), Montreal, Canada
- Research Centre - Technopole en réadaptation pédiatrique, UHC Sainte-Justine Research Center, Montreal, Canada
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
| | - Martin Chadoin
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Organization and Human Resources, School of Management Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Marion Inigo
- School of Rehabilitation, Faculty of Medicine, University of Montreal (UdeM), Montreal, Canada
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
| | - Karen Messing
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Mélanie Lefrançois
- Department of Organization and Human Resources, School of Management Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Hélène Sultan-Taïeb
- Department of Organization and Human Resources, School of Management Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Céline Chatigny
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Educational Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Jessica Riel
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Industrial Relations, Université du Québec en Outaouais, Montreal, Canada
| | - Jena Webb
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Biological Sciences, Université du Québec à Montréal, Montreal, Canada
| | - Myriam Fillion
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- Department of Science and Technology, TéLUQ University, Quebec, Canada
| | - Cathy Vaillancourt
- CINBIOSE Research Center, Université du Québec à Montréal, Montreal, Canada
- INRS-Armand Frappier, Laval, Canada
| | - Marie Bellemare
- Department of Industrial Relations, Université du Québec en Outaouais, Montreal, Canada
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Training School Counselors and Nurses to Enhance Collaboration Through Animal-Assisted Therapy. CLIN NURSE SPEC 2022; 36:204-213. [PMID: 35714323 DOI: 10.1097/nur.0000000000000681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/AIMS The school nurse and school counselor serve an important role to foster student academic achievement, physical and mental health, and connectiveness. Each is paramount to student success; therefore, efforts should be made to further enhance collaborative efforts. Researchers sought to determine if an online training course centered on integrative methods would enhance collaboration between the school nurse and counselor. DESIGN This study used a quasi-experimental design with 3 data points (pretest, posttest, and 6-month follow-up), assessing the impact of educational content and knowledge application based on an online training module incorporating animal-assisted therapy (AAT) concepts and the school counselor and school nurse collaboration model. METHODS The continuing professional development questionnaire was used to evaluate professionals' behavior, specifically focusing on how knowledge translates into practice. The intervention included a training course designed for school nurses and counselors. Researchers analyzed data to determine how their collaboration and endorsement of AAT changed over time. RESULTS School counselors endorsed collaboration and intention of AAT application in schools at a higher rate than school nurses. However, after the intervention, differences between school counselors and nurses diminished over time. CONCLUSION The findings provide recommendations for the clinical nurse specialist to implement evidence-based programs targeting school nurse and school counselor collaboration.
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Ayivi-Vinz G, Bakwa Kanyinga F, Bergeron L, Décary S, Adisso ÉL, Zomahoun HTV, Daniel SJ, Tremblay M, Plourde KV, Guay-Bélanger S, Légaré F. Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review. JMIR MEDICAL EDUCATION 2022; 8:e36948. [PMID: 35318188 PMCID: PMC9112082 DOI: 10.2196/36948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/11/2022] [Accepted: 03/21/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory-informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory-informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. OBJECTIVE We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. METHODS We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60%). CONCLUSIONS The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. TRIAL REGISTRATION PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=116492.
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Affiliation(s)
- Gloria Ayivi-Vinz
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Felly Bakwa Kanyinga
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Lysa Bergeron
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Évèhouénou Lionel Adisso
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Unité de Soutien SSA Québec, Université Laval, Quebec, QC, Canada
| | - Sam J Daniel
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Martin Tremblay
- Direction du Développement Professionnel Continu, Fédération des Médecins Spécialistes du Québec, Montreal, QC, Canada
| | - Karine V Plourde
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - Sabrina Guay-Bélanger
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Université Laval, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Unité de Soutien SSA Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Deom Tardif A, Gogovor A, Guay-Bélanger S, Audet D, Parent N, Gaudreau A, Remy-Lamarche D, Vigneault L, Ngueta G, Bilodeau A, Légaré F. Integration of sex and gender in a continuing professional development course on diabetes and depression: a mixed methods feasibility study. BMJ Open 2022; 12:e050890. [PMID: 35459660 PMCID: PMC9036429 DOI: 10.1136/bmjopen-2021-050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/28/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Assess the feasibility and impact of a continuous professional development (CPD) course on type 2 diabetes and depression on health professionals' intention to include sex and gender considerations in patient care. DESIGN AND SETTING In collaboration with CPD organisations and patient-partners, we conducted a mixed-methods feasibility controlled trial with postintervention measures in three Canadian provinces. PARTICIPANTS Of 178 eligible health professionals, 127 completed questionnaires and 67 participated in semistructured group discussions. INTERVENTION AND COMPARATOR An interactive 1 hour CPD course, codesigned with patient-partners, on diabetes and depression that included sex and gender considerations (innovation) was compared with a similar course that did not include them (comparator). OUTCOMES Feasibility of recruitment and retention of CPD organisations and patient-partners throughout the study; adherence to planned activities; health professionals' intention to include sex and gender considerations in patient care as measured by the CPD-Reaction questionnaire; and barriers and facilitators using the Theoretical Domains Framework. RESULTS All recruited CPD organisations and patient-partners remained engaged throughout the study. All planned CPD courses occurred. Overall, 71% of eligible health professionals participated (63% under 44 years old; 79.5% women; 67.7% practising in French; 66.9% practising in Quebec; 78.8% in urban practice). After training, mean intention scores for the innovation (n=49) and control groups (n=78) were 5.65±0.19 and 5.19±0.15, respectively. Mean difference was -0.47 (CI -0.95 to 0.01; p=0.06). Adjusted for age, gender and practice settings, mean difference was -0.57 (CI -1.09 to -0.05; p=0.03). We identified eight theoretical domains related to barriers and six related to facilitators for providing sex-adapted and gender-adapted diabetes and depression care. CONCLUSIONS CPD training on diabetes and depression that includes sex and gender considerations is feasible and, compared with CPD training that does not, may prompt health professionals to modify their care. Addressing identified barriers and facilitators could increase intention. TRIAL REGISTRATION NUMBER NCT03928132 with ClinicalTrials.gov; Post-results.
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Affiliation(s)
- Alèxe Deom Tardif
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Sabrina Guay-Bélanger
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Denis Audet
- University Family Medicine Group Saint-François-d'Assise, Quebec, Quebec, Canada
| | - Nicole Parent
- Direction de la formation professionnelle, Médecins francophones du Canada, Montreal, Quebec, Canada
| | - André Gaudreau
- Patient Partner, Université Laval, Quebec, Quebec, Canada
| | | | - Luc Vigneault
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Patient Partner, CAP Rétablissement, Quebec, Quebec, Canada
| | - Gérard Ngueta
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - André Bilodeau
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - France Légaré
- VITAM Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
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21
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Cheung IW, Bland VR, Castro-Noriega E, Silva DS, Miller KJ, Michalak EE, Goldsmith CH. Pilot of a Training Format for Clinicians' Continuing Professional Development: Open House With Rotating Short Segments. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:e92-e95. [PMID: 34108385 DOI: 10.1097/ceh.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Access to continuing professional development offered at lunchtime is limited by hospital scheduling that has staff members taking their lunch breaks at different times. To overcome this barrier, we developed a three-part training format with (1) a focus group segment soliciting participants' opinions on the training's target behavior, (2) a didactic segment introducing tools to support the behavior, and (3) a question-and-answer segment about the session topic. We rotated through these segments, each 15 minutes long, over 3 hours. Participants could join at any segment and experience the full curriculum after 45 minutes. METHODS We piloted this training format five times at three hospitals. Our training aimed to encourage clinicians to consistently inform involuntary patients about their Mental Health Act rights. We gauged the effect of the training and participants' opinions of the session using the Continuing Professional Development Reaction questionnaire and a session evaluation, respectively. RESULTS Continuing Professional Development-Reaction results (n = 80) showed a detectable increase in clinicians' intent to consistently give involuntary patients rights advice. Participants reported finding the training organized, informative, and valuable. DISCUSSION The open house with rotating short segments is a feasible and adaptable training format to engage clinicians in voluntary continuing professional development.
