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PubMed2006

Genetic technologies meet the public: the discourses of concern.

To clarify concerns that the public has with genetic technologies, the article presents the results of focus group interviews conducted in Denmark in 2000. The concerns of the public are divided into three ideal-typical categories: social (dealing with environmental and health risks), economic (dealing with both the threats and opportunities of the new technologies), and cultural (taking up ethical and moral concerns). Following a general discussion of why it is important to take these discourses of concern seriously, each discursive category is discussed with examples taken from the focus group interviews.

Biotechnology↗
PubMed1990

Continuing professional education needs of clinical dietitians in Pennsylvania.

A multimethod needs assessment generated both qualitative and quantitative data about continuing professional education needs and interests of Pennsylvania clinical dietitians. The study also evaluated three different needs assessment procedures. First, data were obtained from 22 clinical dietitians invited to participate in focus group interviews. The dietitians suggested continuing education topics representing four aspects of practice: clinical, procedural, professional development, and management skills. With the data obtained, two needs assessment instruments subsequently were prepared and distributed at a statewide conference. Fourteen percent of 650 attending dietitians volunteered to participate in the needs assessment process. Forty-four completed a survey using an electronic preference recording device, and 50 completed printed questionnaires. Although not directly comparable, responses to both questionnaire formats generally confirmed suggestions obtained from focus groups. Topics such as computer applications, patient education, staff development, and time management led the wide variety of choices selected. Respondents favored live, affordable, conveniently located programs delivered effectively by experts using a participatory format. Of the three assessment procedures used, focus group interviews provided the most detailed information for planning continuing education. Surveys based on focus group results are useful for contributing quantitative data. We conclude that a comprehensive plan for dietitians' professional development through continuing professional education should include structured needs assessments. The assessments are necessary to determine the diverse and changing concerns, needs, and preferences of dietitians and the organizations employing them.

Dietetics↗
PubMed1990

Assessing beliefs of older rural Americans about nutrition education: use of the focus group approach.

We used the focus group interview technique as a preliminary research step in developing a nutrition education intervention for rural seniors who, because of less than optimal eating habits and changing demographics, are an important target audience. Sixty-eight well, active, rural North Dakota seniors, 60 years or older, from communities of 2,500 or fewer people, participated in five focus groups conducted in late summer 1988. As a qualitative research approach, focus group interviews offer a means of obtaining in-depth information on a specific topic from representatives of a target audience in a discussion group atmosphere. Focus groups require careful preparation and structuring and should include a capable moderator, a prepared discussion guide, carefully recruited participants, and a comfortable setting. The process generated ideas that we are using to develop a health promotion nutrition intervention that will be a mailed-home approach, including use of incentives, social role models, cholesterol screening, and learning activities. The intervention relies on the interest and ability of seniors to make positive health changes. We conclude that the focus group approach is useful in developing nutrition education interventions.

Aged↗
PubMed2000

[Evaluation of inpatient satisfaction. Comparison of different survey methods].

OBJECTIVES: To assess the impact of patient satisfaction survey method on response rate, data quality and satisfaction. PATIENTS AND METHODS: Four modes of data collection were assessed during a randomized trial that included 400 inpatients discharged from a teaching hospital. RESULTS: The response rate was 58% within the mail survey group (72% with follow-up letter) versus 73% and 81% within the home and telephone interview group (p < 0.01). 69% of the mailed questionnaires contained no missing values versus 94% and 96% for home and telephone interview modes (p < 0.01). The global satisfaction scale score was greater within the mail survey groups (8.1/10 without follow-up letter and 7.9 with follow-up letter) than within the telephone interview group (7.8) and the face to face interview group (7.3), (p < 0.05). CONCLUSION: Mail survey with follow-up letter constitutes an operational method despite lower data quality and overestimation of patients' satisfaction scores.

Adult↗
PubMed2001

Genetic testing for colorectal carcinoma susceptibility: focus group responses of individuals with colorectal carcinoma and first-degree relatives.

