1
|
Stacey D, Lewis KB, Smith M, Carley M, Volk R, Douglas EE, Pacheco-Brousseau L, Finderup J, Gunderson J, Barry MJ, Bennett CL, Bravo P, Steffensen K, Gogovor A, Graham ID, Kelly SE, Légaré F, Sondergaard H, Thomson R, Trenaman L, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2024; 1:CD001431. [PMID: 38284415 PMCID: PMC10823577 DOI: 10.1002/14651858.cd001431.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Patient decision aids are interventions designed to support people making health decisions. At a minimum, patient decision aids make the decision explicit, provide evidence-based information about the options and associated benefits/harms, and help clarify personal values for features of options. This is an update of a Cochrane review that was first published in 2003 and last updated in 2017. OBJECTIVES To assess the effects of patient decision aids in adults considering treatment or screening decisions using an integrated knowledge translation approach. SEARCH METHODS We conducted the updated search for the period of 2015 (last search date) to March 2022 in CENTRAL, MEDLINE, Embase, PsycINFO, EBSCO, and grey literature. The cumulative search covers database origins to March 2022. SELECTION CRITERIA We included published randomized controlled trials comparing patient decision aids to usual care. Usual care was defined as general information, risk assessment, clinical practice guideline summaries for health consumers, placebo intervention (e.g. information on another topic), or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently screened citations for inclusion, extracted intervention and outcome data, and assessed risk of bias using the Cochrane risk of bias tool. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made (informed values-based choice congruence) and the decision-making process, such as knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision-making, and adverse events. Secondary outcomes were choice, confidence in decision-making, adherence to the chosen option, preference-linked health outcomes, and impact on the healthcare system (e.g. consultation length). We pooled results using mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs), applying a random-effects model. We conducted a subgroup analysis of 105 studies that were included in the previous review version compared to those published since that update (n = 104 studies). We used Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the certainty of the evidence. MAIN RESULTS This update added 104 new studies for a total of 209 studies involving 107,698 participants. The patient decision aids focused on 71 different decisions. The most common decisions were about cardiovascular treatments (n = 22 studies), cancer screening (n = 17 studies colorectal, 15 prostate, 12 breast), cancer treatments (e.g. 15 breast, 11 prostate), mental health treatments (n = 10 studies), and joint replacement surgery (n = 9 studies). When assessing risk of bias in the included studies, we rated two items as mostly unclear (selective reporting: 100 studies; blinding of participants/personnel: 161 studies), due to inadequate reporting. Of the 209 included studies, 34 had at least one item rated as high risk of bias. There was moderate-certainty evidence that patient decision aids probably increase the congruence between informed values and care choices compared to usual care (RR 1.75, 95% CI 1.44 to 2.13; 21 studies, 9377 participants). Regarding attributes related to the decision-making process and compared to usual care, there was high-certainty evidence that patient decision aids result in improved participants' knowledge (MD 11.90/100, 95% CI 10.60 to 13.19; 107 studies, 25,492 participants), accuracy of risk perceptions (RR 1.94, 95% CI 1.61 to 2.34; 25 studies, 7796 participants), and decreased decisional conflict related to feeling uninformed (MD -10.02, 95% CI -12.31 to -7.74; 58 studies, 12,104 participants), indecision about personal values (MD -7.86, 95% CI -9.69 to -6.02; 55 studies, 11,880 participants), and proportion of people who were passive in decision-making (clinician-controlled) (RR 0.72, 95% CI 0.59 to 0.88; 21 studies, 4348 participants). For adverse outcomes, there was high-certainty evidence that there was no difference in decision regret between the patient decision aid and usual care groups (MD -1.23, 95% CI -3.05 to 0.59; 22 studies, 3707 participants). Of note, there was no difference in the length of consultation when patient decision aids were used in preparation for the consultation (MD -2.97 minutes, 95% CI -7.84 to 1.90; 5 studies, 420 participants). When patient decision aids were used during the consultation with the clinician, the length of consultation was 1.5 minutes longer (MD 1.50 minutes, 95% CI 0.79 to 2.20; 8 studies, 2702 participants). We found the same direction of effect when we compared results for patient decision aid studies reported in the previous update compared to studies conducted since 2015. AUTHORS' CONCLUSIONS Compared to usual care, across a wide variety of decisions, patient decision aids probably helped more adults reach informed values-congruent choices. They led to large increases in knowledge, accurate risk perceptions, and an active role in decision-making. Our updated review also found that patient decision aids increased patients' feeling informed and clear about their personal values. There was no difference in decision regret between people using decision aids versus those receiving usual care. Further studies are needed to assess the impact of patient decision aids on adherence and downstream effects on cost and resource use.
Collapse
Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | | | | | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Volk
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elisa E Douglas
- Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeanette Finderup
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael J Barry
- Informed Medical Decisions Program, Massachusetts General Hospital, Boston, MA, USA
| | - Carol L Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Paulina Bravo
- Education and Cancer Prevention, Fundación Arturo López Pérez, Santiago, Chile
| | - Karina Steffensen
- Center for Shared Decision Making, IRS - Lillebælt Hospital, Vejle, Denmark
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec, Canada
| | - Ian D Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology, Public Health and Preventative Medicine, University of Ottawa, Ottawa, Canada
| | - Shannon E Kelly
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - France Légaré
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Université Laval, Quebec, Canada
| | | | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA
| | | |
Collapse
|
2
|
Tonogai J, von Bergmann H, Chvartszaid D, Dempster L. Patient and clinician perspectives on implant dentistry decision aid content: Results from an enhanced Delphi study. J Prosthodont 2024; 33:18-26. [PMID: 37026173 DOI: 10.1111/jopr.13691] [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: 10/24/2022] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
PURPOSE To investigate patient and clinician perspectives on what is considered important to include in a decision aid for replacement of a missing tooth with an implant. METHODS An online modified Delphi method with pair comparisons technique was used to survey participants (66 patients, 48 prosthodontists, 46 periodontists, and 31 oral surgeons) in Ontario, Canada from November 2020 to April 2021 regarding the importance of information provided during an implant consultation. Round one included 19 items derived from the literature and informed consent protocols. The decision to retain an item was based on group consensus, defined as at least 75% of participants identifying the item as "important" or "highly important." After analysis of round one results, a second-round survey was sent to all participants to rank the relative importance of the consensus items. Statistical testing was completed using the Kruskal-Wallis one-way analysis of variance test and post hoc Mann-Whitney U tests with a significance level set at p ≤ 0.05. RESULTS The first and second surveys had response rates of 77.0% and 45.6%, respectively. In round one, all items except purpose of steps reached group consensus. In round two, the highest group ranked items were patient responsibilities for treatment success and follow-ups after treatment. The lowest group ranked items were cost factors and restorative steps. Significant differences between the stakeholder groups were found on several items, including diagnosis (p ≤ 0.00), non-implant options (p ≤ 0.00), and cost (p ≤ 0.01). In general, patients' opinions were significantly different than clinicians' opinions on the relative importance of items. CONCLUSIONS Clinicians and patients feel that multiple items are important to include in a decision aid for implant therapy; however, differences exist between patients and clinicians on the relative importance of items.
Collapse
Affiliation(s)
- James Tonogai
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - HsingChi von Bergmann
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Chvartszaid
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Laura Dempster
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Herman AM, Park AL, Lee C, Paul H, Choplin EG, Deitcher L, Ghuman S, Hartsock J, Youngstrom EA. Advancing the Actionability of Mental Health Information: Identifying Online, Evidence-Based Mental Health Resources. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:773-780. [PMID: 37266799 DOI: 10.1007/s10488-023-01276-9] [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] [Accepted: 05/16/2023] [Indexed: 06/03/2023]
Abstract
To improve the dissemination and actionability of mental health research, many mental health professionals have developed online informational resources to increase the general public's awareness of mental health difficulties and available treatments. Yet, limited information exists on the quality and scope of these resources. This study aimed to explore the scope and quantity of online, free, evidence-based mental health resources. Fifty-two mental health professionals nominated 178 resources, which predominantly consisted of homepages and links to more information. When reviewing the original nominations, our team identified an additional 290 resources (e.g., fact sheets linked from a nominated homepage). Of the 468 total nominated resources, 72 were screened out due to not meeting the inclusion criteria of being free (inter-screener reliability = 95%), evidence-based (inter-screener reliability = 94%), and online (inter-screener reliability = 96%). Nominated resources most commonly covered anxiety and obsessive-compulsive disorder (n = 67) and suicide (n = 60). Resources providing information about the mental health problem were most common (n = 210) and resources providing information about immediate help (e.g., hotline) were least common (n = 57). Our findings indicate many free, online, evidence-based resources are available and raise questions of whether efforts to disseminate mental health research are recreating the issue of information overload. Other considerations and future directions for improving the utilization and synthesizing of available resources are discussed.
Collapse
Affiliation(s)
- Alyssa M Herman
- Department of Psychology, University of Oregon, 1227 University St, Eugene, OR, 97403, USA.
| | - Alayna L Park
- Department of Psychology, University of Oregon, 1227 University St, Eugene, OR, 97403, USA
| | - Cameron Lee
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Hannah Paul
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Emma G Choplin
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lily Deitcher
- Department of Psychology, University of Edinburgh, Edinburgh, Scotland
| | | | - Jeremiah Hartsock
- School of Information and Library Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A Youngstrom
- Department of Psychology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
4
|
Housten AJ, Kozower BD, Engelhardt KE, Robinson C, Puri V, Samson P, Cooksey K, Politi MC. Developing an Educational and Decision Support Tool for Stage I Lung Cancer Using Decision Science. Ann Thorac Surg 2023; 115:299-308. [PMID: 35926640 DOI: 10.1016/j.athoracsur.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines recommend shared decision-making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision-making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities. METHODS The purpose of this review is to reflect on the process of tool development; identify the challenges associated with meeting the needs of patients, clinicians from multiple disciplines, and institutional workflow during implementation; and propose recommendations for future clinicians who wish to develop, refine, or implement similar tools into routine care. RESULTS In this review, we: (1) discuss guidelines for decision aid development; (2) describe how we applied those to create an education and decision support tool for patients with clinical stage I lung cancer deciding between radiation therapy and surgical resection; and (3) highlight challenges in implementing and evaluating the tool. CONCLUSIONS We provide recommendations for those seeking to develop, refine, or implement similar tools into routine care.
Collapse
Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Krista Cooksey
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri.
| |
Collapse
|
5
|
Agbadje TT, Pilon C, Bérubé P, Forest JC, Rousseau F, Rahimi SA, Giguère Y, Légaré F. User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study. JMIR Pediatr Parent 2022; 5:e35381. [PMID: 35896164 PMCID: PMC9490528 DOI: 10.2196/35381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/22/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. OBJECTIVE This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. METHODS For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants' reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. RESULTS A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. CONCLUSIONS Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice.
Collapse
Affiliation(s)
- Titilayo Tatiana Agbadje
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Chantale Pilon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | | | - Jean-Claude Forest
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
| | - Yves Giguère
- Department of Molecular Biology, Medical Biochemistry, and Pathology, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| |
Collapse
|
6
|
Alcorn SR, Elledge CR, LaVigne AW, Kleinberg L, Smith TJ, Levin AS, Fiksel J, Zeger S, McNutt T, DeWeese TL, Wright JL. Improving providers' survival estimates and selection of prognosis- and guidelines-appropriate treatment for patients with symptomatic bone metastases: Development of the Bone Metastases Ensemble Trees for Survival Decision Support Platform. J Eval Clin Pract 2022; 28:581-598. [PMID: 35090073 DOI: 10.1111/jep.13652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES In the management of symptomatic bone metastases, current practice guidelines do not provide clear methodology for selecting palliative radiotherapy (RT) regimens based on specific patient and disease features. Decision support aids may offer an effective means for translating the complex data needed to render individualised treatment decisions, yet no such tools are available for use in this setting. Thus, we describe the development of the Bone Metastases Ensemble Trees for Survival-Decision Support Platform (BMETS-DSP), which aims to optimise selection of evidence-based, individualised palliative RT regimens. METHOD The Ottawa Decision Support Framework was used as the theoretical basis for development of BMETS-DSP. First, we utilised stakeholder input and review of the literature to assess determinants underlying the provider decision. Based on this assessment and iterative stakeholder feedback, we developed the web-based, provider-facing BMETS-DSP. Consistent with the underlying theoretical framework, our design also included assessment of decision quality using the International Patient Decision Aids Standards (IPDAS) certification checklist. RESULTS Stakeholder input and review of 54 evidence-based publications identified the following determinants of the provider decision: estimated prognosis, characteristics of the target symptomatic lesion and the primary cancer type, consideration of alternative interventions, access to patient-specific recommendations, and patient preferences. Based on these determinants, we developed the BMETS-DSP that (1) collects patient-specific data, (2) displays an individualised predicted survival curve, and (3) provides case-specific, evidence-based recommendations regarding RT, open surgery, systemic therapy, and hospice referral to aid in the decision-making process. The finalised tool met IPDAS quality requirements. Preliminary results of a pilot assessment suggest impact of clinical outcomes. CONCLUSIONS We describe the successful development of a provider-facing decision support platform to aid in the provision of palliative RT in better alignment with patient and disease features. Impact of the BMETS-DSP on decision outcomes will be further assessed in a randomised, controlled study.