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Affiliation(s)
- Iva W Cheung
- Dr. Cheung: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;Ms. Bland: Tertiary Mental Health and Substance Use, Vancouver Coastal Health, Vancouver, British Columbia, Canada;Ms. Castro-Noriega: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;Dr. Silva: Sydney Health Ethics, Sydney School of Public Health, Sydney, NSW, Australia;Dr. Miller: BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada;Dr. Michalak: Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada ; and Dr. Goldsmith: Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
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Poulin Herron A, Agbadje TT, Guay-Bélanger S, Ngueta G, Roch G, Rousseau F, Légaré F. Web-Based Training for Nurses on Using a Decision Aid to Support Shared Decision Making about Prenatal Screening: a Controlled Trial. JMIR Nurs 2021; 5:e31380. [PMID: 34874274 PMCID: PMC8826152 DOI: 10.2196/31380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nurses play an important role in supporting pregnant women making decisions about prenatal screening for Down syndrome. We developed a web-based shared decision-making (SDM) training program for health professionals focusing on Down syndrome screening decisions. Objective In this study, we aim to assess the impact of an SDM training program on nurses’ intention to use a decision aid with pregnant women deciding on prenatal screening for Down syndrome. Methods In this 2-arm, parallel controlled trial, French-speaking nurses working with pregnant women in the province of Quebec were recruited by a private survey firm. They were allocated by convenience either to the intervention group (web-based SDM course that included prenatal screening) or to the control group (web-based course focusing on prenatal screening alone, with no SDM content). The primary outcome was the intention to use a decision aid. Secondary outcomes were psychosocial variables of intention, knowledge, satisfaction, acceptability, perceived usefulness, and reaction to the pedagogical approach. All outcomes were self-assessed through web-based questionnaires, including the space for written comments. We used 2-tailed Student t test and Fisher exact test to compare continuous and categorical variables between groups, respectively. Results Of the 57 participants assessed for eligibility, 40 (70%) were allocated to the intervention (n=20) or control group (n=20) and 36 (n=18 in each) completed the courses. The mean age of the participants was 41 (SD 9) years. Most were women (39/40, 98%), White (38/40, 95%), clinical nurses (28/40, 70%), and had completed at least a bachelor’s degree (30/40, 75%). After the intervention, the mean score of intention was 6.3 (SD 0.8; 95% CI 5.9-6.7) for the intervention group and 6.0 (SD 1.2; 95% CI 5.42-6.64) for the control group (scale 1-7). The differences in intention and other psychosocial variable scores between the groups were not statistically significant. Knowledge scores for SDM were significantly higher in the intervention group (79%, 95% CI 70-89 vs 64%, 95% CI 57-71; P=.009). The intervention was significantly more acceptable in the intervention group (4.6, 95% CI 4.4-4.8 vs 4.3, 95% CI 4.1-4.5; P=.02), and reaction to the pedagogical approach was also significantly more positive in the intervention group (4.7, 95% CI 4.5-4.8 vs 4.4, 95% CI 4.2-4.5; P=.02). There was no significant difference in overall satisfaction (or in perceived usefulness). Furthermore, 17 participants (9 in the intervention group and 8 in the control group) provided written comments on the intervention. Conclusions This study focuses on web-based nursing education and its potential to support pregnant women’s decision-making needs. It shows that nurses’ intention to use a decision aid to enhance SDM in prenatal care is high, with or without training, but that their knowledge about SDM can be improved with web-based training. International Registered Report Identifier (IRRID) RR2-10.2196/17878
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Affiliation(s)
- Alex Poulin Herron
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Faculty of Nursing, Université Laval, Quebec, CA
| | - Titilayo Tatiana Agbadje
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Sabrina Guay-Bélanger
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA
| | - Gérard Ngueta
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Department of Epidemiology, Faculty of Medicine, Université Laval, Quebec, CA
| | - Geneviève Roch
- Faculty of Nursing, Université Laval, Quebec, CA.,Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA
| | - François Rousseau
- Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Quebec, CA
| | - France Légaré
- Centre de recherche VITAM, CIUSSS de la Capitale-Nationale, Quebec City, Canada., 2525, chemin de la Canardière, Quebec, CA.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre , Hôpital Saint François d'Assise, Quebec, CA.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, CA
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Courvoisier M, Baddeliyanage R, Wilhelm L, Bayliss L, Straus SE, Fahim C. Evaluation of the partners in research course: a patient and researcher co-created course to build capacity in patient-oriented research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:76. [PMID: 34717764 PMCID: PMC8556807 DOI: 10.1186/s40900-021-00316-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/14/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In the past decade, patient-oriented research (POR) has been at the forefront of healthcare research in Canada because it has the potential to make research more meaningful and relevant to patient needs. Despite this growing emphasis on and expectation to conduct POR, there is limited guidance about how to apply POR in practice. To address this capacity building need, the Knowledge Translation (KT) Program and patient partners co-designed, delivered, and evaluated Partners in Research (PiR), a 2-month online course for patients and researchers to collectively learn how to conduct and engage in POR. METHODS PiR was delivered to 4 cohorts of patients and researchers between 2017 and 2018. For each cohort, we evaluated the impact of the course on participants' knowledge, self-efficacy, intentions, and use of POR using surveys at 3 time points: baseline, post-course and 6-months post-course. We also monitored the process of course design and delivery by assessing implementation quality of the PiR course. Participants were asked to rate their satisfaction with course format, course materials, quality of delivery and their level of engagement via a 7-point Likert scale in the post-course survey. RESULTS A total of 151 participants enrolled in the PiR course throughout the 4 cohorts. Of these, 49 patients and 33 researchers (n = 82 participants) consented to participate in the course evaluation. Process and outcome evaluations collected over a 9-month period indicated that participation in the PiR course increased knowledge of POR concepts for patients (p < .001) and for researchers (p < .001) from pre-course to post-course timepoints. Likewise, self-efficacy to engage in POR increased from baseline to post-course for both patients (p < .001) and researchers (p < .001). Moreover, participants reported high levels of satisfaction with content, delivery and interactive components of the course. CONCLUSIONS The PiR course increased capacity in POR for both researchers and patients. This work enhances our understanding of how to design useful and engaging education opportunities to increase patient and researcher capacity in POR.
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Affiliation(s)
| | - Richelle Baddeliyanage
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, ON, M5B 1T8, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 500, Toronto, ON, M5T 3M7, Canada
| | - Linda Wilhelm
- The Canadian Arthritis Patient Alliance, Midland, Canada
| | - Lorraine Bayliss
- Transdisciplinary Understanding and Training On Research (TUTOR), Centre for Studies in Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 3K7, Canada
| | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, ON, M5B 1T8, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria St., Toronto, ON, M5B 1T8, Canada.
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Politi MC, Forcino RC, Parrish K, Durand MA, O'Malley AJ, Elwyn G. Cost talk: protocol for a stepped-wedge cluster randomized trial of an intervention helping patients and urologic surgeons discuss costs of care for slow-growing prostate cancer during shared decision-making. Trials 2021; 22:422. [PMID: 34187547 PMCID: PMC8240421 DOI: 10.1186/s13063-021-05369-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Costs of care are important to patients making cancer treatment decisions, but clinicians often do not feel prepared to discuss treatment costs. We aim to (1) assess the impact of a conversation-based decision aid (Option Grid) containing cost information about slow-growing prostate cancer management options, combined with urologic surgeon training, on the frequency and quality of patient-urologic surgeon cost conversations, and (2) examine the impact of the decision aid and surgeon training on decision quality. METHODS We will conduct a stepped-wedge cluster randomized trial in outpatient urology practices affiliated with a large academic medical center in the USA. We will randomize five urologic surgeons to four intervention sequences and enroll their patients with a first-time diagnosis of slow-growing prostate cancer independently at each period. Primary outcomes include frequency of cost conversations, initiator of cost conversations, and whether or not a referral is made to address costs. These outcomes will be collected by patient report (post-visit survey) and by observation (audio-recorded clinic visits) with consent. Other outcomes include the following: patient-reported decisional conflict post-visit and at 3-month follow-up, decision regret at 3-month follow-up, shared decision-making post-visit, communication post-visit, and financial toxicity post-visit and at 3-month follow-up; clinician-reported attitudes about shared decision-making before and after the study, and feasibility of sustained intervention use. We will use hierarchical regression analysis to assess patient-level outcomes, including urologic surgeon as a random effect to account for clustering of patient participants. DISCUSSION This study evaluates a two-part intervention to improve cost discussions between urologic surgeons and patients when deciding how to manage slow-growing prostate cancer. Establishing the effectiveness of the strategy under study will allow for its replication in other clinical decision contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT04397016 . Registered on 21 May 2020.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Rachel C Forcino
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Katelyn Parrish
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA.,Université Toulouse III Paul Sabatier, Toulouse, France
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA.,Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Dartmouth College, Lebanon, NH, USA
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Ridde V, Gautier L, Dagenais C, Chabrol F, Hou R, Bonnet E, David PM, Cloos P, Duhoux A, Lucet JC, Traverson L, de Araujo Oliveira SR, Cazarin G, Peiffer-Smadja N, Touré L, Coulibaly A, Honda A, Noda S, Tamura T, Baba H, Kodoi H, Zinszer K. Learning from public health and hospital resilience to the SARS-CoV-2 pandemic: protocol for a multiple case study (Brazil, Canada, China, France, Japan, and Mali). Health Res Policy Syst 2021; 19:76. [PMID: 33957954 PMCID: PMC8100363 DOI: 10.1186/s12961-021-00707-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND All prevention efforts currently being implemented for COVID-19 are aimed at reducing the burden on strained health systems and human resources. There has been little research conducted to understand how SARS-CoV-2 has affected health care systems and professionals in terms of their work. Finding effective ways to share the knowledge and insight between countries, including lessons learned, is paramount to the international containment and management of the COVID-19 pandemic. The aim of this project is to compare the pandemic response to COVID-19 in Brazil, Canada, China, France, Japan, and Mali. This comparison will be used to identify strengths and weaknesses in the response, including challenges for health professionals and health systems. METHODS We will use a multiple case study approach with multiple levels of nested analysis. We have chosen these countries as they represent different continents and different stages of the pandemic. We will focus on several major hospitals and two public health interventions (contact tracing and testing). It will employ a multidisciplinary research approach that will use qualitative data through observations, document analysis, and interviews, as well as quantitative data based on disease surveillance data and other publicly available data. Given that the methodological approaches of the project will be largely qualitative, the ethical risks are minimal. For the quantitative component, the data being used will be made publicly available. DISCUSSION We will deliver lessons learned based on a rigorous process and on strong evidence to enable operational-level insight for national and international stakeholders.
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Affiliation(s)
- Valéry Ridde
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France.