BACKGROUND: Colorectal carcinoma (CRC) may be the most frequent form of hereditary cancer. Genetic counseling and testing for heritable CRC is a promising approach for reducing the high incidence and mortality rates associated with the disease. Patients with CRC or those with at least one family member with the disease are the most likely persons to request or be offered genetic testing in the clinical or research setting. Currently, however, little is known about the behavioral, psychosocial, ethical, legal, and economic outcomes of CRC genetic counseling and testing. METHODS: Eight focus group interviews, four for CRC patients (n = 28) and four for first-degree relatives (n = 33), were conducted to obtain insights into attitudes, beliefs, and informational needs about genetic testing for hereditary CRC. RESULTS: Focus group interviews revealed a general lack of knowledge about cancer genetics and genetic testing; worry about confidentiality issues; strong concern for family members, particularly children; and a need for primary care providers to be informed about these issues. Major perceived advantages of genetic testing included improving health-related decisions, guiding physicians in making recommendations for surveillance, and informing relatives about risk potential. Disadvantages included potential discrimination, adverse psychologic effects, and financial costs associated with testing. CONCLUSIONS: As knowledge and media coverage of genetics continue to expand, it becomes increasingly important to continue efforts on behalf of, and in partnership with, those individuals most affected by genetic testing for hereditary cancer syndromes. These findings provide data needed to develop and implement informational, educational, counseling, and research-oriented programs that are sensitive to individuals' concerns and preferences.

Adult↗
PubMed2005

Registered nurses perception of work satisfaction at a Tertiary Care University Hospital.

Hospitals are facing serious challenges to provide high quality care with current nursing shortages. Nursing shortages are of major concern for Nursing Management, clinicians and administrators as they lead to impact on quality of care. Under-stressed, frustrated and demoralized nurses give rise to concern for hospital Nursing Management in providing quality care according to set standards. A descriptive qualitative research design was used to explore the registered nurses' perceptions regarding the high turnover rates among nurses at a Tertiary Care University Hospital. Data was collected from nurses working at various speciality areas, which were: Critical Care, Medical and Surgical Care, Ambulatory Care, Maternal/Child and Emergency departments. A convenience sample of 45 registered nurses from nine subspecialty groups was selected for a focus group interview and five focus groups were selected for a study population. Findings of exit interviews (from 1 September 2001 to 28 February 2002) were also included in the data analysis. These exit interviews of RNs were conducted by Nurse Recruiter at the time of their resignations. The data analysis showed that the most dissatisfying factors at work and within the work setting were identified as: high workload, stress associated with high workload, biased Nursing Management, lack of appreciation and monetary incentives, finally a rigid attitude of Nursing Management. However, the most satisfying factors were: working with an internationally reputable organization, patients' positive feedback and availability of required material or equipment. The study participants recommended that nursing retention could be improved at the Tertiary Care University Hospital by launching the following strategies by Nursing Management: reducing workload by adequate nurse-patient ratios according to international standards, promoting respect of nurses in front of patients and other staff, rewards and recognition of nurses, simplifying nursing documentation, increasing recreational activities for nurses and empowering nurses and Nursing Management group.

Adult↗
PubMed2006

The effect of problem-based learning on students' approaches to learning in the context of clinical nursing education.

The effect of problem-based learning (PBL) on nursing students' approaches to learning has received scanty attention in nursing education. The purpose of the present study was to evaluate the effect of PBL on students' approaches to learning in clinical nursing education. Using a one-group before-after quasi-experimental design, the revised two-factor Study Process Questionnaire (R-SPQ-2F) was administered to compare students' approaches to learning before and after a period of clinical education in which PBL was implemented. Focus group interviews were used to elicit from students their PBL experience. Of the 237 students who participated in the study, 187 returned the R-SPQ-2F, representing a response rate of 78.9%. Twenty-eight of the students also participated in focus group interviews. The R-SPQ-2F scores indicated that for the deep approach to learning, the post-test mean score was noticeably higher than that at the pre-test (p=0.005). No significant difference was observed between the pre-test and post-test mean scores for the surface approach to learning (p>or=0.05). The four themes inductively derived from students' descriptions of their clinical education experience (motivated to learn; self-direction in learning; active, interactive and student-centred learning; and enjoyment in learning) also suggested that the students adopted a deep approach to learning during a period of clinical education in which PBL was implemented.

Adult↗
PubMed2002

[Bio-psychosocial treatment approach to somatizing patients in primary care: a pilot study].