Collapse
Affiliation(s)
- Sara R Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christen R Elledge
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Anna W LaVigne
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thomas J Smith
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Adam S Levin
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jacob Fiksel
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Scott Zeger
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Todd McNutt
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Theodore L DeWeese
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Roohi G, Jahani MA, Farhadi Z, Mahmoudi G. A knowledge implementation model in health system management based on the PARIHS model. Health Res Policy Syst 2022; 20:66. [PMID: 35710382 PMCID: PMC9205052 DOI: 10.1186/s12961-022-00874-7] [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: 10/21/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran. METHODS The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software. RESULTS The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model. CONCLUSION The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.
Collapse
Affiliation(s)
- Ghanbar Roohi
- Healthcare Services Management, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran
| | - Mohammad Ali Jahani
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Zeynab Farhadi
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ghahraman Mahmoudi
- Hospital Administration Research Center, Sari Branch, Islamic Azad University, Sari, Iran.
| |
Collapse
|
8
|
Zheng LF, Ngoh SHA, Ng JYX, Tan NC. Clinician perspectives on a culturally adapted patient decision aid concerning maintenance therapy for asthma. J Asthma 2021; 59:1463-1472. [PMID: 33926335 DOI: 10.1080/02770903.2021.1923736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients with persistent asthma often show poor adherence to inhaled corticosteroids (ICS). Shared decision-making can improve adherence rates in this population. Patient decision aids (PDAs) are tools to facilitate shared decision-making. To date, only one PDA, developed in a Canadian French-speaking population, exists for patients considering ICS maintenance therapy. This PDA has been culturally adapted in this study to contextualize to the needs of multi-ethnic Asian patients in Singapore. This study explored the views of local clinicians on the content, design and implementation of this newly-adapted PDA. METHODS 24 clinicians, who were purposively sampled from polyclinics and a tertiary institution, were interviewed on the content, design and implementation of the PDA. The interviews were audio-recorded, transcribed and analyzed via thematic analysis. RESULTS Clinicians generally accepted the design of the PDA. They suggested for the target users to be patients on Step 2 of GINA guidelines and the number of options to be reduced from four to two (do nothing or start inhaled corticosteroids). Moreover, they supported including a list of values for patients to select from given that Asian patients often do not articulate their values readily. The addition of more visual aids, the production of multilingual Asian editions and the involvement of nurses to administer the PDA was also suggested. CONCLUSION The PDA was culturally-adapted with local clinicians' perspectives to target multi-ethnic Asian patients with persistent asthma (Step 2 GINA guidelines). The main changes include a list of values and addition of visual aids.
Collapse
Affiliation(s)
- L F Zheng
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| | - S H A Ngoh
- SingHealth Polyclinics, Singapore, Singapore
| | - J Y X Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - N C Tan
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore, Singapore
| |
Collapse
|
9
|
Montpetit-Tourangeau K, Kairy D, Ahmed S, Anaby D, Bussières A, Lamontagne MÈ, Rochette A, Shikako-Thomas K, Thomas A. A strategic initiative to facilitate knowledge translation research in rehabilitation. BMC Health Serv Res 2020; 20:973. [PMID: 33097043 PMCID: PMC7585309 DOI: 10.1186/s12913-020-05772-8] [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: 01/20/2020] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there is a growing body of literature supporting clinical decision-making for rehabilitation professionals, suboptimal use of evidence-based practices in that field persists. A strategic initiative that ensures the relevance of the research and its implementation in the context of rehabilitation could 1) help improve the coordination of knowledge translation (KT) research and 2) enhance the delivery of evidence-based rehabilitation services offered to patients with physical disabilities. This paper describes the process and methods used to develop a KT strategic initiative aimed at building capacity and coordinating KT research in physical rehabilitation and its strategic plan; it also reports the initial applications of the strategic plan implementation. METHODS We used a 3-phase process consisting of an online environmental scan to identify the extent of KT research activities in physical rehabilitation in Quebec, Canada. Data from the environmental scan was used to develop a strategic plan that structures KT research in physical rehabilitation. Seven external KT experts in health science reviewed the strategic plan for consistency and applicability. RESULTS Sixty-four KT researchers were identified and classified according to the extent of their level of involvement in KT. Ninety-six research projects meeting eligibility criteria were funded by eight of the fourteen agencies and organizations searched. To address the identified gaps, a 5-year strategic plan was developed, containing a mission, a vision, four main goals, nine strategies and forty-two actions. CONCLUSION Such initiatives can help guide researchers and relevant key stakeholders, to structure, organize and advance KT research in the field of rehabilitation. The strategies are being implemented progressively to meet the strategic initiative's mission and ultimately enhance users' rehabilitation services.
Collapse
Affiliation(s)
- Katherine Montpetit-Tourangeau
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada. .,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.
| | - Dahlia Kairy
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Sara Ahmed
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec, H3A 1A2, Canada
| | - Dana Anaby
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, Room 408, Hamilton, Ontario, L8S 1C7, Canada
| | - André Bussières
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Département Chiropratique, Université du Québec à Trois-Rivières, 3351, boul. Des Forges, C. P. 500, Trois-Rivières, Quebec, G9A 5H, Canada
| | - Marie-Ève Lamontagne
- Département de réadaptation, Université Laval, Quebec, Quebec, G1V 0A6, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration, Institut de Réadaptation en Déficience Physique de Québec, 525 Boul Wilfrid-Hamel, Quebec, Quebec, G1M 2S8, Canada
| | - Annie Rochette
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, P.O. Box 6128, Station Centre-Ville, Montreal, Quebec, H3C 3J7, Canada.,Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
| | - Keiko Shikako-Thomas
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,CanChild Centre for Childhood Disability Research, McMaster University, 1400 Main Street West, Room 408, Hamilton, Ontario, L8S 1C7, Canada
| | - Aliki Thomas
- Centre for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada.,School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3654 Sir William Osler, Montreal, Quebec, H3G 1Y5, Canada.,Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, 1110 Pine Avenue West, Montreal, Quebec, H3G 1A3, Canada
| |
Collapse
|
10
|
Beaudoin M, Best KL, Routhier F, Atack L, Hitzig SL, Kairy D. Usability of the Participation and Quality of Life (PAR-QoL) Outcomes Toolkit Website for Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:64-77. [PMID: 32095067 DOI: 10.1310/sci2601-64] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Quality of life (QoL) is an important parameter to monitor during rehabilitation; however, accurate assessment is challenging. Among individuals with spinal cord injury (SCI), assessing QoL is further challenged due to complex sequelae, such as secondary health conditions and factors related to community integration. A Participation and Quality of Life (PAR-QoL) toolkit was created to aid clinicians and researchers in the selection of QoL outcomes tools specific to SCI. Objectives: The aim of this study was to evaluate the use and usability of the PAR-QoL toolkit. Methods: A cross-sectional study was conducted using an online survey from December 2013 to November 2016. Google Analytics were collected from April 2012 to April 2018. Survey sections addressed "use" (behavioral practices and actual use) and "usability" (perceived ease of use and perceived usefulness). Any person who visited the PAR-QoL website was invited to complete the survey. Summary statistics and percent concordances were calculated to describe results from the survey and Google Analytics. Results: The PAR-QoL website had 188,577 users. The five most visited webpages were outcome tools, with bounce rates ranging from 77% to 90%. Of the 46 survey respondents, 67% were not current users of the PAR-QoL website, and 87% intended to use the resources in the future. Conclusion: Uptake of the PAR-QoL website is currently limited. Usability of the PAR-QoL website may be improved by modifying navigation, removing the "less useful" components, ensuring regular updates of content and resources, and promoting the website.
Collapse
Affiliation(s)
- Maude Beaudoin
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Krista L Best
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - François Routhier
- Université Laval, Quebec City, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec City, Canada
| | - Lynda Atack
- Applied Research and Innovation Centre, Centennial College, Toronto, Canada
| | - Sander L Hitzig
- Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.,St. John's Rehab Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada.,University of Toronto, Toronto, Canada.,York University, Toronto, Canada
| | - Dahlia Kairy
- Université de Montréal, Montréal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montréal, Canada
| |
Collapse
|
11
|
Hoekstra F, McBride CB, Borisoff J, Fetterly MJ, Ginis S, Latimer-Cheung AE, Ma JK, Maffin J, Mah L, West CR, Willms R, Martin Ginis KA. Translating the international scientific spinal cord injury exercise guidelines into community and clinical practice guidelines: a Canadian evidence-informed resource. Spinal Cord 2020; 58:647-657. [PMID: 31949284 PMCID: PMC7283041 DOI: 10.1038/s41393-019-0410-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 11/18/2022]
Abstract
Study design Knowledge translation (KT) study. Objectives To demonstrate how to use systematic, community-engaged methods to (1) translate the international scientific spinal cord injury (SCI) exercise guidelines into community and clinical practice guidelines, and (2) develop supporting resources. Setting Canada. Methods An expert panel of SCI researchers and stakeholders translated the guidelines and developed a supporting resource, using a KT process guided by an adapted version of the Appraisal of Guidelines, Research and Evaluation (AGREE) II Instrument. Pilot tests with end-users were conducted throughout. Results The panel recommended (1) the two scientific exercise guidelines be combined and presented in a single message titled “The Canadian SCI physical activity guidelines”; (2) development of an online supporting resource, with educational and motivational information presented in “layers” to address the needs and preferences of diverse end-users. The top layer presents and explains the Canadian SCI physical activity guidelines. The deeper layers include information on benefits, overcoming barriers, activity examples, safety tips, and links to existing resources. Interviews with adults with SCI (n = 8) and survey-data from end-users (n = 90) showed that the guidelines and supporting resource were perceived as clear, useful, and appropriate. Conclusion Using community-engaged methods, the two scientific SCI exercise guidelines were combined into one single physical activity guideline message. This KT process provides a template for groups in other countries to translate the scientific SCI exercise guidelines to their local settings using a similar systematic, community-engaged approach. Sponsorship Rick Hansen Institute; Social Sciences and Humanities Research Council of Canada.
Collapse
Affiliation(s)
- Femke Hoekstra
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | | | - Jaimie Borisoff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Engineering Design Laboratory, British Columbia Institute of Technology, Burnaby, BC, Canada
| | | | - Spero Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Amy E Latimer-Cheung
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Jasmin K Ma
- Arthritis Research Canada, Richmond, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | | | - Lorne Mah
- Spinal Cord Injury BC, Vancouver, BC, Canada
| | - Christopher R West
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Cellular and Physiological Sciences, University of British Columbia, Kelowna, BC, Canada.,Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, Canada
| | - Rhonda Willms
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada
| | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada. .,Centre for Chronic Disease Prevention and Management, Southern Medical Program, University of British Columbia, Kelowna, Canada. .,Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada.
| |
Collapse
|
12
|
Dreesens D, Stiggelbout A, Agoritsas T, Elwyn G, Flottorp S, Grimshaw J, Kremer L, Santesso N, Stacey D, Treweek S, Armstrong M, Gagliardi A, Hill S, Légaré F, Ryan R, Vandvik P, van der Weijden T. A conceptual framework for patient-directed knowledge tools to support patient-centred care: Results from an evidence-informed consensus meeting. PATIENT EDUCATION AND COUNSELING 2019; 102:1898-1904. [PMID: 31118137 DOI: 10.1016/j.pec.2019.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 05/01/2019] [Accepted: 05/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Patient-directed knowledge tools are designed to engage patients in dialogue or deliberation, to support patient decision-making or self-care of chronic conditions. However, an abundance of these exists. The tools themselves and their purposes are not always clearly defined; creating challenges for developers and users (professionals, patients). The study's aim was to develop a conceptual framework of patient-directed knowledge tool types. METHODS A face-to-face evidence-informed consensus meeting with 15 international experts. After the meeting, the framework went through two rounds of feedback before informal consensus was reached. RESULTS A conceptual framework containing five patient-directed knowledge tool types was developed. The first part of the framework describes the tools' purposes and the second focuses on the tools' core elements. CONCLUSION The framework provides clarity on which types of patient-directed tools exist, the purposes they serve, and which core elements they prototypically include. It is a working framework and will require further refinement as the area develops, alongside validation with a broader group of stakeholders. PRACTICE IMPLICATIONS The framework assists developers and users to know which type a tool belongs, its purpose and core elements, helping them to develop and use the right tool for the right job.