| | - Lara Gautier
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Christian Dagenais
- Faculté des arts et des sciences, University of Montreal, Montréal, Québec, Canada
| | - Fanny Chabrol
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
| | - Renyou Hou
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
- Laboratory of Ethnology and Comparative Sociology, Université Paris Nanterre/CNRS, Paris, France
| | - Emmanuel Bonnet
- UMR 215 Prodig, CNRS, Université Paris 1 Panthéon-Sorbonne, AgroParisTech, Institut de recherche pour le développement (IRD), Aubervilliers, France
| | - Pierre-Marie David
- Faculté de Pharmacie, Université de Montréal, Montréal, Canada
- Pole 1 de recherche sur la transformation des pratiques cliniques et organisationnelles, CISSS de Laval, Montréal, Canada
| | - Patrick Cloos
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Duhoux
- Pole 1 de recherche sur la transformation des pratiques cliniques et organisationnelles, CISSS de Laval, Montréal, Canada
- Faculté des sciences infirmières, Université de Montréal, Montréal, Québec, Canada
| | - Jean-Christophe Lucet
- AP-HP, Bichat-Claude Bernard Hospital, Paris, France
- IAME, INSERM, Université de Paris, Paris, France
| | - Lola Traverson
- Centre Population et Développement (Ceped), Institut de recherche pour le développement (IRD) Université de Paris, ERL INSERM SAGESUD, Paris, France
| | | | - Gisele Cazarin
- Institut Aggeu Magalhães, Oswaldo Cruz Fondacion, Recife, Brazil
| | - Nathan Peiffer-Smadja
- AP-HP, Bichat-Claude Bernard Hospital, Paris, France
- IAME, INSERM, Université de Paris, Paris, France
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | | | | | - Ayako Honda
- Research Center for Health Policy and Economics, Hitotsubashi Institute for Advanced Study, Hitotsubashi University, Tokyo, Japan
| | - Shinichiro Noda
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Toyomitsu Tamura
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroko Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
| | - Haruka Kodoi
- Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montréal, Québec, Canada
- Centre de recherche en santé publique (CRePS), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
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26
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Abbasgholizadeh Rahimi S, Rodriguez C, Croteau J, Sadeghpour A, Navali AM, Légaré F. Continuing professional education of Iranian healthcare professionals in shared decision-making: lessons learned. BMC Health Serv Res 2021; 21:225. [PMID: 33712014 PMCID: PMC7953598 DOI: 10.1186/s12913-021-06233-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/02/2021] [Indexed: 02/01/2023] Open
Abstract
Background In this study, we sought to assess healthcare professionals’ acceptance of and satisfaction with a shared decision making (SDM) educational workshop, its impact on their intention to use SDM, and their perceived facilitators and barriers to the implementation of SDM in clinical settings in Iran. Methods We conducted an observational quantitative study that involved measurements before, during, and immediately after the educational intervention at stake. We invited healthcare professionals affiliated with Tabriz University of Medical Sciences, East Azerbaijan, Iran, to attend a half-day workshop on SDM in December 2016. Decisions about prenatal screening and knee replacement surgery was used as clinical vignettes. We provided a patient decision aid on prenatal screening that complied with the International Patient Decision Aids Standards and used illustrate videos. Participants completed a sociodemographic questionnaire and a questionnaire to assess their familiarity with SDM, a questionnaire based on theoretical domains framework to assess their intention to implement SDM, a questionnaire about their perceived facilitators and barriers of implementing SDM in their clinical practice, continuous professional development reaction questionnaire, and workshop evaluation. Quantitative data was analyzed descriptively and with multiple linear regression. Results Among the 60 healthcare professionals invited, 41 participated (68%). Twenty-three were female (57%), 18 were specialized in family and emergency medicine, or community and preventive medicine (43%), nine were surgeons (22%), and 14 (35%) were other types of specialists. Participants’ mean age was 37.51 ± 8.64 years with 8.09 ± 7.8 years of clinical experience. Prior to the workshop, their familiarity with SDM was 3.10 ± 2.82 out of 9. After the workshop, their belief that practicing SDM would be beneficial and useful (beliefs about consequences) (beta = 0.67, 95% CI 0.27, 1.06) and beliefs about capability of using SDM (beta = 0.32, 95% CI -0.08, 0.72) had the strongest influence on their intention of practicing SDM. Participants perceived the main facilitator and barrier to perform SDM were training and high patient load, respectively. Conclusions Participants thought the workshop was a good way to learn SDM and that they would be able to use what they had learned in their clinical practice. Future studies need to study the level of intention of participants in longer term and evaluate the impact of cultural differences on practicing SDM and its implementation in both western and non-western countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06233-6.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada. .,Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Canada.
| | - Charo Rodriguez
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada.,Institute of Health Sciences Education (IHSE), Faculty of Medicine and Health Sciences, McGill University, Montréal, Canada
| | - Jordie Croteau
- L'institut national d'excellence en santé et en services sociaux (INESSS), Quebec City, Canada
| | - Alireza Sadeghpour
- Tabriz University of Medical Sciences, Tabriz, Iran.,Orthopedic Surgery Department, Shohada University Hospital, Tabriz, Iran
| | - Amir-Mohammad Navali
- Tabriz University of Medical Sciences, Tabriz, Iran.,Orthopedic Surgery Department, Shohada University Hospital, Tabriz, Iran
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Canada.,VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec City, Canada
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27
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Kepper MM, Walsh-Bailey C, Brownson RC, Kwan BM, Morrato EH, Garbutt J, de las Fuentes L, Glasgow RE, Lopetegui MA, Foraker R. Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model. Front Digit Health 2021; 3:648777. [PMID: 34713122 PMCID: PMC8521811 DOI: 10.3389/fdgth.2021.648777] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/10/2021] [Indexed: 11/13/2022] Open
Abstract
Health information technology (HIT) has not been broadly adopted for use in outpatient healthcare settings to effectively address obesity in youth, especially among disadvantaged populations that face greater barriers to good health. A well-designed HIT tool can deliver behavior change recommendations and provide community resources to address this gap, and the Obesity-Related Behavioral Intervention Trials (ORBIT) model can guide its development and refinement. This article reports the application of the ORBIT model to (1) describe the characteristics and design of a novel HIT tool (the PREVENT tool) using behavioral theory, (2) illustrate the use of stakeholder-centered "designing for dissemination and sustainability" principles, and (3) discuss the practical implications and directions for future research. Two types of stakeholder engagement (customer discovery and user testing) were conducted with end users (outpatient healthcare teams). Customer discovery interviews (n = 20) informed PREVENT tool components and intervention targets by identifying (1) what healthcare teams (e.g., physicians, dietitians) identified as their most important "jobs to be done" in helping adolescents who are overweight/obese adopt healthy behaviors, (2) their most critical "pains" and "gains" related to overweight/obesity treatment, and (3) how they define success compared to competing alternatives. Interviews revealed the need for a tool to help healthcare teams efficiently deliver tailored, evidence-based behavior change recommendations, motivate patients, and follow-up with patients within the constraints of clinic schedules and workflows. The PREVENT tool was developed to meet these needs. It facilitates prevention discussions, delivers tailored, evidence-based recommendations for physical activity and food intake, includes an interactive map of community resources to support behavior change, and automates patient follow-up. Based on Self-Determination Theory, the PREVENT tool engages the patient to encourage competence and autonomy to motivate behavior change. The use of this intentional, user-centered design process should increase the likelihood of the intended outcomes (e.g., behavior change, weight stabilization/loss) and ultimately increase uptake, implementation success, and long-term results. After initial tool development, user-testing interviews (n = 13) were conducted using a think-aloud protocol that provided insight into users' (i.e., healthcare teams) cognitive processes, attitudes, and challenges when using the tool. Overall, the PREVENT tool was perceived to be useful, well-organized, and visually appealing.
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Affiliation(s)
- Maura M. Kepper
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Bethany M. Kwan
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Elaine H. Morrato
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, United States
| | - Jane Garbutt
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Lisa de las Fuentes
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Russell E. Glasgow
- Department of Family Medicine, Adult & Child Consortium for Health Outcomes Research & Delivery Science, University of Colorado Anschutz Medical Camps, Aurora, CO, United States
| | - Marcelo A. Lopetegui
- Centro de Informática Biomédica, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Randi Foraker
- Institute for Public Health, Washington University in St. Louis, St. Louis, MO, United States
- Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
- Center for Population Health Informatics, Institute for Informatics, Washington University in St. Louis, St. Louis, MO, United States
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A Patient Decision Aid for Men With Localized Prostate Cancer: A Comparative Case Study of Natural Implementation Approaches. Cancer Nurs 2020; 43:E10-E21. [PMID: 30312191 DOI: 10.1097/ncc.0000000000000651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are multiple options for men diagnosed with localized prostate cancer. Patient decision aids (PtDAs) help empower individuals and reduce unwarranted practice variation, but few are used in clinical practice. OBJECTIVE We compared 2 programs implementing PtDAs for men with localized prostate cancer. METHODS This was a comparative case study. Case 1 was a hospital prostate pathway and case 2 was a provincial prostate pathway with 2 locations (2a, 2b). Nurses provided the men with PtDAs and answered questions. Data sources were as follows: (a) 2 years administrative data for men with localized prostate cancer, (b) clinicians survey and interviews, and (c) patients/spouses interviews. Analysis was within and across cases. RESULTS The PtDA was used with 23% of men in case 1 (95% confidence interval, 19.8%-26.1%) and 98% of men in case 2a (95% confidence interval, 96.5%-99.8%). The pathway was not implemented in case 2b. Men given the PtDA had positive experiences. Many clinicians supported the use of PtDAs, some adapted their discussions with patients, and others did not support the use of PtDAs. To increase use in case 1, participants identified needing a Canadian PtDA available electronically and endorsed by all clinicians. In case 2b, the provincial prostate pathway needed to be implemented. CONCLUSIONS There was variable uptake of the PtDAs between the cases. Men who received the PtDA had positive outcomes. Several strategies were identified to increase or sustain PtDA use. IMPLICATIONS FOR PRACTICE Nurses have a key role in supporting men making decisions about prostate cancer treatment by providing PtDAs, answering questions, and advocating for men's preferences.