OBJECTIVE: To explore the feasibility of a brief psychosocial intervention for somatizing patients in the Primary Care setting and its potential effects on these patients' quality of life. DESIGN: Prospective series of 12 cases, with pre and post-intervention analyses.Setting. Three general practices of the Basque Health Service. PATIENTS: Consecutive sample of 12 patients, between 18 and 65 years-old, complaining about at least six medically unexplained symptoms for female patients or at least four for male patients. Intervention and measurement. DEPENAS intervention was carried out: Detection- Explanation-Plan-Exploration- Normalization-Action-Follow-up. Differences between before- and after-intervention health-related quality of life (SF-36) were compared and group interviews were held with the three collaborator general practitioners. RESULTS: Overall quality of life improvement was estimated in 8 points (SD, 13.4; P =.073). Intra-GP correlation coefficients, necessary for estimate the size of the clinical trial, were null for five scales, and 0.058, 0.098 and 0.28 for the other three scales. Group interviews showed that DEPENAS bio-psycho-social intervention is acceptable for general practitioners and that there was a high risk of contamination when the same doctor simultaneously treated some patients and not others. CONCLUSIONS: The improvement seen after the intervention, although not totally attributable to it due to the lack of a control group, justify the need of conducting a clinical controlled trial randomised by GPs to avoid contamination.

Adolescent↗
PubMed2006

Implications of process evaluation for clinical effectiveness and clinical practice in a trial on chronic shoulder complaints.

OBJECTIVE: The intervention process was evaluated in a randomised clinical trial on the effectiveness of a behavioural Graded Exercise Therapy (GET) programme for patients with chronic shoulder complaints in primary care settings. This process evaluation was done for three reasons: first, to know whether the programme was performed as planned; second, to know whether or not this treatment is feasible in normal practice; third, to identify needs for improvement of the protocol to facilitate implication. METHODS: We evaluated the extent to which the programme is being applied according to protocol, patient adherence to the programme and the suitability of the programme according to patients and physiotherapists. Twenty participating physiotherapists and 87 patients allocated to GET were asked to evaluate the intervention process. Furthermore, a sample of 10 patients, taken from the total number of 87 patients allocated to GET, was invited to take part in a focus group interview at the end of the study. We evaluated the intervention process using a treatment registration form filled in by the physiotherapists during treatment, evaluation forms filled in independently by physiotherapists and patients 26 weeks after the start of the treatment period, and information gathered during the focus group interview at the end of the study. RESULTS: GET was applied according to protocol to an acceptable extent, and participating patients showed satisfactory adherence to the programme. CONCLUSIONS: Clinical effectiveness of GET in this trial is not influenced by flaws in the application of the programme or by lack of patient adherence. PRACTICE IMPLICATIONS: The programme could be improved in terms of the process of goal-setting, and the implementation of GET could be facilitated if the programme is embedded in a multidisciplinary approach in primary care.

Exercise Therapy↗
PubMedDate not supplied

Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder.

Ninety-four staff from a regionally based mental health service and associated health and human services completed a two-day workshop introducing dialectical behaviour therapy, with a smaller number also undertaking advanced training. Survey and focus group data were collected on participants' demographics, attitudes, knowledge and experience of working with persons with this disorder, prior to and at one-month and six-months following completion of the introductory workshops. Quantitative and qualitative findings indicated that involvement in the training program was a positive experience for the majority of participants, with knowledge regarding detection and treatment and staff attitudes toward consumers being improved following exposure to the principles and practice of dialectical behaviour therapy. Discourse analysis of the focus group interview data pre- and post-training indicated a significant shift in the meanings staff associate with borderline personality disorder, with a pervasive therapeutic pessimism being displaced by more optimistic understandings and outlooks. Improved therapeutic outlook is likely to have positive implications for staff engagement with service users with borderline personality disorder. While this article provides a brief overview of the findings of the survey, the main purpose is to report the findings of the focus group interviews.

Adult↗
PubMed2006

Putting informed and shared decision making into practice.

OBJECTIVE: To investigate the practice, experiences and views of motivated and trained family physicians as they attempt to implement informed and shared decision making (ISDM) in routine practice and to identify and understand the barriers they encounter. BACKGROUND: Patient involvement in decision making about their health care has been the focus of much academic activity. Although significant conceptual and experimental work has been done, ISDM rarely occurs. Physician attitudes and lack of training are identified barriers. DESIGN: Qualitative analysis of transcripts of consultations and key informant group interviews. SETTINGS AND PARTICIPANTS: Six family physicians received training in the ISDM competencies. Audiotapes of office consultations were made before and after training. Transcripts of consultations were examined to identify behavioural markers associated with each competency and the range of expression of the competencies. The physicians attended group interviews at the end of the study to explore experiences of ISDM. RESULTS: The physicians liked the ISDM model and thought that they should put it into practice. Evidence from transcripts indicated they were able to elicit concerns, ideas and expectations (although not about management) and agree an action plan. They did not elicit preferences for role or information. They sometimes offered choices. They had difficulty achieving full expression of any of the competencies and integrating ISDM into their script for the medical interview. The study also identified a variety of competency-specific barriers. CONCLUSION: A major barrier to the practice of ISDM by motivated physicians appears to be the need to change well-established patterns of communication with patients.