Collapse
Affiliation(s)
- Dunja Dreesens
- Knowledge Institute of Medical Specialists, Utrecht, the Netherlands; Department of Family Medicine, Maastricht University/School CAPHRI, Maastricht, the Netherlands.
| | - Anne Stiggelbout
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands.
| | - Thomas Agoritsas
- Division of General Internal Medicine & Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, USA.
| | - Signe Flottorp
- Division of health services, Norwegian Institute of Public Health, Oslo, Norway; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Leontien Kremer
- Department Pediatrics, University of Amsterdam, Amsterdam, the Netherlands; Princess Maxima Centrum for Pediatric Oncology, Utrecht, the Netherlands.
| | - Nancy Santesso
- Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada.
| | - Dawn Stacey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Nursing, University of Ottawa, Ottawa, Canada.
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK.
| | - Melissa Armstrong
- Department of Neurology, College of Medicine / University of Florida, Gainesville, USA.
| | - Anna Gagliardi
- University Health Network/Toronto General Hospital Research Institute, Toronto, Canada.
| | - Sophie Hill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia; Cochrane Consumers and Communication Group, La Trobe University, Melbourne, Australia.
| | | | - Rebecca Ryan
- Centre for Health Communication and Participation, La Trobe University, Melbourne, Australia; Cochrane Consumers and Communication Group, La Trobe University, Melbourne, Australia.
| | - Per Vandvik
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway.
| | - Trudy van der Weijden
- Department of Family Medicine, Maastricht University/School CAPHRI, Maastricht, the Netherlands.
| |
Collapse
|
13
|
Abstract
In this opinion piece, I explore practice and complexity, the latter a term often used in relation to the field of special care dentistry. As research is usually concerned with generating new knowledge of some sort, I explore how knowledge is viewed from a practice perspective, as shared, transitory and situated in interactions, rather than being a thing possessed. This leads into a discussion of how the word complexity has been viewed in complexity science, contrasting it with the linear models generated in the evidence-based practice realm from research and research-informed guidelines. Finally, I address the inherent paradox of attempting to align linear models generated from research with the complexity of practice. I suggest that to evaluate and improve practices we should use narrative and exploratory methods that allow its complexity to be made sense of, made transparent and made available for interpretation.
Collapse
Affiliation(s)
- Dominic Hurst
- Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Dental Hospital, Turner Street, London, UK.
| |
Collapse
|
14
|
van der Weijden T, Dreesens D, Faber MJ, Bos N, Drenthen T, Maas I, Kersten S, Malanda U, van der Scheur S, Post H, Knops A. Developing quality criteria for patient-directed knowledge tools related to clinical practice guidelines. A development and consensus study. Health Expect 2019; 22:201-208. [PMID: 30417517 PMCID: PMC6433309 DOI: 10.1111/hex.12843] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 09/22/2018] [Accepted: 10/02/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Patient-directed knowledge tools such as patient versions of guidelines and patient decision aids are increasingly developed to facilitate shared decision making. In this paper, we report how consensus was reached within the Netherlands on quality criteria for development, content and governance of these tools. METHOD A 12-month development and consensus study. The consortium worked on four work packages: (a) reviewing existing criteria; (b) drafting the quality criteria; (c) safe-guarding the acceptability and feasibility of the draft criteria by participatory research in on-going tool development projects; and (d) gaining formal support from national stakeholders on the quality criteria. RESULTS We reached consensus on a 8-step guidance; describing minimal quality criteria for (a) the team composition; (b) setting the scope; (c) identifying needs; (d) the content and format; (e) testing the draft; (f) finalizing and approval; (g) dissemination and application, and (h) ownership and revision. The participants of the on-going tool development projects were positive about the quality criteria in general, but divided as to the degree of detail. Whereas some expressed a clear desire for procedural standards, others felt that it would be sufficient to provide only general directions. Despite the different views as to the degree of detail, consensus was reached in three stakeholder meetings. DISCUSSION We successfully collaborated with all stakeholders and achieved formal support from national stakeholders on a set of minimum criteria for the development process, content and governance of patient-directed knowledge tools.
Collapse
Affiliation(s)
| | | | | | - Nanne Bos
- Netherlands Institute for Health Services Research NIVELUtrechtThe Netherlands
| | - Ton Drenthen
- Dutch College of General PractitionersUtrechtThe Netherlands
| | - Ingrid Maas
- Dutch Association of Medical SpecialistsUtrechtThe Netherlands
| | | | - Uriëll Malanda
- Health Care Institute of the NetherlandsDiemenThe Netherlands
| | | | - Heleen Post
- Dutch Federation of Patients’ OrganisationsUtrechtThe Netherlands
| | - Anouk Knops
- Dutch Federation of Patients’ OrganisationsUtrechtThe Netherlands
| |
Collapse
|
15
|
Généreux M, Lafontaine M, Eykelbosh A. From Science to Policy and Practice: A Critical Assessment of Knowledge Management before, during, and after Environmental Public Health Disasters. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16040587. [PMID: 30781625 PMCID: PMC6407109 DOI: 10.3390/ijerph16040587] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 11/16/2022]
Abstract
Canada regularly faces environmental public health (EPH) disasters. Given the importance of evidence-based, risk-informed decision-making, we aimed to critically assess the integration of EPH expertise and research into each phase of disaster management. In-depth interviews were conducted with 23 leaders in disaster management from Canada, the United States, the United Kingdom, and Australia, and were complemented by other qualitative methods. Three topics were examined: governance, knowledge creation/translation, and related barriers/needs. Data were analyzed through a four-step content analysis. Six critical success factors emerged from the analysis: blending the best of traditional and modern approaches; fostering community engagement; cultivating relationships; investing in preparedness and recovery; putting knowledge into practice; and ensuring sufficient human and financial resources. Several promising knowledge-to-action strategies were also identified, including mentorship programs, communities of practice, advisory groups, systematized learning, and comprehensive repositories of tools and resources. There is no single roadmap to incorporate EPH expertise and research into disaster management. Our findings suggest that preparation for and management of EPH disaster risks requires effective long-term collaboration between science, policy, and EPH practitioners at all levels in order to facilitate coordinated and timely deployment of multi-sectoral/jurisdictional resources when and where they are most needed.
Collapse
Affiliation(s)
- Mélissa Généreux
- Eastern Townships Integrated University Centre in Health and Social Services-Sherbrooke Hospital University Centre, Sherbrooke, QC J1G 1B1, Canada.
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada.
| | - Marc Lafontaine
- Chemical Emergency Preparedness and Response Unit, Environmental Health Science and Research Bureau, Healthy Environments and Consumer Safety Branch, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Angela Eykelbosh
- National Collaborating Centre for Environmental Health, Vancouver, BC V5Z 4C2, Canada.
| |
Collapse
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
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.
Collapse
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
| | | | | |
Collapse
|
18
|
Légaré F, Adekpedjou R, Stacey D, Turcotte S, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner‐Banzhoff N. Interventions for increasing the use of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2018; 7:CD006732. [PMID: 30025154 PMCID: PMC6513543 DOI: 10.1002/14651858.cd006732.pub4] [Citation(s) in RCA: 222] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Shared decision making (SDM) is a process by which a healthcare choice is made by the patient, significant others, or both with one or more healthcare professionals. However, it has not yet been widely adopted in practice. This is the second update of this Cochrane review. OBJECTIVES To determine the effectiveness of interventions for increasing the use of SDM by healthcare professionals. We considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and five other databases on 15 June 2017. We also searched two clinical trials registries and proceedings of relevant conferences. We checked reference lists and contacted study authors to identify additional studies. SELECTION CRITERIA Randomized and non-randomized trials, controlled before-after studies and interrupted time series studies evaluating interventions for increasing the use of SDM in which the primary outcomes were evaluated using observer-based or patient-reported measures. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane.We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 87 studies (45,641 patients and 3113 healthcare professionals) conducted mainly in the USA, Germany, Canada and the Netherlands. Risk of bias was high or unclear for protection against contamination, low for differences in the baseline characteristics of patients, and unclear for other domains.Forty-four studies evaluated interventions targeting patients. They included decision aids, patient activation, question prompt lists and training for patients among others and were administered alone (single intervention) or in combination (multifaceted intervention). The certainty of the evidence was very low. It is uncertain if interventions targeting patients when compared with usual care increase SDM whether measured by observation (standardized mean difference (SMD) 0.54, 95% confidence interval (CI) -0.13 to 1.22; 4 studies; N = 424) or reported by patients (SMD 0.32, 95% CI 0.16 to 0.48; 9 studies; N = 1386; risk difference (RD) -0.09, 95% CI -0.19 to 0.01; 6 studies; N = 754), reduce decision regret (SMD -0.10, 95% CI -0.39 to 0.19; 1 study; N = 212), improve physical (SMD 0.00, 95% CI -0.36 to 0.36; 1 study; N = 116) or mental health-related quality of life (QOL) (SMD 0.10, 95% CI -0.26 to 0.46; 1 study; N = 116), affect consultation length (SMD 0.10, 95% CI -0.39 to 0.58; 2 studies; N = 224) or cost (SMD 0.82, 95% CI 0.42 to 1.22; 1 study; N = 105).It is uncertain if interventions targeting patients when compared with interventions of the same type increase SDM whether measured by observation (SMD 0.88, 95% CI 0.39 to 1.37; 3 studies; N = 271) or reported by patients (SMD 0.03, 95% CI -0.18 to 0.24; 11 studies; N = 1906); (RD 0.03, 95% CI -0.02 to 0.08; 10 studies; N = 2272); affect consultation length (SMD -0.65, 95% CI -1.29 to -0.00; 1 study; N = 39) or costs. No data were reported for decision regret, physical or mental health-related QOL.Fifteen studies evaluated interventions targeting healthcare professionals. They included educational meetings, educational material, educational outreach visits and reminders among others. The certainty of evidence is very low. It is uncertain if these interventions when compared with usual care increase SDM whether measured by observation (SMD 0.70, 95% CI 0.21 to 1.19; 6 studies; N = 479) or reported by patients (SMD 0.03, 95% CI -0.15 to 0.20; 5 studies; N = 5772); (RD 0.01, 95%C: -0.03 to 0.06; 2 studies; N = 6303); reduce decision regret (SMD 0.29, 95% CI 0.07 to 0.51; 1 study; N = 326), affect consultation length (SMD 0.51, 95% CI 0.21 to 0.81; 1 study, N = 175), cost (no data available) or physical health-related QOL (SMD 0.16, 95% CI -0.05 to 0.36; 1 study; N = 359). Mental health-related QOL may slightly improve (SMD 0.28, 95% CI 0.07 to 0.49; 1 study, N = 359; low-certainty evidence).It is uncertain if interventions targeting healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.30, 95% CI -1.19 to 0.59; 1 study; N = 20) or reported by patients (SMD 0.24, 95% CI -0.10 to 0.58; 2 studies; N = 1459) as the certainty of the evidence is very low. There was insufficient information to determine the effect on decision regret, physical or mental health-related QOL, consultation length or costs.Twenty-eight studies targeted both patients and healthcare professionals. The interventions used a combination of patient-mediated and healthcare professional directed interventions. Based on low certainty evidence, it is uncertain whether these interventions, when compared with usual care, increase SDM whether measured by observation (SMD 1.10, 95% CI 0.42 to 1.79; 6 studies; N = 1270) or reported by patients (SMD 0.13, 95% CI -0.02 to 0.28; 7 studies; N = 1479); (RD -0.01, 95% CI -0.20 to 0.19; 2 studies; N = 266); improve physical (SMD 0.08, -0.37 to 0.54; 1 study; N = 75) or mental health-related QOL (SMD 0.01, -0.44 to 0.46; 1 study; N = 75), affect consultation length (SMD 3.72, 95% CI 3.44 to 4.01; 1 study; N = 36) or costs (no data available) and may make little or no difference to decision regret (SMD 0.13, 95% CI -0.08 to 0.33; 1 study; low-certainty evidence).It is uncertain whether interventions targeting both patients and healthcare professionals compared to interventions of the same type increase SDM whether measured by observation (SMD -0.29, 95% CI -1.17 to 0.60; 1 study; N = 20); (RD -0.04, 95% CI -0.13 to 0.04; 1 study; N = 134) or reported by patients (SMD 0.00, 95% CI -0.32 to 0.32; 1 study; N = 150 ) as the certainty of the evidence was very low. There was insuffient information to determine the effects on decision regret, physical or mental health-related quality of life, or consultation length or costs. AUTHORS' CONCLUSIONS It is uncertain whether any interventions for increasing the use of SDM by healthcare professionals are effective because the certainty of the evidence is low or very low.
