Biomedical subjects

Dauna Crooks

Publications and source records attributed to Dauna Crooks.

5 recordsLinked to original sources

PubMed2006

Decision making in palliative radiation therapy: reframing hope in caregivers and patients with brain metastases.

GOALS OF WORK: To explore the major factors important in decision making for whole-brain radiotherapy (WBRT) for patients with brain metastases and their caregivers. PATIENTS AND METHODS: Two parallel qualitative studies, one for patients and one for caregivers of patients with newly diagnosed brain metastases, were conducted. Semistructured interviews were conducted and audiotaped with each participant. Content analysis and theme extraction of the transcripts were undertaken to identify recurring themes and relational patterns. RESULTS: Twenty patients and 19 caregivers (including eight patient and caregiver pairs) were recruited into the study. Four major factors were identified to influence decision making of whole-brain radiation: hope, knowledge, expectations of radiation therapy, and current symptoms. Analysis reveals that patients generally focus on current informational needs, while caregivers want more information about the future (e.g., life expectancy and anticipated symptoms). Caregivers expressed frustration when unable to explore future needs because patients were unprepared to discuss prognostic issues. Participants expressed substantial relief when offered WBRT after the diagnosis, but WBRT is often considered the only available plan rather than an informed choice. CONCLUSIONS: Given the importance of caregivers in the care of patients with brain metastases, fulfilling their unique informational needs appears to require more attention. The blurred boundary between hopes and expectations for WBRT creates unique challenges in joint treatment decision making for patients with brain metastases and their caregivers.

Adaptation, Psychological↗

PubMed2004

Why cancer patients enter randomized clinical trials: exploring the factors that influence their decision.

PURPOSE: Few interventions have been designed and tested to improve recruitment to clinical trials in oncology. The multiple factors influencing patients' decisions have made the prioritization of specific interventions challenging. The present study was undertaken to identify the independent predictors of a cancer patient's decision to enter a randomized clinical trial. METHODS: A list of factors from the medical literature was augmented with a series of focus groups involving cancer patients, physicians, and clinical research associates (CRAs). A series of questionnaires was developed with items based on these factors and were administered concurrently to 189 cancer patients, their physicians, and CRAs following the patient's decision regarding trial entry. Forward logistic regression modeling was performed using the items significantly correlated (by univariate analysis) with the decision to enter a clinical trial. RESULTS: A number of items were significantly correlated with the patient's decision. In the multivariate logistic regression model, the patient's perception of personal benefit was the most important, with an odds ratio (OR) of 3.08 (P < .05). CRA-related items involving supportive aspects of the decision-making process were also important. These included whether the CRA helped with the decision (OR = 1.71; P < .05), and whether the decision was hard for the patient to make (OR = 0.52; P < .05). CONCLUSION: Strategies that better address the potential benefits of trial entry may result in improved accrual. Interventions or aids that focus on the supportive aspects of the decision-making process while respecting the need for information and patient autonomy may also lead to meaningful improvements in accrual.

Adult↗

PubMed2002

Factors that influence the recruitment of patients to Phase III studies in oncology: the perspective of the clinical research associate.

BACKGROUND: The multiple determinants of a patient's decision to enter into a clinical trial have been explored largely from the perspectives of patients and their physicians. Little research has involved clinical research associates (CRAs) formally, despite their central role in the process of recruitment. The current study was initiated to explore the factors that influence the decision of patients with cancer regarding clinical trial entry, specifically from the perspective of the CRA. METHODS: Two focus groups of CRAs from the Hamilton Regional Cancer Center were organized. A skilled facilitator guided both groups through exploratory and subsequent confirmatory phases of discussions, which were audiotaped for review and coding using a process of consensus employing intercoder triangulation. RESULTS: The two groups identified a number of factors that they believed influenced the recruitment process. Numerous physician and patient factors were reaffirmed, such as the impression of the scientific merit of a study or the sense of personal benefit, respectively. More uniquely, CRAs identified information transfer within the informed consent process as a major aspect of their specialized role. It was believed that full disclosure of information, in terms of both the content and the techniques and styles of delivery, was an important predictor of recruitment success. The groups quickly reached consensus on which factors they believed were the most important overall with respect to influencing study recruitment. CONCLUSIONS: CRAs appear to have a unique role in the process of recruiting patients to active clinical trials. They believe that they have an important influence on recruitment success. Further research to validate this impression is required, because, ultimately, a greater understanding of the relative roles of physician and patient factors and, potentially, CRA factors will be important in the development of ethical and supportive strategies to optimize the recruitment of patients with cancer into randomized clinical trials.

Attitude of Health Personnel↗

PubMed2002

A new perspective on competencies for self-directed learning.

In baccalaureate in nursing programs, self-directed methods of education have been used for many decades. A major goal of this type of approach to education is to provide students with the necessary competencies to become lifelong learners. Students must be exposed to self-directed learning competencies to obtain the knowledge, skills, and attributes unique to their personal and professional growth. It has been proposed that six competencies are required for students to become self-directed learners: self-assessment of learning gaps; evaluation of self and others; reflection; information management; critical thinking; and critical appraisal. Each of these skills are not mutually exclusive but are interrelated in such a way that students use all or a combination of them simultaneously to direct and control their learning.

Clinical Competence↗

PubMedDate not supplied

Caregiving for women with advanced breast cancer.

AIM: To describe the psychosocial impact on caregivers of caring for women with advanced breast cancer. METHODS: Five focus groups were held with bereaved caregivers. Qualitative content analysis of the transcripts was conducted to identify emerging themes. RESULTS: Two categories of caregivers were identified: spouse caregivers (SCGs) and non-spouse caregivers (NSCGs), who were either close friends or relatives. SCGs and the patient managed care cooperatively and shared care-related decision making. Working SCGs managed multiple roles but employers gave them support and freedom to take the time that was necessary to care for their wives. NSCGs had the most life roles to manage, and saw themselves as agents for the patient. The terminal phase of disease was most burdensome for all caregivers, although NSCGs had the most difficulties. During this phase, the patients' activities of daily living became much more impaired. In addition, some patients were not willing to receive continence support from caregivers, and some caregivers found that they could not provide continence support. SCGs were able to negotiate these care-related roles with their spouse, but NSCGs struggled to satisfy the wishes of the patient. CONCLUSION: Caregivers assume great responsibility for providing care, particularly during the terminal phase. Caregiving becomes more complex with each additional life role of the caregiver. SCGs have two advantages: (1) living with the patient facilitates caregiving and (2) patterns of decision making that were established previous to the illness facilitated shared decision making between the patient and spouse caregiver.

Breast Neoplasms↗