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29
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Poulin Herron A, Agbadje TT, Cote M, Djade CD, Roch G, Rousseau F, Légaré F. Web-Based Training for Nurses on Shared Decision Making and Prenatal Screening for Down Syndrome: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e17878. [PMID: 33118955 PMCID: PMC7661244 DOI: 10.2196/17878] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/16/2020] [Accepted: 05/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Pregnant women often find it difficult to choose from among the wide variety of available prenatal screening options. To help pregnant women and their partners make informed decisions based on their values, needs, and preferences, a decision aid and a web-based shared decision making (SDM) training program for health professionals have been developed. In Canada, nurses provide maternity care and thus can train as decision coaches for prenatal screening. However, there is a knowledge gap about the effectiveness of SDM interventions in maternity care in nursing practice. Objective This study aims to assess the impact of an SDM training program on nurses’ intentions to use a decision aid for prenatal screening and on their knowledge and to assess their overall impressions of the training. Methods This is a 2-arm parallel randomized trial. French-speaking nurses working with pregnant women in the province of Quebec were recruited online by a private survey firm. They were randomly allocated (1:1 ratio) to either an experimental group, which completed a web-based SDM training program that included prenatal screening, or a control group, which completed a web-based training program focusing on prenatal screening alone. The experimental intervention consisted of a 3-hour web-based training hosted on the Université Laval platform with 4 modules: (1) SDM; (2) Down syndrome prenatal screening; (3) decision aids; and (4) communication between health care professionals and the patient. For the control group, the topic of SDM in Module 1 was replaced with “Context and history of prenatal screening,” and the topic of decision aids in Module 3 was replaced with “Consent in prenatal screening.” Participants completed a self-administered sociodemographic questionnaire with close-ended questions. We also assessed the participants' (1) intention to use a decision aid in prenatal screening clinical practice, (2) knowledge, (3) satisfaction with the training, (4) acceptability, and (5) perceived usefulness of the training. The randomization was done using a predetermined sequence and included 40 nurses. Participants and researchers were blinded. Intention to use a decision aid will be assessed by a t test. Bivariate and multivariate analysis will be performed to assess knowledge and overall impressions of the training. Results This study was funded in 2017 and approved by Genome Canada. Data were collected from September 2019 to late January 2020. This paper was initially submitted before data analysis began. Results are expected to be published in winter 2020. Conclusions Study results will inform us on the impact of an SDM training program on nurses’ intention to use and knowledge of decision aids for prenatal screening and their overall impressions of the training. Participant feedback will also inform an upgrade of the program, if needed. Trial Registration ClinicalTrials.gov NCT04162288; https://clinicaltrials.gov/ct2/show/NCT04162288 International Registered Report Identifier (IRRID) DERR1-10.2196/17878
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Affiliation(s)
- Alex Poulin Herron
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Faculty of Nursing, Université Laval, Québec, QC, Canada
| | - Titilayo Tatiana Agbadje
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Melissa Cote
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Codjo Djignefa Djade
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Geneviève Roch
- Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Faculty of Nursing, Université Laval, Québec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec, QC, Canada.,Centre Hospitalier Universitaire de Québec - Université Laval Research Centre, Hôpital Saint-François d'Assise, Québec City, QC, Canada
| | - Francois Rousseau
- Centre Hospitalier Universitaire de Québec - Université Laval Research Centre, Hôpital Saint-François d'Assise, Québec City, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Université Laval, Québec City, QC, Canada
| | - France Légaré
- Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Québec, QC, Canada.,Centre de recherche en santé durable (VITAM), Québec, QC, Canada.,Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Québec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
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30
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Yu C, Choi D, Bruno BA, Thorpe KE, Straus SE, Cantarutti P, Chu K, Frydrych P, Hoang-Kim A, Ivers N, Kaplan D, Leung FH, Maxted J, Rezmovitz J, Sale J, Sodhi-Helou S, Stacey D, Telner D. Impact of MyDiabetesPlan, a Web-Based Patient Decision Aid on Decisional Conflict, Diabetes Distress, Quality of Life, and Chronic Illness Care in Patients With Diabetes: Cluster Randomized Controlled Trial. J Med Internet Res 2020; 22:e16984. [PMID: 32996893 PMCID: PMC7557444 DOI: 10.2196/16984] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 05/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM. OBJECTIVE This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level. METHODS A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used. RESULTS At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0). CONCLUSIONS Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery. TRIAL REGISTRATION ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078.
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Affiliation(s)
- Catherine Yu
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Dorothy Choi
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Brigida A Bruno
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sharon E Straus
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | | | - Karen Chu
- Bridgepoint Active Healthcare (Sinai Health System), Toronto, ON, Canada
| | - Paul Frydrych
- Mount Dennis Weston Health Centre, Humber River Family Health Team, Toronto, ON, Canada
| | - Amy Hoang-Kim
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Kaplan
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Fok-Han Leung
- St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - John Maxted
- Markham Stouffville Hospital, Markham, ON, Canada
| | | | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital (Unity Health Toronto), Toronto, ON, Canada
| | - Sumeet Sodhi-Helou
- Toronto Western Family Health Team, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Deanna Telner
- South East Toronto Family Health Team (Toronto East Health Network), Toronto, ON, Canada
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Boland L, Brosseau L, Caspar S, Graham ID, Hutchinson AM, Kothari A, McNamara K, McInnes E, Angel M, Stacey D. Reporting health research translation and impact in the curriculum vitae: a survey. Implement Sci Commun 2020; 1:20. [PMID: 32885181 PMCID: PMC7427883 DOI: 10.1186/s43058-020-00021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 02/10/2020] [Indexed: 11/12/2022] Open
Abstract
Background Increasingly, health researchers must demonstrate the impact and real-life applications of their research. We investigated how health researchers with expertise in knowledge translation report research translation activities and impact on their curriculum vitae (CV). Methods We conducted a cross-sectional survey of health researchers with expertise in knowledge translation as we anticipated best practices in CV reporting from this specialized group. Our survey asked participants about their reporting of research translation and impact activities on their CVs, intention to report, and barriers and facilitators to reporting such activities on their CVs. We calculated univariate descriptive statistics for all quantitative data. Linear regression models determined predictors of researchers’ intention to report research translation and impact activities on their CVs. We analyzed open-ended qualitative responses using content analysis. Results One hundred and fifty-three health researchers responded to the survey (response rate = 29%). Most respondents were Canadian, were female, and had a doctoral degree. Eighty-two percent indicated they reported at least one research translation and/or impact indicator on their CVs. Of those, health researchers commonly reported the following: advisory/regulatory committee membership related to research program (83%), research translation award(s) (61%), and academic performance assessments (59%). Researchers least commonly indicated the following: citation metric scores (31%), summaries of impact (21%), and requests to use research materials and/or products (19%). Fewer than half of the health researchers intended to report knowledge translation (43%) and impact (33%) on their CVs. Strong beliefs about capabilities and consequences of reporting research translation and/or impact were significant predictors of intention. Main barriers were as follows: CV templates do not include research translation and impact activities, participants perceived employers do not value research translation and impact activities, and lack of metrics to evaluate research translation and impact. Ninety-six percent were unaware of a CV template formatted to include research translation and/or impact reporting. Conclusions Knowledge translation and impact indicators on the CV are inconsistently reported by our sample of health researchers. Modifiable barriers should be addressed to support more consistent reporting of such activities, including providing a CV template that includes research translation and impact as well as clear metrics to quantify them.
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Affiliation(s)
- L Boland
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - L Brosseau
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON K1H 8M5 Canada
| | - S Caspar
- Faculty of Health Sciences-Therapeutic Recreation Program, University of Lethbridge, 4401 University Drive, Lethbridge, AB T1K 3M4 Canada
| | - I D Graham
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Epidemiology and Public Health Faculty of Medicine, University of Ottawa, 307D-600 Peter Morand Cresent, Ottawa, ON K1G 5Z3 Canada.,School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia
| | - A M Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC Australia.,Monash Health, Clayton, VIC Australia
| | - A Kothari
- School of Health Studies, Western University, 1151 Richmond Street, London, ON N6A 3K7 Canada
| | - K McNamara
- School of Medicine, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - E McInnes
- Nursing Research Institute St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Daniel Mannix Building, Australian Catholic University Fitzroy, Fitzroy, VIC Australia
| | - M Angel
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - D Stacey
- Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada.,School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
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Lawani MA, Côté L, Coudert L, Morin M, Witteman HO, Caron D, Kroger E, Voyer P, Rodriguez C, Légaré F, Giguere AMC. Professional training on shared decision making with older adults living with neurocognitive disorders: a mixed-methods implementation study. BMC Med Inform Decis Mak 2020; 20:189. [PMID: 32787829 PMCID: PMC7424655 DOI: 10.1186/s12911-020-01197-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/22/2020] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Shared decision making with older adults living with neurocognitive disorders is challenging for primary healthcare professionals. We studied the implementation of a professional training program featuring an e-learning activity on shared decision making and five Decision Boxes on the care of people with neurocognitive disorders, and measured the program's effects. METHODS In this mixed-methods study, we recruited healthcare professionals in family medicine clinics and homecare settings in the Quebec City area (Canada). The professionals signed up for training as a continuing professional development activity and answered an online survey before and after training to assess their knowledge, and intention to adopt shared decision making. We recorded healthcare professionals' access to each training component, and conducted telephone interviews with a purposeful sample of extreme cases: half had completed training and the other half had not. We performed bivariate analyses with the survey data and a thematic qualitative analysis of the interviews, as per the theory of planned behaviour. RESULTS Of the 47 participating healthcare professionals, 31 (66%) completed at least one training component. Several factors restricted participation, including lack of time, training fragmentation into several components, poor adaptation of training to specific professions, and technical/logistical barriers. Ease of access, ease of use, the usefulness of training content and the availability of training credits fostered participation. Training allowed Healthcare professionals to improve their knowledge about risk communication (p = 0.02), and their awareness of the options (P = 0.011). Professionals' intention to adopt shared decision making was high before training (mean ± SD = 5.88 ± 0.99, scale from 1 to 7, with 7 high) and remained high thereafter (5.94 ± 0.9). CONCLUSIONS The results of this study will allow modifying the training program to improve participation rates and, ultimately, uptake of meaningful shared decision making with patients living with neurocognitive disorders.
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Affiliation(s)
- Moulikatou Adouni Lawani
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Luc Côté
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 1323, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Laetitia Coudert
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Michèle Morin
- Laval University, Pavillon Ferdinand-Vandry, room 4211, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Holly O. Witteman
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Danielle Caron
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Edeltraut Kroger
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, Office L-2, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
| | - Philippe Voyer
- Pavillon Ferdinand-Vandry, room 3445, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Charo Rodriguez
- Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, 3rd floor, Montreal, QC H3S 1Z1 Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 4th floor, Room 4578, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
| | - Anik M. C. Giguere
- Department of Family Medicine and Emergency Medicine, Laval University, Pavillon Ferdinand-Vandry, room 2881, 1050 avenue de la Médecine, Quebec, QC G1V 0A6 Canada
- VITAM Research Centre on Sustainable Health, Pavillon Landry-Poulin, Door A-1-2, 2nd floor, Room 2416, 2525 Chemin de la Canardière, Québec, QC G1J 0A4 Canada
- Quebec Excellence Centre on Aging, St-Sacrement Hospital, Office L-2, 1050 chemin Ste-Foy, Quebec, QC G1S 4L8 Canada
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Miller KJ, Park JE, Ramanathan K, Abel J, Zhao Y, Mamdani A, Pak M, Fung A, Gao M, Humphries KH. Examining Coronary Revascularization Practice Patterns for Diabetics: Perceived Barriers, Facilitators, and Implications for Knowledge Translation. Can J Cardiol 2020; 36:1236-1243. [PMID: 32621887 DOI: 10.1016/j.cjca.2019.11.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 10/25/2019] [Accepted: 11/07/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The FREEDOM trial provided robust evidence that coronary artery bypass grafting (CABG) was superior to percutaneous coronary intervention (PCI) for coronary revascularization in patients with diabetes mellitus (DM) and multivessel coronary artery disease (MV-CAD). The present study examined practice pattern changes and perceived barriers and facilitators to implementing FREEDOM trial evidence in British Columbia (BC). METHODS Using a population-based database of cardiac procedures in BC, PCI:CABG ratios from 2007-2014 were compared before and after publication of the FREEDOM trial in the 4 tertiary cardiac centres that provided both CABG and PCI. Surveys of barriers and facilitators to implementation of evidence in practice were completed by 57 health care providers (HCPs) attending educational outreach sessions conducted in 2016-17 at 5 tertiary cardiac centres in BC. RESULTS The overall PCI:CABG ratio declined from 1.59 (95% confidence interval [CI] 1.48-1.70, range 1.16-1.86) before publication to 0.88 (95% CI 0.75-1.01, range 0.56-0.82) after publication (P < 0.01). This decline from before to after publication was significant in 3 centres, but not in the fourth centre (from 1.62 to 1.49; P = 0.61). Barriers were identified at the levels of evidence (applicability, credibility), HCP (awareness/knowledge, practice behaviours), patient (knowledge/misconceptions, preferences), and systems (siloing of care, financial disincentives, resource limitations, geography). Facilitators were additional studies/guidelines, education/dissemination, shared decision making, a heart team approach, changes to remuneration models, and increased resources. CONCLUSIONS Following publication of the FREEDOM trial, the proportion of patients with DM and MV-CAD undergoing CABG increased in BC; however, practice patterns varied across cardiac centres. HCPs attributed these practice variations to multilevel barriers and facilitators. Future knowledge translation strategies should be multifaceted and tailored to identified determinants.