Collapse
Affiliation(s)
- France Légaré
- Université LavalCentre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL‐UL)2525, Chemin de la CanardièreQuebecQuébecCanadaG1J 0A4
| | - Rhéda Adekpedjou
- Université LavalDepartment of Social and Preventive MedicineQuebec CityQuebecCanada
| | - Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | - Stéphane Turcotte
- Centre de Recherche du CHU de Québec (CRCHUQ) ‐ Hôpital St‐François d'Assise10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Jennifer Kryworuchko
- The University of British ColumbiaSchool of NursingT201 2211 Wesbrook MallVancouverBritish ColumbiaCanadaV6T 2B5
| | - Ian D Graham
- University of OttawaSchool of Epidemiology, Public Health and Preventative Medicine600 Peter Morand CrescentOttawaONCanada
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Mary C Politi
- Washington University School of MedicineDivision of Public Health Sciences, Department of Surgery660 S Euclid AveSt LouisMissouriUSA63110
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Glyn Elwyn
- Cardiff UniversityCochrane Institute of Primary Care and Public Health, School of Medicine2nd Floor, Neuadd MeirionnyddHeath ParkCardiffWalesUKCF14 4YS
| | - Norbert Donner‐Banzhoff
- University of MarburgDepartment of Family Medicine / General PracticeKarl‐von‐Frisch‐Str. 4MarburgGermanyD‐35039
| | | |
Collapse
|
19
|
Abdullah G, Higuchi KAS, Ploeg J, Stacey D. Mentoring as a Knowledge Translation Intervention for Implementing Nursing Practice Guidelines: A Qualitative Study. Int J Nurs Educ Scholarsh 2018; 15:/j/ijnes.2018.15.issue-1/ijnes-2017-0077/ijnes-2017-0077.xml. [PMID: 29466236 DOI: 10.1515/ijnes-2017-0077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022]
Abstract
An interpretive descriptive qualitative study was conducted to explore the characteristics and outcomes of mentoring used for implementing nursing practice guidelines. We interviewed six mentees, eight mentors, and four program leaders who were involved in the Registered Nurses' Association of Ontario fellowship program in Ontario, Canada. Inductive content analysis was used and study rigor was verified using triangulation of findings and member checking. Mentors were described as accessible, dedicated, and having expertise; mentees were described as enthusiastic, self-directed, and having mixed levels of expertise. The mentoring process included building relationships, developing learning plans, and using teaching and learning activities guided by learning plans to support development of mentees. Mentoring was described as positively impacting mentoring relationships, mentees, mentors, and organizations. A central feature of this fellowship program was the learning plan used to identify mentees' needs, guide mentoring activities, and monitor measureable outcomes.
Collapse
Affiliation(s)
- Ghadah Abdullah
- Nursing Administration, King Abdulaziz University Hospital, P.O Box 80215, Jeddah 21589, Saudi Arabia
| | - Kathryn A S Higuchi
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa ON K1H 8M5 Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton ON L8S 4K1, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa ON K1H 8M5 Canada
| |
Collapse
|
20
|
van der Scheer JW, Martin Ginis KA, Ditor DS, Goosey-Tolfrey VL, Hicks AL, West CR, Wolfe DL. Effects of exercise on fitness and health of adults with spinal cord injury: A systematic review. Neurology 2017; 89:736-745. [PMID: 28733344 DOI: 10.1212/wnl.0000000000004224] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/15/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To synthesize and appraise research testing the effects of exercise interventions on fitness, cardiometabolic health, and bone health among adults with spinal cord injury (SCI). METHODS Electronic databases were searched (1980-2016). Included studies employed exercise interventions for a period ≥2 weeks, involved adults with acute or chronic SCI, and measured fitness (cardiorespiratory fitness, power output, or muscle strength), cardiometabolic health (body composition or cardiovascular risk factors), or bone health outcomes. Evidence was synthesized and appraised using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). RESULTS A total of 211 studies met the inclusion criteria (22 acute, 189 chronic). For chronic SCI, GRADE confidence ratings were moderate to high for evidence showing exercise can improve all of the reviewed outcomes except bone health. For acute SCI, GRADE ratings were very low for all outcomes. For chronic SCI, there was low to moderate confidence in the evidence showing that 2-3 sessions/week of upper body aerobic exercise at a moderate to vigorous intensity for 20-40 minutes, plus upper body strength exercise (3 sets of 10 repetitions at 50%-80% 1-repetition maximum for all large muscle groups), can improve cardiorespiratory fitness, power output, and muscle strength. For chronic SCI, there was low to moderate confidence in the evidence showing that 3-5 sessions per week of upper body aerobic exercise at a moderate to vigorous intensity for 20-44 minutes can improve cardiorespiratory fitness, muscle strength, body composition, and cardiovascular risk. CONCLUSIONS Exercise improves fitness and cardiometabolic health of adults with chronic SCI. The evidence on effective exercise types, frequencies, intensities, and durations should be used to formulate exercise guidelines for adults with SCI.
Collapse
Affiliation(s)
- Jan W van der Scheer
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Kathleen A Martin Ginis
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada.
| | - David S Ditor
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Victoria L Goosey-Tolfrey
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Audrey L Hicks
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Christopher R West
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| | - Dalton L Wolfe
- From the School for Sports, Exercise and Health Sciences (J.W.v.d.S., V.L.G.-T.), Peter Harrison Centre for Disability Sport, National Centre for Sport and Exercise Medicine, Loughborough University, UK; School of Health and Exercise Sciences (K.A.M.G.), University of British Columbia, Kelowna; ICORD (K.A.M.G., C.R.W.) and School of Kinesiology (C.R.W.), University of British Columbia, Vancouver; Department of Kinesiology (D.S.D.), Brock University, St. Catharines; Department of Kinesiology (A.L.H.), McMaster University, Hamilton; and Parkwood Institute (D.L.W.), Lawson Health Research Institute, London, Canada
| |
Collapse
|
21
|
Ludwig C, Bennis C, Carley M, Gifford W, Kuziemsky C, Lafreniere-Davis N, McCrady K, Nichol K, Owens G, Roscoe D, Sandrelli T, Simmons H, Truant T, Verhaegen M, Stacey D. Managing Symptoms During Cancer Treatments: Barriers and Facilitators to Home Care Nurses Using Symptom Practice Guides. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017. [DOI: 10.1177/1084822317713011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nurses are instrumental in helping clients safely manage at home and triage potentially life-threatening symptoms from cancer. The purpose of this study was to assess factors influencing home care nurses’ use of 15 evidence-informed symptom practice guides for providing telephone or in-home nursing services to clients with cancer. A mixed-methods descriptive study was guided by the Knowledge-to-Action Framework. All six nursing agencies within a regional home care authority participated. Data collection included retrospective audit of symptom management in 50 patient records, 14 interviews, and barriers survey from 150 of 243 (61.7%) registered nurses and registered practical nurses providing cancer symptom support in home care. Chart audit revealed more than 80% of clients were on chemotherapy and common symptoms were nausea/vomiting (44%), constipation (32%), fatigue (32%), loss of appetite (32%), and pain (20%). Nurses had positive intentions ( M = 5.4 out of 7; SD = 1.3) and felt capable of using the symptom practice guides ( M = 5.4; SD = 1.0), held strong beliefs about the consequences ( M = 5.8; SD = 1.1) and moral norms of using them ( M = 5.7; SD = 1.1), and identified neutral to low social influence ( M = 3.0; SD = 1.6). Common barriers were inadequate time in practice, learning curve, need to integrate into documentation, and competing system changes. Common facilitators were being comprehensive, an evidence-based resource for use in practice, and having consistent symptom management guides across settings. Overall, the symptom guides were well received by the nurses. Interventions nurses identified to overcome barriers were education, clear organizational mandate for implementation, and integration with documentation.
Collapse
Affiliation(s)
- Claire Ludwig
- Champlain Community Care Access Centre, Ottawa, Ontario, Canada
| | | | - Meg Carley
- Ottawa Hospital Research Institute, Ontario, Canada
| | | | | | - Nicole Lafreniere-Davis
- client/caregiver representative, pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Homecare study
| | - Kate McCrady
- We Care Home Health Services, Ottawa, Ontario, Canada
| | | | - Glenda Owens
- Champlain Community Care Access Centre, Ottawa, Ontario, Canada
| | - Diane Roscoe
- Carefor Health & Community Services, Ottawa, Ontario, Canada
| | - Tami Sandrelli
- Access Healthcare Services Inc., Pembroke, Ontario, Canada
| | | | - Tracy Truant
- The University of British Columbia, Vancouver, Canada
| | - Melina Verhaegen
- client/caregiver representative, pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) Homecare study
| | - Dawn Stacey
- Ottawa Hospital Research Institute, Ontario, Canada
- University of Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Gagné ME, Boulet LP. Implementation of asthma clinical practice guidelines in primary care: A cross-sectional study based on the Knowledge-to-Action Cycle. J Asthma 2017; 55:310-317. [PMID: 28548896 DOI: 10.1080/02770903.2017.1323919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Based on the Knowledge-to-Action Cycle, we assessed the self-reported implementation and perception of asthma clinical practice guideline (CPG) recommendations in primary care physicians (PCPs), along with the barriers and facilitators to CPG use in primary care. METHODS We conducted a cross-sectional study. Using the extended Asthma Physicians' Practice Assessment Questionnaire©, PCPs self-reported the following: their knowledge of 15 key asthma CPG recommendations, the perceived usefulness of each of these recommendations, their motivation to apply these recommendations, and their agreement with the content of these recommendations. Participants also reported the barriers and facilitators to CPG use in primary care. RESULTS Out of the 46 potential participants, 43 physicians completed the questionnaire (response rate: 93%). Results underlined care gaps regarding the provision of asthma education and written action plans, inhaler technique demonstrations, and assessment of patients' concerns. Results showed that the majority of physicians knew the key asthma CPG recommendations, but their motivation to implement them and the perceived usefulness of these recommendations varied from one proposal to another. Main barriers to the implementation of these recommendations were related to time and resources. PCPs stressed the importance of teamwork for enhancing the use of asthma CPGs in primary care. CONCLUSIONS Our results suggest that the implementation of asthma CPGs remains suboptimal in primary care. Interventions addressing the identified barriers and providing facilitators to asthma CPG implementation, such as continuing education, could be implemented and evaluated to sustain asthma CPG use in primary care settings.
Collapse
Affiliation(s)
- Myriam E Gagné
- a Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health , Laval University , Quebec City , Quebec , Canada.,b Quebec Heart and Lung Institute , Quebec City , Quebec , Canada
| | - Louis-Philippe Boulet
- a Knowledge Translation, Education and Prevention Chair in Respiratory and Cardiovascular Health , Laval University , Quebec City , Quebec , Canada.,b Quebec Heart and Lung Institute , Quebec City , Quebec , Canada.,c Faculty of Medicine , Laval University , Quebec City , Quebec , Canada
| |
Collapse
|
23
|
Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, Holmes‐Rovner M, Llewellyn‐Thomas H, Lyddiatt A, Thomson R, Trevena L. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017; 4:CD001431. [PMID: 28402085 PMCID: PMC6478132 DOI: 10.1002/14651858.cd001431.pub5] [Citation(s) in RCA: 1210] [Impact Index Per Article: 172.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are interventions that support patients by making their decisions explicit, providing information about options and associated benefits/harms, and helping clarify congruence between decisions and personal values. OBJECTIVES To assess the effects of decision aids in people facing treatment or screening decisions. SEARCH METHODS Updated search (2012 to April 2015) in CENTRAL; MEDLINE; Embase; PsycINFO; and grey literature; includes CINAHL to September 2008. SELECTION CRITERIA We included published randomized controlled trials comparing decision aids to usual care and/or alternative interventions. For this update, we excluded studies comparing detailed versus simple decision aids. DATA COLLECTION AND ANALYSIS Two reviewers independently screened citations for inclusion, extracted data, and assessed risk of bias. Primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were attributes related to the choice made and the decision-making process.Secondary outcomes were behavioural, health, and health system effects.We pooled results using mean differences (MDs) and risk ratios (RRs), applying a random-effects model. We conducted a subgroup analysis of studies that used the patient decision aid to prepare for the consultation and of those that used it in the consultation. We used GRADE to assess the strength of the evidence. MAIN RESULTS We included 105 studies involving 31,043 participants. This update added 18 studies and removed 28 previously included studies comparing detailed versus simple decision aids. During the 'Risk of bias' assessment, we rated two items (selective reporting and blinding of participants/personnel) as mostly unclear due to inadequate reporting. Twelve of 105 studies were at high risk of bias.With regard to the attributes of the choice made, decision aids increased participants' knowledge (MD 13.27/100; 95% confidence interval (CI) 11.32 to 15.23; 52 studies; N = 13,316; high-quality evidence), accuracy of risk perceptions (RR 2.10; 95% CI 1.66 to 2.66; 17 studies; N = 5096; moderate-quality evidence), and congruency between informed values and care choices (RR 2.06; 95% CI 1.46 to 2.91; 10 studies; N = 4626; low-quality evidence) compared to usual care.Regarding attributes related to the decision-making process and compared to usual care, decision aids decreased decisional conflict related to feeling uninformed (MD -9.28/100; 95% CI -12.20 to -6.36; 27 studies; N = 5707; high-quality evidence), indecision about personal values (MD -8.81/100; 95% CI -11.99 to -5.63; 23 studies; N = 5068; high-quality evidence), and the proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83; 16 studies; N = 3180; moderate-quality evidence).Decision aids reduced the proportion of undecided participants and appeared to have a positive effect on patient-clinician communication. Moreover, those exposed to a decision aid were either equally or more satisfied with their decision, the decision-making process, and/or the preparation for decision making compared to usual care.Decision aids also reduced the number of people choosing major elective invasive surgery in favour of more conservative options (RR 0.86; 95% CI 0.75 to 1.00; 18 studies; N = 3844), but this reduction reached statistical significance only after removing the study on prophylactic mastectomy for breast cancer gene carriers (RR 0.84; 95% CI 0.73 to 0.97; 17 studies; N = 3108). Compared to usual care, decision aids reduced the number of people choosing prostate-specific antigen screening (RR 0.88; 95% CI 0.80 to 0.98; 10 studies; N = 3996) and increased those choosing to start new medications for diabetes (RR 1.65; 95% CI 1.06 to 2.56; 4 studies; N = 447). For other testing and screening choices, mostly there were no differences between decision aids and usual care.The median effect of decision aids on length of consultation was 2.6 minutes longer (24 versus 21; 7.5% increase). The costs of the decision aid group were lower in two studies and similar to usual care in four studies. People receiving decision aids do not appear to differ from those receiving usual care in terms of anxiety, general health outcomes, and condition-specific health outcomes. Studies did not report adverse events associated with the use of decision aids.In subgroup analysis, we compared results for decision aids used in preparation for the consultation versus during the consultation, finding similar improvements in pooled analysis for knowledge and accurate risk perception. For other outcomes, we could not conduct formal subgroup analyses because there were too few studies in each subgroup. AUTHORS' CONCLUSIONS Compared to usual care across a wide variety of decision contexts, people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions. There is growing evidence that decision aids may improve values-congruent choices. There are no adverse effects on health outcomes or satisfaction. New for this updated is evidence indicating improved knowledge and accurate risk perceptions when decision aids are used either within or in preparation for the consultation. Further research is needed on the effects on adherence with the chosen option, cost-effectiveness, and use with lower literacy populations.
Collapse
Affiliation(s)
- Dawn Stacey
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
- Ottawa Hospital Research InstituteCentre for Practice Changing Research501 Smyth RdOttawaONCanadaK1H 8L6
| | - France Légaré
- CHU de Québec Research Center, Université LavalPopulation Health and Optimal Health Practices Research Axis10 Rue de l'Espinay, D6‐727Québec CityQCCanadaG1L 3L5
| | - Krystina Lewis
- University of OttawaSchool of Nursing451 Smyth RoadOttawaONCanada
| | | | - Carol L Bennett
- Ottawa Hospital Research InstituteClinical Epidemiology ProgramAdministrative Services Building, Room 2‐0131053 Carling AvenueOttawaONCanadaK1Y 4E9
| | - Karen B Eden
- Oregon Health Sciences UniversityDepartment of Medical Informatics and Clinical EpidemiologyBICC 5353181 S.W. Sam Jackson Park RoadPortlandOregonUSA97239‐3098
| | - Margaret Holmes‐Rovner
- Michigan State University College of Human MedicineCenter for Ethics and Humanities in the Life SciencesEast Fee Road956 Fee Road Rm C203East LansingMichiganUSA48824‐1316
| | - Hilary Llewellyn‐Thomas
- Dartmouth CollegeThe Dartmouth Center for Health Policy & Clinical Practice, The Geisel School of Medicine at DartmouthHanoverNew HampshireUSA03755
| | - Anne Lyddiatt
- No affiliation28 Greenwood RoadIngersollONCanadaN5C 3N1
| | - Richard Thomson
- Newcastle UniversityInstitute of Health and SocietyBaddiley‐Clark BuildingRichardson RoadNewcastle upon TyneUKNE2 4AX
| | - Lyndal Trevena
- The University of SydneyRoom 322Edward Ford Building (A27)SydneyNSWAustralia2006
| | | |
Collapse
|
24
|
Portocarrero MEL, Giguère AMC, Lépine J, Garvelink MM, Robitaille H, Delanoë A, Lévesque I, Wilson BJ, Rousseau F, Légaré F. Use of a patient decision aid for prenatal screening for Down syndrome: what do pregnant women say? BMC Pregnancy Childbirth 2017; 17:90. [PMID: 28320334 PMCID: PMC5359918 DOI: 10.1186/s12884-017-1273-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 03/09/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient decision aids (PtDAs) help people make difficult, values-sensitive decisions. Prenatal screening for assessing the risk of genetic conditions in the fetus is one such decision and patient decision aids are rarely used in this clinical context. We sought to identify factors influencing pregnant women's use of a patient decision aid for deciding about prenatal screening for Down syndrome (DS). METHODS This qualitative study was embedded in a sequential mixed-methods research program whose main aim is to implement shared decision-making (SDM) in the context of prenatal screening for DS in the province of Quebec, Canada. We planned to recruit a purposive sample of 45 pregnant women with low-risk pregnancy consulting for prenatal care at three clinical sites. Participating women watched a video depicting a prenatal care follow-up during which a pregnant woman, her partner and a health professional used a PtDA to decide about prenatal screening for DS. The women were then interviewed about factors that would influence the use of this PtDA using questions based on the Theoretical Domains Framework (TDF). We performed content analysis of transcribed verbatim interviews. RESULTS Out of 216 eligible women, 100 agreed to participate (46% response rate) and 46 were interviewed. Regarding the type of health professional responsible for their prenatal care, 19 participants (41%) reported having made a decision about prenatal screening for DS with an obstetrician-gynecologist, 13 (28%) with a midwife, 12 (26%) with a family physician, and two (4%) decided on their own. We identified 54 factors that were mapped onto nine of the 12 TDF domains. The three most frequently-mentioned were: opinion of the pregnant woman's partner (n = 33, 72%), presentation of the PtDA by health professional and a discussion (n = 27, 72%), and not having encountered a PtDA (n = 26, 57%). CONCLUSION This study allowed us to identify factors influencing pregnant women's use of a PtDA for prenatal screening for DS. Use of a PtDA by health professionals and patients is one step in providing the needed decision support and our study results will allow us to design an effective implementation strategy for PtDAs for prenatal screening for DS.
Collapse
Affiliation(s)
| | - Anik M. C. Giguère
- Centre d’Excellence sur le Vieillissement de Québec, CHU de Québec Research Centre, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
| | - Johanie Lépine
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada
| | - Mirjam M. Garvelink
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada
| | - Hubert Robitaille
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada
| | - Agathe Delanoë
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada
| | - Isabelle Lévesque
- CHU de Québec, Hôpital St-François d’Assise, and Obstetrics and Gynecology Department, Faculty of Medicine, Laval University, Quebec, Canada
| | - Brenda J. Wilson
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - François Rousseau
- Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Laval University, Quebec, Canada
- Health Technology Assessment and Evidence-based Laboratory Medicine, Quebec, Canada
| | - France Légaré
- Population Health and Practice-Changing Research Group, CHU de Québec Research Centre, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Laval University, Quebec, Canada
- Population Health and Optimal Health Practice Research Group, CHU de Québec Research Centre, Hôpital St-François d’Assise, 10, rue de l’Espinay/D6-730, Quebec, G1L 3L5 Canada
| |
Collapse
|
25
|
Altokhais TI, Al-Obaid OA, Kattan AE, Amer YS. Assessment of implementability of an adapted clinical practice guideline for surgical antimicrobial prophylaxis at a tertiary care university hospital. J Eval Clin Pract 2017; 23:156-164. [PMID: 27807920 DOI: 10.1111/jep.12658] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Surgical site infections are the most common healthcare-associated infections. Appropriate surgical antimicrobial prophylaxis (SAP), which is an integral part of surgical site infection SSI prevention, is one of the major preventable risks to surgical patient safety. Several clinical practice guidelines (CPGs) for SAP have been published. The aim of this study was to adapt a CPG for SAP and to assess its implementability. METHODS The methodology was based on two validated tools for CPGs, namely, the ADAPTE and the Guideline Implementability Appraisal (GLIA). RESULTS The ADAPTE CPG adaptation process methodology was utilized to produce an adapted CPG for SAP based on the American Society of Health System Pharmacists 2013 CPG. The finalized CPG was then assessed to identify any possible intrinsic barriers for implementation. CONCLUSIONS In conclusion, the ADAPTE tool is a practical and successful tool for production of CPGs. The GLIA tool is useful for assessing and preparing the finalized adapted CPG for the transition from the production stage to the implementation stage. GLIA could be added to the ADAPTE process either as a final step or to check the draft of the CPG before finalization.
Collapse
Affiliation(s)
- Tariq I Altokhais
- Division of Pediatric Surgery, Department of Surgery, Surgery Departmental CPG Committee, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Omar A Al-Obaid
- Division of Colorectal Surgery, Department of Surgery, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah E Kattan
- Division of Plastic Surgery, Department of Surgery, Surgery Departmental Quality Team, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Yasser S Amer
- Quality Management Department, CPG Steering Committee, Research Chair for Evidence-based Health Care and Knowledge Translation, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | -
- King Saud University Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
26
|
Wielaert S, van de Sandt-Koenderman MW, Dammers N, Sage K. ImPACT: a multifaceted implementation for conversation partner training in aphasia in Dutch rehabilitation settings. Disabil Rehabil 2016; 40:76-89. [DOI: 10.1080/09638288.2016.1243160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | | | - Nina Dammers
- Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Karen Sage
- Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
27
|
Patient preference and evidence based decisions on anticoagulant therapy for atrial fibrillation. Thromb Res 2016; 145:149-50. [PMID: 27503747 DOI: 10.1016/j.thromres.2016.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
|
28
|
Stacey D, Green E, Ballantyne B, Tarasuk J, Skrutkowski M, Carley M, Chapman K, Kuziemsky C, Kolari E, Sabo B, Saucier A, Shaw T, Tardif L, Truant T, Cummings GG, Howell D. Implementation of Symptom Protocols for Nurses Providing Telephone-Based Cancer Symptom Management: A Comparative Case Study. Worldviews Evid Based Nurs 2016; 13:420-431. [PMID: 27243574 PMCID: PMC5157760 DOI: 10.1111/wvn.12166] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2016] [Indexed: 12/01/2022]
Abstract
Background The pan‐Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence‐informed protocols for symptom management. Aim To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone‐based symptom support to cancer patients. Methods A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. Results At baseline, >85% nurses rated protocols positively but barriers were identified (64‐80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self‐management. Twenty‐two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support. Linking Evidence to Action Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses’ use of evidence‐informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses’ confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally.