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Affiliation(s)
- Kimberly J Miller
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
| | - Julie E Park
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Krishnan Ramanathan
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Abel
- Division of Cardiothoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yinshan Zhao
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Avanish Mamdani
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Melissa Pak
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Anthony Fung
- Division of Cardiothoracic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Min Gao
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- British Columbia Centre for Improved Cardiovascular Health, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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Urban K, Wright PB, Hester AL, Curran G, Rojo M, Tsai PF. Evaluation of an Education Strategy versus Usual Care to Implement the STEADI Algorithm in Primary Care Clinics in an Academic Medical Center. Clin Interv Aging 2020; 15:1059-1066. [PMID: 32753856 PMCID: PMC7345972 DOI: 10.2147/cia.s256416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Although falls are the leading cause of morbidity and mortality in the US in the older adult population, there is little information regarding implementation of evidence-based fall prevention guidelines within primary care settings. The objective of this study was to address this gap in the literature by determining the effectiveness of the use of education and written materials as implementation strategies. Methods Using a prospective, mixed methods, controlled before-and-after study design, we studied the effect of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) education and written materials on knowledge and intention to use in primary care clinics as well as test the screening, assessment, and intervention behaviors. This manuscript details the quantitative findings of the study, using STEADI Knowledge Test, Continuing Professional Development (CPD) Reaction Questionnaire, and EMR Reports. We compared data between the study arms (usual implementation versus education implementation) using descriptive statistics, paired t-tests, and factorial ANOVAs. Results In total, data from 29 primary care staff, including physicians, APRNs, RNs, and medical assistants, were analyzed. Although we found a statistically significant difference within the education arm between immediate pretests and posttests/surveys mean scores, there was no statistically significant difference between the study arms' knowledge, intent to use STEADI, or use behaviors. The pre/immediate post education mean knowledge score increased by 1.19 (p= 0.02) and the pre/immediate post education intent to use mean increased by 0.64 (p 0.01). There was no statistically significant change between the study arms over time. Conclusion Educational strategies, particularly written materials and an online module, did not increase the long-term use of the STEADI toolkit. Implementation research is needed to identify the strategies that are most effective for promoting the adoption of STEADI in primary care.
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Affiliation(s)
- Kelly Urban
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Patricia B Wright
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Amy L Hester
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,HD Nursing, Bauxite, Arkansas, USA
| | - Geoffrey Curran
- College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Martha Rojo
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Pao-Feng Tsai
- School of Nursing, Auburn University, Auburn, Alabama, USA
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Adekpedjou R, Haesebaert J, Stacey D, Brière N, Freitas A, Rivest LP, Légaré F. Variations in factors associated with healthcare providers' intention to engage in interprofessional shared decision making in home care: results of two cross-sectional surveys. BMC Health Serv Res 2020; 20:203. [PMID: 32164669 PMCID: PMC7069220 DOI: 10.1186/s12913-020-5064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background DOLCE (Improving Decision making On Location of Care with the frail Elderly and their caregivers) was a post-intervention clustered randomised trial (cRT) to assess the effect of training home care teams on interprofessional shared decision-making (IP-SDM). Alongside the cRT, we sought to monitor healthcare providers’ level of behavioural intention to engage in an IP-SDM approach and to identify factors associated with this intention. Methods We conducted two cross-sectional surveys in the province of Quebec, Canada, one each at cRT entry and exit. Healthcare providers (e.g. nurses, occupational therapists and social workers) in the 16 participating intervention and control sites self-completed an identical paper-based questionnaire at entry and exit. Informed by the Integrated model for explaining healthcare professionals’ clinical behaviour by Godin et al. (2008), we assessed their behavioural intention to engage in IP-SDM to support older adults and caregivers of older adults with cognitive impairment to make health-related housing decisions. We also assessed psychosocial variables underlying their behavioural intention and collected sociodemographic data. We used descriptive statistics and linear mixed models to account for clustering. Results Between 2014 and 2016, 271 healthcare providers participated at study entry and 171 at exit. At entry, median intention level was 6 in a range of 1 (low) to 7 (high) (Interquartile range (IQR): 5–6.5) and factors associated with intention were social influence (β = 0.27, P < 0.0001), beliefs about one’s capabilities (β = 0.43, P < 0.0001), moral norm (β = 0.31, P < 0.0001) and beliefs about consequences (β = 0.21, P < 0.0001). At exit, median intention level was 5.5 (IQR: 4.5–6.5). Factors associated with intention were the same but did not include moral norm. However, at exit new factors were kept in the model: working in rehabilitation (β = − 0.39, P = 0.018) and working as a technician (β = − 0.41, P = 0.069) (compared to as a social worker). Conclusion Intention levels were high but decreased from entry to exit. Factors associated with intention also changed from study entry to study exit. These findings may be explained by the major restructuring of the health and social care system that took place during the 2 years of the study, leading to rapid staff turnover and organisational disturbance in home care teams. Future research should give more attention to contextual factors and design implementation interventions to withstand the disruption of system- and organisational-level disturbances. Trial registration Clinicaltrials.gov (NCT02244359). Registered on September 19th, 2014.
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Affiliation(s)
- Rhéda Adekpedjou
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Julie Haesebaert
- Université de Lyon, Université Claude Bernard Lyon 1, Université Saint-Étienne, HESPER EA 7425, F-69008 Lyon, F-42023, Saint-Etienne, France
| | - Dawn Stacey
- Ottawa Hospital Research Institute and Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Nathalie Brière
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Quebec, Canada
| | - Adriana Freitas
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada
| | - Louis-Paul Rivest
- Department of Mathematics and Statistics, Université Laval, Quebec, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada. .,Canada Research Chair in Shared Decision Making and Knowledge Translation, 2525, chemin de la Canardière, Quebec, G1J 0A4, Canada.
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Slootweg YM, Walg C, Koelewijn JM, Van Kamp IL, De Haas M. Knowledge, attitude and practices of obstetric care providers towards maternal red-blood-cell immunization during pregnancy. Vox Sang 2019; 115:211-220. [PMID: 31884705 PMCID: PMC7187211 DOI: 10.1111/vox.12883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 11/29/2022]
Abstract
Background and objectives A successful routine RBC alloantibody screening programme should not lead to unnecessary emotional burden during pregnancy due to inadequate counselling on the risk of severe haemolytic disease of the foetus and the newborn (HDFN). Rareness of this disease may result in insufficient knowledge and subsequent inadequate information transfer to women, diagnosed with RBC antibodies. We investigated the current knowledge, views and experiences of Dutch obstetric care providers regarding RBC alloimmunization during pregnancy. Materials and methods We performed a quantitative cross‐sectional study, using a structured digital questionnaire to measure knowledge, attitude and practices (KAP) regarding maternal RBC alloimmunization among Dutch obstetric care providers in 2016. Results About 10% of obstetric care providers completed the questionnaire. A sufficient level of knowledge was found in 7% of all participants (N = 329). Knowledge about RhD immunisation and prophylaxis was sufficient in 60% of the responders. Knowledge gaps were found concerning the relevance of non‐RhD RBC antibodies, the indications for giving extra RhD prophylaxis and the interpretation of laboratory test results. Healthcare providers estimated their own level of knowledge ‘sufficient’ (primary/secondary care) to ‘good’ (tertiary care), and all participants considered their professional role important within the screening programme. Conclusion Dutch obstetric care providers showed a lack of knowledge regarding maternal RBC immunization. Awareness of the lack of knowledge is necessary to help obstetric care providers to be careful in giving information and even to decide to contact the expert centre before counselling the patient.
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Affiliation(s)
- Yolentha M Slootweg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Chawa Walg
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Joke M Koelewijn
- Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - Inge L Van Kamp
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Masja De Haas
- Department of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Immunohematology Diagnostics, Sanquin Diagnostic Services, Amsterdam, The Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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Devane C, Renner RM, Munro S, Guilbert É, Dunn S, Wagner MS, Norman WV. Implementation of mifepristone medical abortion in Canada: pilot and feasibility testing of a survey to assess facilitators and barriers. Pilot Feasibility Stud 2019; 5:126. [PMID: 31720004 PMCID: PMC6839244 DOI: 10.1186/s40814-019-0520-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Direct primary care provision of first-trimester medical abortion could potentially address inequitable abortion access in Canada. However, when Health Canada approved the combination medication Mifegymiso® (mifepristone 200 mg/misoprostol 800 mcg) for medical abortion in July 2015, we hypothesized that the restrictions to distribution, prescribing, and dispensing would impede the uptake of this evidence-based innovation in primary care. We developed and pilot-tested a survey related to policy and practice facilitators and barriers to assess successful initiation and ongoing clinical provision of medical abortion service by physicians undertaking mifepristone training. Additionally, we explored expert, stakeholder, and physician perceptions of the impact of facilitators and barriers on abortion services throughout Canada. METHODS In phase 1, we developed a survey using 2 theoretical frameworks: Greenhalgh's conceptual model for the Diffusion of Innovations in health service organizations (which we operationalized) and Godin's framework to assess the impact of professional development on the uptake of new practices operationalized in Légaré's validated questionnaire. We finalized questions in phase 2 using the modified Delphi methodology. The survey was then tested by an expert panel of 25 nationally representative physician participants and 4 clinical content experts. Qualitative analysis of transcripts enriched and validated the content by identifying these potential barriers: physicians dispensing the medication, mandatory training to become a prescriber, burdens for patients, lack of remuneration for mifepristone provision, and services available in my community. To assess the usability and reliability of the online survey, in phase 3, we pilot-tested the survey for feasibility. RESULTS We developed and tested a 61-item Mifepristone Implementation Survey suitable to study the facilitators and barriers to implementation of mifepristone first-trimester medical abortion practice by physicians in Canada. CONCLUSIONS Our team operationalized Greenhalgh's theoretical framework for Diffusion of Innovations in health systems to explore factors influencing the implementation of first-trimester medical abortion provision. This process may be useful for those evaluating other health system innovations. Identification of facilitators and barriers to implementation of mifepristone practice in Canada and knowledge translation has the potential to inform regulatory and health system changes to support and scale up facilitators and mitigate barriers to equitable medical abortion provision.