Collapse
Affiliation(s)
- Dawn Stacey
- Professor, School of Nursing, University of Ottawa, and Scientist, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Esther Green
- Director, Person Centred Perspective, Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Barbara Ballantyne
- Advance Practice Nurse, Palliative Care, Health Sciences North, Sudbury, Ontario, Canada
| | - Joy Tarasuk
- Health Services Manager, Ambulatory Oncology Clinics, Cancer Care Program, QEII Health Sciences Centre, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Myriam Skrutkowski
- Clinical Research Coordinator, Cancer Care Mission, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Meg Carley
- Clinical Research Coordinator, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kim Chapman
- Clinical Nurse Specialist, Oncology, Horizon Health Network, Fredericton and Upper River Valley Area, Fredericton, New Brunswick, Canada
| | - Craig Kuziemsky
- Associate Professor, Director of Masters in Health Systems Program, Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Kolari
- Systemic Treatment Chemotherapy Nurse, Health Sciences North, Sudbury, Ontario, Canada
| | - Brenda Sabo
- Associate Professor & Associate Director, Undergraduate Nursing Program, Dalhousie University School of Nursing, Halifax, Nova Scotia, Canada
| | - Andréanne Saucier
- Director of Nursing, Montreal General Hospital, Montreal, Quebec, Canada
| | - Tara Shaw
- Primary Care Nurse, Nova Scotia Cancer Center Clinic, QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Lucie Tardif
- Faculty lecturer, McGill University, Associate Director of Nursing, Cancer Care Mission, McGill University Health Center, Montreal, Quebec, Canada
| | - Tracy Truant
- Doctoral Candidate, University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
| | - Greta G Cummings
- Centennial Professor, University of Alberta, and Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Doris Howell
- Senior Scientist, Oncology Nursing Research and Education, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Patient and family experiences with accessing telephone cancer treatment symptom support: a descriptive study. Support Care Cancer 2015; 24:893-901. [PMID: 26275766 DOI: 10.1007/s00520-015-2859-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/13/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Assess patient and family member experiences with telephone cancer treatment symptom support. METHODS Descriptive study guided by the Knowledge-to-Action Framework. Patients and family members who received telephone support for a cancer treatment symptom within the last month at one of three ambulatory cancer programs (Nova Scotia, Ontario, Quebec) were eligible. An adapted Short Questionnaire for Out-of-hours Care instrument was analyzed with univariate statistics. RESULTS Of 105 participants, 83 % telephoned about themselves and 17 % for a family member. Participants received advice over the telephone (90 %) and were advised to go to emergency (13 %) and/or the clinic (9 %). Two left a message and were not called back. Participants were "very satisfied" with the manner of nurse or doctor (58 %), explanation about problem (56 %), treatment/advice given (54 %), way call was handled (48 %), getting through (40 %), and wait time to speak to a nurse or doctor (38 %). The proportion "dissatisfied" or "very dissatisfied" for the above items was 4, 5, 9, 11, 10, and 14 %, respectively. Suggestions were shorter call back time, weekend access to telephone support, more knowledgeable advice on self-care strategies, more education at discharge, and shared documentation on calls to avoid repetition and improve continuity. CONCLUSIONS Most patients and family members who responded to the survey were satisfied with telephone-based cancer treatment symptom support. Programs could improve telephone support services by providing an estimated time for callback, ensuring that nurses have access to and use previous call documentation, and enhancing patient education on self-care strategies for managing and triaging treatment-related symptoms.
Collapse
|
30
|
Stacey D, Carley M, Ballantyne B, Skrutkowski M, Whynot A. Perceived factors influencing nurses' use of evidence-informed protocols for remote cancer treatment-related symptom management: A mixed methods study. Eur J Oncol Nurs 2015; 19:268-77. [DOI: 10.1016/j.ejon.2014.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 10/24/2022]
|
31
|
Hall SF, Irish JC, Gregg RW, Groome PA, Rohland S. Adherence to and uptake of clinical practice guidelines: lessons learned from a clinical practice guideline on chemotherapy concomitant with radiotherapy in head-and-neck cancer. ACTA ACUST UNITED AC 2015; 22:e61-8. [PMID: 25908922 DOI: 10.3747/co.22.2235] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical practice guidelines (cpgs) are systematically developed statements designed to assist practitioners and patients in making decisions about appropriate heath care interventions. Clinical practice guidelines are expensive and time-consuming to create. A cpg on concurrent chemotherapy with radiation therapy (ccrt) was developed in Ontario at a time when treatment approaches for head-and-neck cancer were changing significantly. METHODS An assessment of treatments and outcomes based on electronic and chart data obtained from a population-based study of 571 patients with oropharynx cancer treated in Ontario (2003-2004) was combined with a review of relevant knowledge transfer (publications and presentations at major meetings) to understand variation in adherence to a cpg. RESULTS In 9 Ontario cancer treatment centres, ccrt was used for 55% of all patients with oropharyngeal cancer; however, at the centres individually, that proportion ranged from 82% to 39%. Furthermore, there was no agreement on the chemotherapy regimen: 2-4 years later (a period during which newer regimens were emerging), only 4 of 9 centres were following the guideline for most patients. When outcomes of treated patients were compared for centres with "higher" and "lower" use of ccrt, no difference in survival was observed (p = 0.64). CONCLUSIONS At a time of treatment evolution, the new guideline was controversial, and there are many reasons for the mixed adherence. An estimation of adherence should be included during both development and review of guidelines.
Collapse
Affiliation(s)
- S F Hall
- Department of Otolaryngology, Queen's University, Kingston, ON. ; Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
| | - J C Irish
- Department of Otolaryngology, Queen's University, Kingston, ON. ; Department of Surgical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON
| | - R W Gregg
- Department of Oncology, Queen's University, Kingston, ON
| | - P A Groome
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
| | - S Rohland
- Division of Cancer Care and Epidemiology, Queen's University, Kingston, ON
| |
Collapse
|
32
|
Stacey D, Jull J, Beach S, Dumas A, Strychar I, Adamo K, Brochu M, Prud’homme D. Middle-aged women's decisions about body weight management: needs assessment and testing of a knowledge translation tool. Menopause 2015; 22:414-22. [PMID: 25816120 PMCID: PMC4470526 DOI: 10.1097/gme.0000000000000326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/09/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to assess middle-aged women's needs when making body weight management decisions and to evaluate a knowledge translation tool for addressing their needs. METHODS A mixed-methods study used an interview-guided theory-based survey of professional women aged 40 to 65 years. The tool summarized evidence to address their needs and enabled women to monitor actions taken. Acceptability and usability were reported descriptively. RESULTS Sixty female participants had a mean body mass index of 28.0 kg/m(2) (range, 17.0-44.9 kg/m(2)), and half were premenopausal. Common options for losing (82%) or maintaining (18%) weight included increasing physical activity (60%), eating healthier (57%), and getting support (40%). Decision-making involved getting information on options (52%), soliciting others' decisions/advice (20%), and being self-motivated (20%). Preferred information sources included written information (97%), counseling (90%), and social networking websites (43%). Five professionals (dietitian, personal trainer, occupational therapist, and two physicians) had similar responses. Of 53 women sent the tool, 27 provided acceptability feedback. They rated it as good to excellent for information on menopause (96%), body weight changes (85%), and managing body weight (85%). Most would tell others about it (81%). After 4 weeks of use, 25 women reported that the wording made sense (96%) and that the tool had clear instructions (92%) and was easy to use across time (88%). The amount of information was rated as just right (64%), but the tool had limited space for responding (72%). CONCLUSIONS When making decisions about body weight management, women's needs were "getting information" and "getting support." The knowledge translation tool was acceptable and usable, but further evaluation is required.
Collapse
Affiliation(s)
- Dawn Stacey
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Janet Jull
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Sarah Beach
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Alex Dumas
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Irene Strychar
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Kristi Adamo
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Martin Brochu
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| | - Denis Prud’homme
- From the Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Population Health, Faculty of Graduate Studies, University of Ottawa, Ottawa, Ontario, Canada; Département de nutrition, Faculty of Medicine, Université de Montréal and Montreal Diabetes Research Center, Montreal, Quebec, Canada; Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Geriatric Institute of Sherbrooke University, Faculty of Physical Activity and Sports, University of Sherbrooke and Research Center on Aging, Sherbrooke, Quebec, Canada; and Institut de recherche de l’Hôpital Montfort, Ottawa, Ontario, Canada
| |
Collapse
|
33
|
Stacey D, Skrutkowski M, Carley M, Kolari E, Shaw T, Ballantyne B. Training Oncology Nurses to Use Remote Symptom Support Protocols: A Retrospective Pre-/Post-Study. Oncol Nurs Forum 2015; 42:174-82. [DOI: 10.1188/15.onf.174-182] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
34
|
Stacey D, Vandemheen KL, Hennessey R, Gooyers T, Gaudet E, Mallick R, Salgado J, Freitag A, Berthiaume Y, Brown N, Aaron SD. Implementation of a cystic fibrosis lung transplant referral patient decision aid in routine clinical practice: an observational study. Implement Sci 2015; 10:17. [PMID: 25757139 PMCID: PMC4322562 DOI: 10.1186/s13012-015-0206-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/15/2015] [Indexed: 01/25/2023] Open
Abstract
Background The decision to have lung transplantation as treatment for end-stage lung disease from cystic fibrosis (CF) has benefits and serious risks. Although patient decision aids are effective interventions for helping patients reach a quality decision, little is known about implementing them in clinical practice. Our study evaluated a sustainable approach for implementing a patient decision aid for adults with CF considering referral for lung transplantation. Methods A prospective pragmatic observational study was guided by the Knowledge-to-Action Framework. Healthcare professionals in all 23 Canadian CF clinics were eligible. We surveyed participants regarding perceived barriers and facilitators to patient decision aid use. Interventions tailored to address modifiable identified barriers included training, access to decision aids, and conference calls. The primary outcome was >80% use of the decision aid in year 2. Results Of 23 adult CF clinics, 18 participated (78.2%) and 13 had healthcare professionals attend training. Baseline barriers were healthcare professionals’ inadequate knowledge for supporting patients making decisions (55%), clarifying patients’ values for outcomes of options (58%), and helping patients handle conflicting views of others (71%). Other barriers were lack of time (52%) and needing to change how transplantation is discussed (42%). Baseline facilitators were healthcare professionals feeling comfortable discussing bad transplantation outcomes (74%), agreeing the decision aid would be easy to experiment with (71%) and use in the CF clinic (87%), and agreeing that using the decision aid would not require reorganization of the CF clinic (90%). After implementing the decision aid with interventions tailored to the barriers, decision aid use increased from 29% at baseline to 85% during year 1 and 92% in year 2 (p < 0.001). Compared to baseline, more healthcare professionals at the end of the study were confident in supporting decision-making (p = 0.03) but continued to feel inadequate ability with supporting patients to handle conflicting views (p = 0.01). Conclusion Most Canadian CF clinics agreed to participate in the study. Interventions were used to target identified modifiable barriers to using the patient decision aid in routine CF clinical practice. CF clinics reported using it with almost all patients in the second year.
Collapse
|
35
|
Eng JJ, Noonan VK, Townson AF, Higgins CE, Rogers J, Wolfe DL. Impact of an online medical internet site on knowledge and practice of health care providers: a mixed methods study of the Spinal Cord Injury Rehabilitation Evidence project. J Med Internet Res 2014; 16:e296. [PMID: 25537167 PMCID: PMC4285726 DOI: 10.2196/jmir.3453] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 11/23/2014] [Indexed: 12/04/2022] Open
Abstract
Background It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. Objective The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. Methods A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. Results The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers’ clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers’ clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. Conclusions A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers’ practice, and influence their clinical decision making.
Collapse
Affiliation(s)
- Janice J Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
| | | | | | | | | | | |
Collapse
|
36
|
Légaré F, Stacey D, Turcotte S, Cossi MJ, Kryworuchko J, Graham ID, Lyddiatt A, Politi MC, Thomson R, Elwyn G, Donner-Banzhoff N. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev 2014:CD006732. [PMID: 25222632 DOI: 10.1002/14651858.cd006732.pub3] [Citation(s) in RCA: 198] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Shared decision making (SDM) can reduce overuse of options not associated with benefits for all and respects patient rights, but has not yet been widely adopted in practice. OBJECTIVES To determine the effectiveness of interventions to improve healthcare professionals' adoption of SDM. SEARCH METHODS For this update we searched for primary studies in The Cochrane Library, MEDLINE, EMBASE, CINAHL, the Cochrane Effective Practice and Organisation of Care (EPOC) Specialsied Register and PsycINFO for the period March 2009 to August 2012. We searched the Clinical Trials.gov registry and the proceedings of the International Shared Decision Making Conference. We scanned the bibliographies of relevant papers and studies. We contacted experts in the field to identify papers published after August 2012. SELECTION CRITERIA Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series studies evaluating interventions to improve healthcare professionals' adoption of SDM where the primary outcomes were evaluated using observer-based outcome measures (OBOM) or patient-reported outcome measures (PROM). DATA COLLECTION AND ANALYSIS The three overall categories of intervention were: interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both. Studies in each category were compared to studies in the same category, to studies in the other two categories, and to usual care, resulting in nine comparison groups. Statistical analysis considered categorical and continuous primary outcomes separately. We calculated the median of the standardized mean difference (SMD), or risk difference, and range of effect across studies and categories of intervention. We assessed risk of bias. MAIN RESULTS Thirty-nine studies were included, 38 randomised and one non-randomised controlled trial. Categorical measures did not show any effect for any of the interventions. In OBOM studies, interventions targeting both patients and healthcare professionals had a positive effect compared to usual care (SMD of 2.83) and compared to interventions targeting patients alone (SMD of 1.42). Studies comparing interventions targeting patients with other interventions targeting patients had a positive effect, as did studies comparing interventions targeting healthcare professionals with usual care (SDM of 1.13 and 1.08 respectively). In PROM studies, only three comparisons showed any effect, patient compared to usual care (SMD of 0.21), patient compared to another patient (SDM of 0.29) and healthcare professional compared to another healthcare professional (SDM of 0.20). For all comparisons, interpretation of the results needs to consider the small number of studies, the heterogeneity, and some methodological issues. Overall quality of the evidence for the outcomes, assessed with the GRADE tool, ranged from low to very low. AUTHORS' CONCLUSIONS It is uncertain whether interventions to improve adoption of SDM are effective given the low quality of the evidence. However, any intervention that actively targets patients, healthcare professionals, or both, is better than none. Also, interventions targeting patients and healthcare professionals together show more promise than those targeting only one or the other.
Collapse
Affiliation(s)
- France Légaré
- Population Health and Optimal Health Practices Research Axis, CHU de Québec Research Center, Université Laval, 10 Rue de l'Espinay, D6-727, Québec City, Québec, Canada, G1L 3L5
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Orthopaedic Surgical Content Associated with Resources for Clinical Evidence. JOURNAL OF THE CANADIAN HEALTH LIBRARIES ASSOCIATION 2014. [DOI: 10.5596/c13-011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: As evidence-based medicine is increasingly being adopted in medical and surgical practice, effective processing and interpretation of medical literature is imperative. Databases presenting the contents of medical literature have been developed; however, their efficacy merits investigation. The objective of this study was to quantify surgical and orthopaedic content within five evidence-based medicine resources: DynaMed, Clinical Evidence, UpToDate, PIER, and First Consult. Methods: We abstracted surgical and orthopaedic content from UpToDate, DynaMed, PIER, First Consult, and Clinical Evidence. We defined surgical content as that which involved surgical interventions. We classified surgical content by specialty and, for orthopaedics, by subspecialty. The amount of surgical content, as measured by the number of relevant reviews, was compared with the total number of reviews in each database. Likewise, the amount of orthopaedic content, as measured by the number of relevant reviews, was compared with the total number of reviews and the total number of surgical reviews in each database. Results: Across all databases containing a total of 13268 reviews, we identified an average of 18% surgical content. Specifically, First Consult and PIER contained 28% surgical content as a percentage of the total database content. DynaMed contained 14% and Clinical Evidence 11%, whereas UpToDate contained only 9.5% surgical content. Overall, general surgery, pediatrics, and oncology were the most common specialty areas in all databases. Discussion: Our findings suggest that the limited surgical content within these large scope resources poses difficulties for physicians and surgeons seeking answers to complex clinical questions, specifically within the field of orthopaedics. This study therefore demonstrates the potential need for, and benefit of, surgery-specific or even specialty-specific tools.
Collapse
|
38
|
Brouwers MC, Makarski J, Garcia K, Akram S, Darling GE, Ellis PM, Evans WK, Giacomini M, Martelli-Reid L, Ung YC. A mixed methods approach to understand variation in lung cancer practice and the role of guidelines. Implement Sci 2014; 9:36. [PMID: 24655753 PMCID: PMC3998045 DOI: 10.1186/1748-5908-9-36] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 03/10/2014] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Practice pattern data demonstrate regional variation and lower than expected rates of adherence to practice guideline (PG) recommendations for the treatment of stage II/IIIA resected and stage IIIA/IIIB unresected non-small cell lung cancer (NSCLC) patients in Ontario, Canada. This study sought to understand how clinical decisions are made for the treatment of these patients and the role of PGs. METHODS Surveys and key informant interviews were undertaken with clinicians and administrators. RESULTS Participants reported favorable ratings for PGs and the evidentiary bases underpinning them. The majority of participants agreed more patients should have received treatment and that regional variation is problematic. Participants estimated that up to 30% of patients are not good candidates for treatment and up to 20% of patients refuse treatment. The most common barrier to implementing PGs was the lack of organizational support by clinical administrative leadership. There was concern that the trial results underpinning the PG recommendations were not generalizable to the typical patients seen in clinic. The qualitative analysis yielded five themes related to physicians' decision making: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence. A dynamic interplay between these factors exists. CONCLUSION Our study demonstrates the challenges inherent in (i) the complexity of clinical decision making; (ii) how quality of care problems are perceived and operationalized; and (iii) the clinical appropriateness and utility of PG recommendations. We argue that systematic and rigorous methodologies to help decision makers mitigate or negotiate these challenges are warranted.
Collapse
Affiliation(s)
- Melissa C Brouwers
- Department of Oncology, McMaster University, Juravinski Hospital Site, 1280 Main Street West, JHCC G207, L8S 4L8 Hamilton, ON, Canada.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2014:CD001431. [PMID: 24470076 DOI: 10.1002/14651858.cd001431.pub4] [Citation(s) in RCA: 836] [Impact Index Per Article: 83.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. OBJECTIVES To assess the effects of decision aids for people facing treatment or screening decisions. SEARCH METHODS For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to September 2008). SELECTION CRITERIA We included published randomized controlled trials of decision aids, which are interventions designed to support patients' decision making by making explicit the decision, providing information about treatment or screening options and their associated outcomes, compared to usual care and/or alternative interventions. We excluded studies of participants making hypothetical decisions. DATA COLLECTION AND ANALYSIS Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes, based on the International Patient Decision Aid Standards (IPDAS), were:A) 'choice made' attributes;B) 'decision-making process' attributes.Secondary outcomes were behavioral, health, and health-system effects. We pooled results using mean differences (MD) and relative risks (RR), applying a random-effects model. MAIN RESULTS This update includes 33 new studies for a total of 115 studies involving 34,444 participants. For risk of bias, selective outcome reporting and blinding of participants and personnel were mostly rated as unclear due to inadequate reporting. Based on 7 items, 8 of 115 studies had high risk of bias for 1 or 2 items each.Of 115 included studies, 88 (76.5%) used at least one of the IPDAS effectiveness criteria: A) 'choice made' attributes criteria: knowledge scores (76 studies); accurate risk perceptions (25 studies); and informed value-based choice (20 studies); and B) 'decision-making process' attributes criteria: feeling informed (34 studies) and feeling clear about values (29 studies).A) Criteria involving 'choice made' attributes:Compared to usual care, decision aids increased knowledge (MD 13.34 out of 100; 95% confidence interval (CI) 11.17 to 15.51; n = 42). When more detailed decision aids were compared to simple decision aids, the relative improvement in knowledge was significant (MD 5.52 out of 100; 95% CI 3.90 to 7.15; n = 19). Exposure to a decision aid with expressed probabilities resulted in a higher proportion of people with accurate risk perceptions (RR 1.82; 95% CI 1.52 to 2.16; n = 19). Exposure to a decision aid with explicit values clarification resulted in a higher proportion of patients choosing an option congruent with their values (RR 1.51; 95% CI 1.17 to 1.96; n = 13).B) Criteria involving 'decision-making process' attributes:Decision aids compared to usual care interventions resulted in:a) lower decisional conflict related to feeling uninformed (MD -7.26 of 100; 95% CI -9.73 to -4.78; n = 22) and feeling unclear about personal values (MD -6.09; 95% CI -8.50 to -3.67; n = 18);b) reduced proportions of people who were passive in decision making (RR 0.66; 95% CI 0.53 to 0.81; n = 14); andc) reduced proportions of people who remained undecided post-intervention (RR 0.59; 95% CI 0.47 to 0.72; n = 18).Decision aids appeared to have a positive effect on patient-practitioner communication in all nine studies that measured this outcome. For satisfaction with the decision (n = 20), decision-making process (n = 17), and/or preparation for decision making (n = 3), those exposed to a decision aid were either more satisfied, or there was no difference between the decision aid versus comparison interventions. No studies evaluated decision-making process attributes for helping patients to recognize that a decision needs to be made, or understanding that values affect the choice.C) Secondary outcomes Exposure to decision aids compared to usual care reduced the number of people of choosing major elective invasive surgery in favour of more conservative options (RR 0.79; 95% CI 0.68 to 0.93; n = 15). Exposure to decision aids compared to usual care reduced the number of people choosing to have prostate-specific antigen screening (RR 0.87; 95% CI 0.77 to 0.98; n = 9). When detailed compared to simple decision aids were used, fewer people chose menopausal hormone therapy (RR 0.73; 95% CI 0.55 to 0.98; n = 3). For other decisions, the effect on choices was variable.The effect of decision aids on length of consultation varied from 8 minutes shorter to 23 minutes longer (median 2.55 minutes longer) with 2 studies indicating statistically-significantly longer, 1 study shorter, and 6 studies reporting no difference in consultation length. Groups of patients receiving decision aids do not appear to differ from comparison groups in terms of anxiety (n = 30), general health outcomes (n = 11), and condition-specific health outcomes (n = 11). The effects of decision aids on other outcomes (adherence to the decision, costs/resource use) were inconclusive. AUTHORS' CONCLUSIONS There is high-quality evidence that decision aids compared to usual care improve people's knowledge regarding options, and reduce their decisional conflict related to feeling uninformed and unclear about their personal values. There is moderate-quality evidence that decision aids compared to usual care stimulate people to take a more active role in decision making, and improve accurate risk perceptions when probabilities are included in decision aids, compared to not being included. There is low-quality evidence that decision aids improve congruence between the chosen option and the patient's values.New for this updated review is further evidence indicating more informed, values-based choices, and improved patient-practitioner communication. There is a variable effect of decision aids on length of consultation. Consistent with findings from the previous review, decision aids have a variable effect on choices. They reduce the number of people choosing discretionary surgery and have no apparent adverse effects on health outcomes or satisfaction. The effects on adherence with the chosen option, cost-effectiveness, use with lower literacy populations, and level of detail needed in decision aids need further evaluation. Little is known about the degree of detail that decision aids need in order to have a positive effect on attributes of the choice made, or the decision-making process.
Collapse
Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Sibbald SL, Wathen CN, Kothari A, Day AMB. Knowledge flow and exchange in interdisciplinary primary health care teams (PHCTs): an exploratory study. J Med Libr Assoc 2013; 101:128-37. [PMID: 23646028 DOI: 10.3163/1536-5050.101.2.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Improving the process of evidence-based practice in primary health care requires an understanding of information exchange among colleagues. This study explored how clinically oriented research knowledge flows through multidisciplinary primary health care teams (PHCTs) and influences clinical decisions. METHODS This was an exploratory mixed-methods study with members of six PHCTs in Ontario, Canada. Quantitative data were collected using a questionnaire and analyzed with social network analysis (SNA) using UCINet. Qualitative data were collected using semi-structured interviews and analyzed with content analysis procedures using NVivo8. RESULTS It was found that obtaining research knowledge was perceived to be a shared responsibility among team members, whereas its application in patient care was seen as the responsibility of the team leader, usually the senior physician. PHCT members acknowledged the need for resources for information access, synthesis, interpretation, or management. CONCLUSION Information sharing in interdisciplinary teams is a complex and multifaceted process. Specific interventions need to be improved such as formalizing modes of communication, better organizing knowledge-sharing activities, and improving the active use of allied health professionals. Despite movement toward team-based models, senior physicians are often gatekeepers of uptake of new evidence and changes in practice.