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Affiliation(s)
- Courtney Devane
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - Regina M. Renner
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Sarah Munro
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Édith Guilbert
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Institut national de santé publique du Québec, Quebec City, QC Canada
| | - Sheila Dunn
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON Canada
| | - Marie-Soleil Wagner
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Department of Obstetrics and Gynaecology, University of Montreal, CHU Sainte-Justine, Montreal, QC Canada
| | - Wendy V. Norman
- Contraception and Abortion Research Team, Women’s Health Research Institute, BC Women’s Hospital and Health Center, Vancouver, BC Canada
- Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Family Practice, Women’s Health Research Institute, University of British Columbia, E202-4500 Oak Street, Vancouver, BC V6H 3N1 Canada
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Abbasgholizadeh Rahimi S, Archambault PM, Ravitsky V, Lemoine ME, Langlois S, Forest JC, Giguère AMC, Rousseau F, Dolan JG, Légaré F. An Analytical Mobile App for Shared Decision Making About Prenatal Screening: Protocol for a Mixed Methods Study. JMIR Res Protoc 2019; 8:e13321. [PMID: 31596249 PMCID: PMC6913686 DOI: 10.2196/13321] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/09/2019] [Accepted: 05/25/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Decisions about prenatal screening to assess the risk of genetic conditions such as Down syndrome are complex and should be well informed. Moreover, the number of available tests is increasing. Shared decision making (SDM) about testing could be facilitated by decision aids powered by mobile technology. OBJECTIVE In this mixed methods study, we aim to (1) assess women's needs and preferences regarding using an app for considering prenatal screening, (2) develop a decision model using the analytical hierarchy process, and (3) develop an analytical app and assess its usability and usefulness. METHODS In phase 1, we will assess the needs of 90 pregnant women and their partners (if available). We will identify eligible participants in 3 clinical sites (a midwife-led birthing center, a family practice clinic, and an obstetrician-led hospital-based clinic) in Quebec City and Montreal, Canada. Using semistructured interviews, we will assess participants' attitudes toward mobile apps for decision making about health, their current use of apps for health purposes, and their expectations of an app for prenatal testing decisions. Self-administered questionnaires will collect sociodemographic information, intentions to use an app for prenatal testing, and perceived importance of decision criteria. Qualitative data will be transcribed verbatim and analyzed thematically. Quantitative data will be analyzed using descriptive statistics and the analytic hierarchy process (AHP) method. In phase 2, we will develop a decision model using the AHP whereby users can assign relative importance to criteria when deciding between options. We will validate the model with potential users and a multidisciplinary team of patients, family physicians, primary care researchers, decision sciences experts, engineers, and experts in SDM, genetics, and bioethics. In phase 3, we will develop a prototype of the app using the results of the first 2 phases, pilot test its usefulness and usability among a sample of 15 pregnant women and their partners (if available), and improve it through 3 iterations. Data will be collected with a self-administered questionnaire. Results will be analyzed using descriptive statistics. RESULTS Recruitment for phase 1 will begin in 2019. We expect results to be available in 2021. CONCLUSIONS This study will result in a validated analytical app that will provide pregnant women and their partners with up-to-date information about prenatal screening options and their risks and benefits. It will help them clarify their values and enable them to weigh the options to make informed choices consistent with their preferences and values before meeting face-to-face with their health care professional. The app will be easy to update with the latest information and will provide women with a user-friendly experience using their smartphones or tablets. This study and the resulting app will contribute to high-quality SDM between pregnant women and their health care team. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13321.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche, Centre intégré en santé et services sociaux de Chaudière-Appalaches, Lévis, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
| | - Vardit Ravitsky
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Marie-Eve Lemoine
- Programmes de bioéthique, Département de médecine sociale et préventive, École de santé publique de l'Université de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Sylvie Langlois
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Jean-Claude Forest
- Centre de recherche, Centre hospitalier universitaire de Québec, Québec, QC, Canada.,Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Anik M C Giguère
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Canadian Research Chair in Shared Decision Making and Knowledge Translation, Québec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - James G Dolan
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, United States
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Université Laval, Québec, QC, Canada
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Rouleau G, Gagnon MP, Côté J, Payne-Gagnon J, Hudson E, Dubois CA, Bouix-Picasso J. Effects of E-Learning in a Continuing Education Context on Nursing Care: Systematic Review of Systematic Qualitative, Quantitative, and Mixed-Studies Reviews. J Med Internet Res 2019; 21:e15118. [PMID: 31579016 PMCID: PMC6777280 DOI: 10.2196/15118] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 12/22/2022] Open
Abstract
Background E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714
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Affiliation(s)
- Geneviève Rouleau
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,University of Montreal Hospital Research Centre, Montreal, QC, Canada
| | - Marie-Pierre Gagnon
- Faculty of Nursing, Université Laval, Quebec, QC, Canada.,Centre de Recherche sur les Soins et les Services de Première Ligne de l'Université Laval, Quebec, QC, Canada
| | - José Côté
- University of Montreal Hospital Research Centre, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | | | - Emilie Hudson
- School of Nursing, McGill University, Montreal, QC, Canada
| | - Carl-Ardy Dubois
- Public Health Research Institute, Université de Montréal, Montreal, QC, Canada.,Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, QC, Canada
| | - Julien Bouix-Picasso
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada.,Education and Health Practices Laboratory, Paris 13 University, Sorbonne Paris Cité University, Paris, France.,Department of Education for Non-Medical Personnel, French Military Health Service Academy, École du Val-de-Grâce, Paris, France
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Latif A, Waring J, Chen LC, Pollock K, Solomon J, Gulzar N, Gulzar S, Anderson E, Choudhary S, Abbasi N, Wharrad HJ, Anderson C. Supporting the provision of pharmacy medication reviews to marginalised (medically underserved) groups: a before/after questionnaire study investigating the impact of a patient-professional co-produced digital educational intervention. BMJ Open 2019; 9:e031548. [PMID: 31530620 PMCID: PMC6756439 DOI: 10.1136/bmjopen-2019-031548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES People who are marginalised (medically underserved) experience significant health disparities and their voices are often 'seldom heard'. Interventions to improve professional awareness and engagement with these groups are urgently needed. This study uses a co-production approach to develop an online digital educational intervention in order to improve pharmacy staffs' intention to offer a community pharmacy medication review service to medically underserved groups. DESIGN Before/after (3 months) self-completion online questionnaire. SETTING Community pharmacies in the Nottinghamshire (England) geographical area. PARTICIPANTS Community pharmacy staff. INTERVENTION Online digital educational intervention. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was 'behaviour change intention' using a validated 12-item survey measure. The secondary outcome measure was pharmacist self-reported recruitment of underserved groups to the medication review service. RESULTS All pharmacies in the Nottinghamshire area (n=237) were approached in June 2017 and responses were received from 149 staff (from 122 pharmacies). At 3 months (after completing the baseline questionnaire), 96 participants (from 80 pharmacies) completed a follow-up questionnaire, of which two-thirds (n=62) reported completing the e-learning. A before/after comparison analysis found an improving trend in all the five constructs of behaviour change intention (intention, social influence, beliefs about capabilities, moral norms and beliefs about consequences), with a significant increase in mean score of participants' 'beliefs about capabilities' (0.44; 95% CI 0.11 to 0.76, p=0.009). In the short-term, no significant change was detected in the number of patients being offered and the patient completing a medication review. CONCLUSIONS Although increases in the numbers of patients being offered a medication review was not detected, the intervention has the potential to significantly improve pharmacy professionals' 'beliefs about capabilities' in the short-term. Wider organisational and policy barriers to engagement with marginasied groups may need to be addressed. Future research should focus on the interplay between digital learning and practice to better identify and understand effective practice change pathways.
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Affiliation(s)
- Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Li-Chia Chen
- Department of Biomolecular Science, University of Manchester Institute of Science and Technology, Manchester, UK
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Lincoln, UK
| | - Nargis Gulzar
- School of Pharmacy, De Montfort University, Leicester, UK
| | - Sulma Gulzar
- The Westgate Practice, South East Staffordshire and Seisdon Peninsular CCG, Staffordshire, UK
| | - Emma Anderson
- Centre for Pharmacy Postgraduate Education (CPPE), University of Manchester, Manchester, UK
| | | | | | | | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
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Bentley MW, Kerr R, Ginger M, Karagoz J. Behavioural change in primary care professionals undertaking online education in dementia care in general practice. Aust J Prim Health 2019; 25:244-249. [PMID: 31138397 DOI: 10.1071/py18079] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 03/07/2019] [Indexed: 02/28/2024]
Abstract
A challenge facing general practice is improving the diagnosis, management and care of people with dementia. Training and education for primary care professionals about knowledge and attitudes about dementia is needed. Online resources can provide educational opportunities for health professionals with limited access to dementia training. An online educational resource (four modules over 3 h) was designed to assist primary care practitioners to develop a systematic framework to identify, diagnose and manage patients with dementia within their practice. Interviews and questionnaires (knowledge, attitudes, confidence and behavioural intentions), with practice nurses and international medical graduates working in general practices, were used to evaluate the resource. Participants' knowledge, confidence and attitudes about dementia increased after completing the modules. Participants had strong intentions to apply a systematic framework to identify and manage dementia. In post-module interviews, participants reported increased awareness, knowledge and confidence in assessing and managing people with dementia, corroborating the questionnaire results. This project has demonstrated some early changes in clinical behaviour around dementia care in general practice. Promoting the value of applying a systematic framework with colleagues and co-workers could increase awareness of, and participation in, dementia assessment by other primary care professionals within general practices.
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Affiliation(s)
- Michael W Bentley
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia; and Corresponding author
| | - Rohan Kerr
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Margaret Ginger
- General Practice Training Tasmania, Level 3 RACT House, 179 Murray Street, Hobart, Tas. 7000, Australia
| | - Jacob Karagoz
- Department of Health and Human Services, State Government of Victoria, 50 Lonsdale Street, Melbourne, Vic. 3000, Australia
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Norman WV, Munro S, Brooks M, Devane C, Guilbert E, Renner R, Kendall T, Soon JA, Waddington A, Wagner MS, Dunn S. Could implementation of mifepristone address Canada's urban-rural abortion access disparity: a mixed-methods implementation study protocol. BMJ Open 2019; 9:e028443. [PMID: 31005943 PMCID: PMC6500320 DOI: 10.1136/bmjopen-2018-028443] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION In January 2017, mifepristone-induced medical abortion was made available in Canada. In this study, we will seek to (1) understand facilitators and barriers to the implementation of mifepristone across Canada, (2) assess the impact of a 'community of practice' clinical and health service support platform and (3) engage in and assess the impact of integrated knowledge translation (iKT) activities aimed to improve health policy, systems and service delivery issues to enhance patient access to mifepristone. METHODS AND ANALYSIS This prospective mixed-methods implementation study will involve a national sample of physicians and pharmacists recruited via an online training programme, professional networks and a purpose-built community of practice website. Surveys that explore constructs related to diffusion of innovation and Godin's behaviour change frameworks will be conducted at baseline and at 6 months, and qualitative data will be collected from electronic interactions on the website. Survey participants and a purposeful sample of decision-makers will be invited to participate in in-depth interviews. Descriptive analyses will be conducted for quantitative data. Thematic analysis guided by the theoretical frameworks will guide interpretation of qualitative data. We will conduct and assess iKT activities involving Canada's leading health system and health professional leaders, including evidence briefs, Geographical Information System (GIS)maps, face-to-face meetings and regular electronic exchanges. Findings will contribute to understanding the mechanisms of iKT relationships and activities that have a meaningful effect on uptake of evidence into policy and practice. ETHICS AND DISSEMINATION Ethical approval was received from the University of British Columbia Children's and Women's Hospital Ethics Review Board (H16-01006). Full publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to research participants through newsletters and media interviews, and to policy-makers through invited evidence briefs and face-to-face presentations.
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Affiliation(s)
- Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Munro
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Courtney Devane
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Edith Guilbert
- Institut national de santé publique du Québec, Québec, Québec, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamil Kendall
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Judith A Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ashley Waddington
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, Ontario, Canada
| | - Marie-Soleil Wagner
- Department of Obstetrics and Gynaecology, University of Montreal, Montreal, Quebec, Canada
| | - Sheila Dunn
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Desjardins A, Boulay MÈ, Gagné M, Simon M, Boulet LP. Family medicine physician teachers and residents' intentions to prescribe and interpret spirometry: a descriptive cross-sectional study. J Asthma 2019; 57:149-159. [PMID: 30905218 DOI: 10.1080/02770903.2018.1553052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Spirometry is the best test to demonstrate airway obstruction, but remains underused in primary care. Objectives: We assessed, among family medicine physician teachers and residents, their intention to prescribe spirometry in patients suspected of chronic obstructive pulmonary disease and their intention to interpret the results. This evaluation is based on the theoretical framework proposed by Godin et al. for the study of factors influencing healthcare professionals' behavior. Methods: Participants of this descriptive cross-sectional study were recruited from eight Family medicine units (FMUs) of Laval University's network. They completed a 23-item self-administered questionnaire measuring their intention to prescribe and to interpret spirometry as well as some determinants of this intention (beliefs about capabilities, beliefs about consequences, social influence and moral norm). Answers to each of the items were scored on a Likert scale (score 1 to 7) where a higher score indicated a greater agreement with the statement. Results: Of the 284 eligible physicians, 104 were included. The mean score ± standard deviation of physicians' intention to prescribe spirometry (6.6 ± 0.7) was higher than to interpret the results (5.8 ± 1.5). Mean scores for all determinants of intention measured were also higher for prescription than for interpretation of spirometry. Conclusion: The results suggest that participants have a very strong intention to prescribe spirometry. Although the intention to interpret the results is positive, it is weaker than for the prescription of the test. Further studies will be needed to assess the barriers to spirometry interpretation.
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Affiliation(s)
- Audrey Desjardins
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
| | - Marie-Ève Boulay
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
| | - Myriam Gagné
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
| | - Mathieu Simon
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
| | - Louis-Philippe Boulet
- Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health, Laval University, Quebec City, QC, Canada.,Quebec Heart and Lung Institute-Laval University, Quebec City, QC, Canada
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Ludwig C, Renaud J, Barbera L, Carley M, Henry C, Jolicoeur L, Kuziemsky C, Patry A, Stacey D. Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study. Curr Oncol 2019; 26:56-64. [PMID: 30853800 PMCID: PMC6380628 DOI: 10.3747/co.25.4198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment-related symptoms. Methods In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings. Results Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan-Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge. Conclusions The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.
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Affiliation(s)
- C Ludwig
- School of Nursing, University of Ottawa, Ottawa, ON
| | | | - L Barbera
- Department of Radiation Oncology, University of Toronto, Toronto, ON
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, ON
| | - M Carley
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
| | - C Henry
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | | | - C Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON
| | - A Patry
- The Ottawa Hospital, Ottawa, ON
| | - D Stacey
- School of Nursing, University of Ottawa, Ottawa, ON
- The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON
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Boland L, Lawson ML, Graham ID, Légaré F, Dorrance K, Shephard A, Stacey D. Post-training Shared Decision Making Barriers and Facilitators for Pediatric Healthcare Providers: A Mixed-Methods Study. Acad Pediatr 2019; 19:118-129. [PMID: 29860134 DOI: 10.1016/j.acap.2018.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/15/2018] [Accepted: 05/26/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To assess barriers to and facilitators of shared decision making (SDM) for pediatric healthcare providers (HCPs) after they have been trained in SDM. METHODS A mixed methods study using triangulation of data sources. Pediatric HCPs with SDM training who worked at a Canadian tertiary care pediatric hospital were eligible. Participants completed a validated SDM barriers survey (n = 60) and a semi-structured interview (n = 11). We calculated descriptive statistics. Univariate and multivariable ordinary least squares linear regression models determined predictors of HCPs' intention to use SDM. Interviews were audiotaped and transcribed verbatim. We analyzed qualitative data using deductive and inductive content analyses and organized categories according to the Ottawa Model of Research Use. RESULTS Intention to use SDM was high (mean score = 5.6/7, SD = 0.78) and positively correlated with SDM use (RR = 1.46, 95% CI 1.18-1.81). However, 52% of survey respondents reported not using SDM after training. HCPs identified factors influencing SDM at the levels of innovation, adopter, environment, and training. Insufficient time (barrier) and buy-in and agreement with SDM (facilitators) were most commonly cited. To improve SDM use, HCPs want a more team-based approach to SDM training, continuing education, and implementation. CONCLUSIONS Despite training and positive intentions, many HCPs report not subsequently using SDM and identified numerous post-training barriers to its use. To overcome SDM barriers and improve uptake, HCPs recommend creating a socially supportive environment through a team-based approach to SDM training and implementation. These findings can inform SDM training and implementation interventions at pediatric health care centers.
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Affiliation(s)
- Laura Boland
- Population Health, Faculty of Health Sciences; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ian D Graham
- School of Epidemiology and Public Health; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - France Légaré
- Hôpital Sainte-François d'Assise, CHU de Québec Research Centre, Université Laval, Quebec City, Quebec, Canada
| | | | | | - Dawn Stacey
- School of Nursing, University of Ottawa; Hôpital Sainte-François d'Assise, CHU de Québec Research Centre, Université Laval, Quebec City, Quebec, Canada.
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Stacey D, Ludwig C, Truant T, Carley M, Bennis C, Gifford W, Kuziemsky C, Nichol K, Lafreniere-Davis N, Owens G, Roscoe D, Roberts P, Verhaegen M. Implementing Practice Guides to Improve Cancer Symptom Management in Homecare: A Comparative Case Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2018. [DOI: 10.1177/1084822318817896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Symptoms experienced by clients with cancer often occur at home and can become life-threatening, posing serious safety concerns. This study evaluated implementation of evidence-informed symptom practice guides to enhance quality of cancer symptom support by homecare nurses. A comparative case study was conducted using the Knowledge to Action Framework. Case were created for each of six agencies providing nursing care within a regional homecare authority. A team of researchers and knowledge users (e.g., managers, educators, family member): (1) assessed factors influencing practice guide use (survey, interviews) at six agencies, (2) adapted 15 practice guides for local use, (3) implemented with interventions to address barriers, and (4) monitored use. Analysis was within and across cases. Of six nursing agencies, one withdrew and five participated. In the baseline survey, 51% of nurses reported using guidelines but nurses did not describe using them in their current practice during the interviews. To overcome barriers, 489 nurses in five agencies were trained in how to use the practice guides, principles were established for documenting cancer symptom management, and practice guides were made available in various formats. Success with implementation varied across the participating cases. Chart audits conducted in three agencies revealed evidence of practice guide use for 16%, 22%, and 70% client visits, respectively. Implementation of evidence-informed practice guides in nursing required an approach tailored for each agency. Training, integration in documentation, and easy access to practice guides increased use for some nurses but ongoing support and reinforcement from nurse leaders is required.