Collapse
Affiliation(s)
- Shannon L Sibbald
- Faculties of Health Sciences and Information and Media Studies, Western University, London ON, N6A 5B9, Canada. ssibbald@ uwo.ca
| | | | | | | |
Collapse
|
41
|
Rader T, Pardo Pardo J, Stacey D, Ghogomu E, Maxwell LJ, Welch VA, Singh JA, Buchbinder R, Légaré F, Santesso N, Toupin April K, O'Connor AM, Wells GA, Winzenberg TM, Johnston R, Tugwell P. Update of strategies to translate evidence from cochrane musculoskeletal group systematic reviews for use by various audiences. J Rheumatol 2013; 41:206-15. [PMID: 24293571 DOI: 10.3899/jrheum.121307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
For rheumatology research to have a real influence on health and well-being, evidence must be tailored to inform the decisions of various audiences. The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. While systematic reviews provided by the CMSG fill a major gap in meeting the need for high-quality evidence syntheses, our work does not end at the completion of a review. The term "knowledge translation" (KT) refers to the activities involved in bringing research evidence to various audiences in a useful form so it can be used to support decision making and improve practices. Systematic reviews give careful consideration to research methods and analysis. Because the review is often long and detailed, the clinically relevant results may not be apparent or in the optimal form for use by patients and their healthcare practitioners. This paper describes 10 formats, many of them new, for ways that evidence from Cochrane Reviews can be translated with the intention of meeting the needs of various audiences, including patients and their families, practitioners, policy makers, the press, and members of the public (the "5 Ps"). Current and future knowledge tools include summary of findings tables, patient decision aids, plain language summaries, press releases, clinical scenarios in general medical journals, frequently asked questions (Cochrane Clinical Answers), podcasts, Twitter messages, Journal Club materials, and the use of storytelling and narratives to support continuing medical education. Future plans are outlined to explore ways of improving the influence and usefulness of systematic reviews by providing results in formats suitable to our varied audiences.
Collapse
Affiliation(s)
- Tamara Rader
- From the Cochrane Musculoskeletal Group (CMSG), Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Bédard M, Marshall S, Man-Son-Hing M, Weaver B, Gélinas I, Korner-Bitensky N, Mazer B, Naglie G, Porter MM, Rapoport MJ, Tuokko H, Vrkljan B. It is premature to test older drivers with the SIMARD-MD. ACCIDENT; ANALYSIS AND PREVENTION 2013; 61:317-321. [PMID: 23628257 DOI: 10.1016/j.aap.2013.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/31/2013] [Accepted: 04/02/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND A new tool, the SIMARD-MD, has been proposed to help physicians identify cognitively impaired drivers who may be unfit to drive, but little empirical evidence is available to justify its use. We analyzed data from a cohort of older Canadian drivers who had undergone cognitive testing to: (1) correlate the SIMARD-MD with other tools that measure cognition (e.g., trail-making test), (2) identify how many drivers, using published cut-offs on the SIMARD-MD, would be recommended to lose their license, or be considered fit to drive, or be required to undergo further driving assessment, and (3) determine if the SIMARD-MD is biased by level of education as many cognitive tools are. METHODS Cross-sectional data from 841 drivers aged 70 and over from seven Canadian sites who are enrolled in a 5-year cohort study were used for the analyses. Scores on the SIMARD-MD were correlated with scores on the other cognitive measures. The recommendations that would be made based on the SIMARD-MD scores were based on published cut-off values suggested by the authors of the tool. The impact of education status was examined using linear regression controlling for age. RESULTS Correlations between the SIMARD-MD and other cognitive measures ranged from .15 to .86. Using published cut-off scores, 21 participants (2.5%) would have been recommended to relinquish their licenses, 428 (50.9%) would have been deemed fit to drive, and 392 (46.6%) would have been required to undergo further testing. We found a difference of 8.19 points (95% CI=4.99, 11.40, p<.001) in favor of drivers with post-secondary education versus those without, representing over 11% of the mean score. DISCUSSION The SIMARD-MD is unlikely to be valuable to clinicians because it lacks sufficient precision to provide clear recommendations about fitness-to-drive. Recommendations based solely on the SIMARD-MD may place many seniors at risk of losing their transportation mobility or incurring unnecessary stress and costs to prove they are safe to drive. Furthermore, the education bias may create an unwanted structural inequity. Hence, adoption of the SIMARD-MD as a tool to determine fitness-to-drive appears premature.
Collapse
Affiliation(s)
- Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada; St. Joseph's Care Group, Thunder Bay, Ontario, Canada; Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Development and evaluation of evidence-informed clinical nursing protocols for remote assessment, triage and support of cancer treatment-induced symptoms. Nurs Res Pract 2013; 2013:171872. [PMID: 23476759 PMCID: PMC3588176 DOI: 10.1155/2013/171872] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 11/29/2012] [Accepted: 12/03/2012] [Indexed: 12/26/2022] Open
Abstract
The study objective was to develop and evaluate a template for evidence-informed symptom protocols for use by nurses over the telephone for the assessment, triage, and management of patients experiencing cancer treatment-related symptoms. Guided by the CAN-IMPLEMENT© methodology, symptom protocols were developed by, conducting a systematic review of the literature to identify clinical practice guidelines and systematic reviews, appraising their quality, reaching consensus on the protocol template, and evaluating the two symptom protocols for acceptability and usability. After excluding one guideline due to poor overall quality, the symptom protocols were developed using 12 clinical practice guidelines (8 for diarrhea and 4 for fever). AGREE Instrument (Appraisal of Guidelines for Research and Evaluation) rigour domain subscale ratings ranged from 8% to 86% (median 60.1 diarrhea; 40.5 fever). Included guidelines were used to inform the protocols along with the Edmonton Symptom Assessment System questionnaire to assess symptom severity. Acceptability and usability testing of the symptom populated template with 12 practicing oncology nurses revealed high readability (n = 12), just the right amount of information (n = 10), appropriate terms (n = 10), fit with clinical work flow (n = 8), and being self-evident for how to complete (n = 5). Five nurses made suggestions and 11 rated patient self-management strategies the highest for usefulness. This new template for symptom protocols can be populated with symptom-specific evidence that nurses can use when assessing, triaging, documenting, and guiding patients to manage their-cancer treatment-related symptoms.
Collapse
|
44
|
Stacey D, Bakker D, Ballantyne B, Chapman K, Cumminger J, Green E, Harrison M, Howell D, Kuziemsky C, MacKenzie T, Sabo B, Skrutkowski M, Syme A, Whynot A. Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols. Implement Sci 2012; 7:110. [PMID: 23164244 PMCID: PMC3527220 DOI: 10.1186/1748-5908-7-110] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 11/06/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. METHODS A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses' use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses' barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. DISCUSSION Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.
Collapse
Affiliation(s)
- Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Debra Bakker
- School of Nursing, Laurentian University, Sudbury, ON, Canada
| | | | | | | | | | | | - Doris Howell
- University Health Network, Princess Margaret Hospital, Toronto, ON, Canada
| | - Craig Kuziemsky
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Terry MacKenzie
- Sudbury Regional Hospital, Regional Cancer Program, Sudbury, ON, Canada
| | - Brenda Sabo
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Myriam Skrutkowski
- Cancer Care Mission, Nursing Department, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | - Ann Syme
- Canadian Partnership Against Cancer, Toronto, ON, Canada
| | | |
Collapse
|
45
|
Schönherr S, Halfens RJ, Meijers JM, Schols JM, Lohrmann C. Structural and process indicators of nutritional care: A comparison between Austrian hospitals and nursing homes. Nutrition 2012; 28:868-73. [DOI: 10.1016/j.nut.2011.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 10/14/2022]
|
46
|
Wood SK, Payne JK. Implementation of national comprehensive cancer network evidence-based guidelines to prevent and treat cancer-related infections. Clin J Oncol Nurs 2012; 16:E111-7. [PMID: 22641329 DOI: 10.1188/12.cjon.e111-e117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Clinical practice guidelines are an important result of evidence-based research. However, current clinical practice remains out of step with the rapid pace of research advancements. Often, decades pass before research is translated into clinical practice. The National Comprehensive Cancer Network (NCCN) has created evidence-based clinical guidelines to promote effective clinical practice. Formerly, the NCCN established guidelines to reduce cancer-related infections only for neutropenic patients; however, they have expanded their guidelines beyond neutropenia to prevent and treat cancer-related infections. Implementing scientific evidence into clinical practice is challenging and complex, and healthcare professionals should understand barriers to implementing clinical practice guidelines to ensure successful translation into practice. This article provides a brief review of NCCN guidelines and describes common barriers encountered during implementation. In addition, a conceptual framework is offered to help identify and address potential concerns before and after adoption of guidelines.
Collapse
Affiliation(s)
- Sylvia K Wood
- Department of Hematologic Malignancy Stem Cell Transplant, Stony Brook University Medical Center, New York, USA.
| | | |
Collapse
|
47
|
Menear M, Grindrod K, Clouston K, Norton P, Légaré F. Advancing knowledge translation in primary care. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:623-e307. [PMID: 22859625 PMCID: PMC3374678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Matthew Menear
- Department of Social and Preventive Medicine at the University of Montreal in Quebec.
| | | | | | | | | |
Collapse
|
48
|
van der Weijden T, Boivin A, Burgers J, Schünemann HJ, Elwyn G. Clinical practice guidelines and patient decision aids. An inevitable relationship. J Clin Epidemiol 2012; 65:584-9. [DOI: 10.1016/j.jclinepi.2011.10.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 08/17/2011] [Accepted: 10/02/2011] [Indexed: 10/14/2022]
|
49
|
Légaré F, Turcotte S, Stacey D, Ratté S, Kryworuchko J, Graham ID. Patientsʼ Perceptions of Sharing in Decisions. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2012; 5:1-19. [DOI: 10.2165/11592180-000000000-00000] [Citation(s) in RCA: 160] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
50
|
Vasse E, Vernooij-Dassen M, Cantegreil I, Franco M, Dorenlot P, Woods B, Moniz-Cook E. Guidelines for psychosocial interventions in dementia care: a European survey and comparison. Int J Geriatr Psychiatry 2012; 27:40-8. [PMID: 21370278 DOI: 10.1002/gps.2687] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2010] [Accepted: 12/09/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The effectiveness of psychosocial interventions in treating people with dementia and their carers is increasingly emphasised in the literature. Dementia guidelines should summarise the scientific evidence and best practice that is currently available, therefore, it should include recommendations for psychosocial interventions. The aims of our study were (1) to collate dementia guidelines from countries across Europe and to check whether they included sections about psychosocial interventions, and (2) to compare the methodological quality and the recommendations for specific psychosocial interventions in these guidelines. METHODS The European dementia guidelines were inventoried. The methodological quality of the guideline sections for psychosocial interventions was assessed with the (AGREE) Appraisal of Guidelines Research and Evaluation instrument. The recommendations for specific psychosocial interventions were extracted from each of these guidelines and compared. RESULTS Guidelines for psychosocial interventions were found in five of 12 countries. Guideline developers, methodological quality and appreciation of available evidence influenced the inclusion of psychosocial interventions in dementia guidelines from Germany, Italy, the Netherlands, Spain and the UK. The UK NICE SCIE guideline had the best methodological quality and included the most recommendations for psychosocial interventions. Physical activity and carer interventions were recommended the most across all guidelines. CONCLUSION The inclusion of psychosocial interventions in dementia guidelines is limited across Europe. High-quality guidelines that include psychosocial interventions and are kept up to date with the emerging evidence are needed. Throughout Europe, special attention to the implementation of evidence-based psychosocial care is needed in the next few years.
Collapse
Affiliation(s)
- E Vasse
- Scientific Institute for Quality of Healthcare and Nijmegen Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|