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Affiliation(s)
- Dawn Stacey
- The University of Ottawa, ON, Canada
- Ottawa Hospital Research Institute, ON, Canada
| | | | - Tracy Truant
- The University of British Columbia, Vancouver, Canada
| | - Meg Carley
- Ottawa Hospital Research Institute, ON, Canada
| | - Cindy Bennis
- Bayshore Home Care Solutions, Cornwall, ON, Canada
| | | | | | | | - Nicole Lafreniere-Davis
- pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Homecare Study, Ottawa, ON, Canada
| | - Glenda Owens
- Champlain Local Health Integration Network, Ottawa, ON, Canada
| | - Diane Roscoe
- Carefor Health & Community Services, Ottawa, ON, Canada
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Sibley KM, Bentley DC, Salbach NM, Gardner P, McGlynn M, O’Hoski S, Shaffer J, Shing P, McEwen S, Beauchamp MK, Hossain S, Straus SE, Jaglal SB. A theory-based multi-component intervention to increase reactive balance measurement by physiotherapists in three rehabilitation hospitals: an uncontrolled single group study. BMC Health Serv Res 2018; 18:724. [PMID: 30231939 PMCID: PMC6146937 DOI: 10.1186/s12913-018-3533-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/11/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Most implementation interventions in rehabilitation, including physiotherapy, have used passive, non-theoretical approaches without demonstrated effectiveness. The goal of this study was to improve an important domain of physiotherapy practice - reactive balance measurement - with a targeted theory-based multi-component intervention developed using the Theoretical Domains Framework. The primary objective was to determine documented reactive balance measure use in a 12-month baseline, during, and for three months post- intervention. METHODS An uncontrolled before-and-after study was completed with physiotherapists at three urban adult rehabilitation hospitals in Ontario, Canada. The 12-month intervention included group meetings, local champions, and health record modifications for a validated reactive balance measure. The primary outcome was the proportion of records with a documented reactive balance measure when balance was assessed pre-, during- and post-intervention. Secondary outcomes were changes in use, knowledge, and confidence post-intervention, differences across sites, and intervention satisfaction. RESULTS Reactive balance was not measured in any of 211 eligible pre-intervention records. Thirty-three physiotherapists enrolled and 28 completed the study. Reactive balance was measured in 31% of 300 eligible records during-intervention, and in 19% of 90 eligible records post-intervention (p < 0.04). Knowledge and confidence significantly increased post-intervention (all p < 0.05). There were significant site differences in use during- and post-intervention (all p < 0.05). Most participants reported satisfaction with intervention content (71%) and delivery (68%). CONCLUSIONS Reactive balance measurement was greater among participants during-intervention relative to the baseline, and use was partially sustained post-intervention. Continued study of intervention influences on clinical reasoning and exploration of site differences is warranted.
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Affiliation(s)
- Kathryn M. Sibley
- Department of Community Health Sciences, University of Manitoba, 379–753 McDermot Avenue, Winnipeg, MB R3E 0W3 Canada
- Centre for Healthcare Innovation, 753 McDermot Avenue, Winnipeg, R3E 0W3 MB Canada
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Danielle C. Bentley
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Faculty of Medicine, University of Toronto, 1180-1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Nancy M. Salbach
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Department of Physical Therapy, University of Toronto, 160–500 University Avenue, Toronto, ON M5G 1V7 Canada
| | - Paula Gardner
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, L2S 3A1 ON Canada
- Bridgepoint Active Healthcare – Sinai Health System, 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
| | - Mandy McGlynn
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Sachi O’Hoski
- West Park Healthcare Centre, Toronto, Canada
- School of Rehabilitation Science, McMaster University, 1400 Main Sreet West, Hamilton, ON L8S 1C7 Canada
| | - Jennifer Shaffer
- Department of Physical Therapy, University of Toronto, 160–500 University Avenue, Toronto, ON M5G 1V7 Canada
- Sunnybrook Health Sciences Centre – St. John’s Rehab, 285 Cummer Avenue, Toronto, ON M2M 2G1 Canada
| | - Paula Shing
- Department of Physical Therapy, University of Toronto, 160–500 University Avenue, Toronto, ON M5G 1V7 Canada
- Bridgepoint Active Healthcare – Sinai Health System, 1 Bridgepoint Drive, Toronto, ON M4M 2B5 Canada
| | - Sara McEwen
- Sunnybrook Health Sciences Centre – St. John’s Rehab, 285 Cummer Avenue, Toronto, ON M2M 2G1 Canada
| | - Marla K. Beauchamp
- School of Rehabilitation Science, McMaster University, 1400 Main Sreet West, Hamilton, ON L8S 1C7 Canada
| | - Saima Hossain
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute – St. Michael’s Hospital, 30 Bond Street, Shuter 2–026, Toronto, ON M5B 1W8 Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Canada
| | - Susan B. Jaglal
- Toronto Rehabilitation Institute- University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
- Department of Physical Therapy, University of Toronto, 160–500 University Avenue, Toronto, ON M5G 1V7 Canada
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Lamont S, Brunero S. The effect of a workplace violence training program for generalist nurses in the acute hospital setting: A quasi-experimental study. NURSE EDUCATION TODAY 2018; 68:45-52. [PMID: 29885569 DOI: 10.1016/j.nedt.2018.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/09/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Workplace violence prevalence has attracted significant attention within the international nursing literature. Little attention to non-mental health settings and a lack of evaluation rigor have been identified within review literature. OBJECTIVES To examine the effects of a workplace violence training program in relation to risk assessment and management practices, de-escalation skills, breakaway techniques, and confidence levels, within an acute hospital setting. DESIGN A quasi-experimental study of nurses using pretest-posttest measurements of educational objectives and confidence levels, with two week follow-up. SETTING A 440 bed metropolitan tertiary referral hospital in Sydney, Australia. PARTICIPANTS Nurses working in specialties identified as a 'high risk' for violence. METHOD A pre-post-test design was used with participants attending a one day workshop. The workshop evaluation comprised the use of two validated questionnaires: the Continuing Professional Development Reaction questionnaire, and the Confidence in Coping with Patient Aggression Instrument. Descriptive and inferential statistics were calculated. The paired t-test was used to assess the statistical significance of changes in the clinical behaviour intention and confidence scores from pre- to post-intervention. Cohen's d effect sizes were calculated to determine the extent of the significant results. RESULTS Seventy-eight participants completed both pre- and post-workshop evaluation questionnaires. Statistically significant increases in behaviour intention scores were found in fourteen of the fifteen constructs relating to the three broad workshop objectives, and confidence ratings, with medium to large effect sizes observed in some constructs. A significant increase in overall confidence in coping with patient aggression was also found post-test with large effect size. CONCLUSIONS Positive results were observed from the workplace violence training. Training needs to be complimented by a multi-faceted organisational approach which includes governance, quality and review processes.
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Affiliation(s)
- Scott Lamont
- Clinical Nurse Consultant, Mental Health Liaison Nursing, Prince of Wales Hospital, Sessional Academic, Sydney Nursing School, University of Sydney, Australia.
| | - Scott Brunero
- Clinical Nurse Consultant, Mental Health Liaison Nursing, Prince of Wales Hospital, Western Sydney University, Australia
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Légaré F, Lee-Gosselin H, Borduas F, Monette C, Bilodeau A, Tanguay D, Stacey D, Gagnon MP, Roch G, Dogba MJ, Bussières A, Tremblay MC, Bélanger AP, Jose C, Desroches S, Robitaille H, Blair L, Rhugenda SM. Approaches to considering sex and gender in continuous professional development for health and social care professionals: An emerging paradigm. MEDICAL TEACHER 2018; 40:875-879. [PMID: 30058455 DOI: 10.1080/0142159x.2018.1483579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Consideration of sex and gender in research and clinical practice is necessary to redress health inequities and reduce knowledge gaps. As all health professionals must maintain and update their skills throughout their career, developing innovative continuing professional education programs that integrate sex and gender issues holds great promise for reducing these gaps. This article proposes new approaches to partnership, team development, pedagogical theory, content development, evaluation and data management that will advance the integration of sex and gender in continuing professional development (CPD). Our perspectives build on an intersectoral and interprofessional research team that includes several perspectives, including those of CPD, health systems, knowledge translation and sex and gender.
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Affiliation(s)
- France Légaré
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - Hélène Lee-Gosselin
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | | | - Céline Monette
- d Médecins Francophone du Canada , Montreal , QC , Canada
| | | | - Dominique Tanguay
- c Institute for Women, Societies, Equality and Equity , Université Laval , Quebec City , QC , Canada
| | - Dawn Stacey
- f School of Nursing Faculty of Health Sciences , University of Ottawa , Ottawa , ON , Canada
- g Ottawa Hospital Research Institute , Ottawa , ON , Canada
| | | | - Geneviève Roch
- h Faculty of Nursing , Université Laval , Quebec City , QC , Canada
- i CHU de Québec, Université Laval Research Centre , Quebec City , QC , Canada
| | - Maman Joyce Dogba
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
- b Faculty of Medicine , Université Laval , Quebec City , QC , Canada
| | - André Bussières
- j Faculty of Medicine , McGill University , Montreal , QC , Canada
| | | | | | - Caroline Jose
- l Department of Family Medicine , University of Sherbrooke , Moncton , NB , Canada
- m Maritimes SPOR Support Unit , Moncton , NB , Canada
| | - Sophie Desroches
- n Institute of Nutrition and Functional Foods , School of Nutrition , Université Laval , Quebec City , QC , Canada
| | - Hubert Robitaille
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
| | - Louisa Blair
- a Université Laval Primary Care Research Centre (CERSSPL-UL) , Quebec City , QC , Canada
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Souli I, Vandyk A, Versailles D, Marcoux I, Salvador A, Peterson WE, Hu J, Stacey D. [Barriers to and facilitators for using a risk assessment tool to prevent violent behaviour in patients with mental health conditions: Perspectives of health care providers]. Rech Soins Infirm 2018:45-57. [PMID: 30066506 DOI: 10.3917/rsi.133.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Regular assessment of risk of violence is shown to be effective in reducing violence in mental health services. PURPOSE To evaluate health care providers' use of a violence risk assessment tool on a mental health unit and the facilitators for and barriers to its use. METHODS A descriptive study using the Dillman approach and informed by the Knowledge to Action framework was conducted. RESULTS Twenty-six health care providers responded to the survey; 62% reported using the violence risk assessment tool available on their unit, but not on a daily basis. Common barriers were lack of knowledge of the tool, lack of resources and time, and negative attitudes toward patients. 42% of participants indicated the need for further training on violence risk assessment. CONCLUSION Despite high exposure to violence, health professionals were not conducting daily risk assessments. The barriers and facilitators identified provide direction for interventions that are necessary if the daily use of violence risk assessment tools is to be increased.
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