Adolescent↗
PubMed1994

Quality of life during chemotherapy in patients with symptomatic advanced colorectal cancer. The Nordic Gastrointestinal Tumor Adjuvant Therapy Group.

BACKGROUND: To increase the knowledge about the palliative effects of chemotherapy in patients with symptomatic advanced colorectal cancer, physician- and patient-rated "quality of life" was studied in a randomized multicenter trial comparing a regimen of methotrexate/5-fluorouracil (5-FU) followed by leucovorin rescue (MFL) with a regimen of 5-FU/leucovorin (FLV). METHODS: Between January 1989 and December 1990, 70 patients completed a quality of life questionnaire at randomization and after every fourth treatment course. At one of the hospitals, the evaluation was done as an interview (interview group, n = 24), whereas a questionnaire was used at the other hospitals (questionnaire group, n = 46). RESULTS: Objective responses (complete response plus partial response) were obtained in 15 (21%) patients, subjective responses in 29 (41%) patients, and an overall improved quality of life in 25 (36%) patients. In addition, 16 (23%) patients had unchanged quality of life during at least 4 months. There was a correlation between objective responses, subjective responses, and improvements in quality of life, although discrepancies were noticed, particularly in patients with only slight symptoms. Response rates were higher in the interview group than in the questionnaire group (P < 0.01). This difference could be related to a more favorable outcome when 5-FU was given as a bolus injection, rather than as a short-term infusion (more than 5 minutes). CONCLUSIONS: Improvements or prolonged stabilization of disease in quality of life can be achieved in at least half of the patients with tumor-related symptoms. However, factors related to the administration of chemotherapy may influence this proportion.

Adult↗
PubMed2002

Overview of themes identified from African American discourse on quality of care.

The article reports on an exploratory descriptive study conducted to establish quality-of-care dimensions from African Americans' perspective, using a combined focus group interview and modified Delphi process. Descriptors of quality, which were identified using participants' vocabulary and thinking patterns, were used to establish quality-of-care dimensions; they were then examined in terms of an adapted quality-of-care framework. Themes and issues related to quality of care also were identified. The article analyzes the qualitative themes abstracted from that discourse and relates focus group interview guide questions to the emerging quality-of-care issues. An interpersonal processes-of-care framework is used to examine the quality-of-care themes, and the quality-of-care issues are discussed using a systems theoretical perspective.

Black or African American↗
PubMed2003

Symptom severity in advanced cancer, assessed in two ethnic groups by interviews with bereaved family members and friends.

Little research has been reported on the experience of cancer among minority ethnic communities in the UK. As part of a wider survey in inner London we interviewed bereaved family members or close friends of 34 first-generation black Caribbeans and of 35 UK-born white patients about symptoms and symptom control in the year before death with cancer. They were drawn from population samples in which the response rates were equal at about 46%. Symptoms in the two ethnic groups were similar. However, multivariate logistic regression indicated greater symptom-related distress in black Caribbeans for appetite loss, pain, dry mouth, vomiting and nausea, and mental confusion. Respondents were also more likely to say, in relation to black Caribbean patients, that general practitioners (though not hospital doctors) could have tried harder to manage symptoms. The findings suggest a need for better assessment and management of cancer symptoms in first-generation Caribbean Londoners, guided by a deeper understanding of cultural influences on their responses to advanced illness.

Attitude to Health↗
PubMed1996

Indicators of the quality of general practice care of patients with chronic illness: a step towards the real involvement of patients in the assessment of the quality of care.

OBJECTIVE: To develop a list of indicators of the general practice care of people with chronic illnesses considered important by both patients and practitioners and to identify the indicators that are considered relevant for patient assessment of health care quality. DESIGN: Qualitative study with focus group interviews and a written consensus procedure. SETTING: General practice in the Netherlands in 1993. SUBJECTS: 34 patients with chronic illness, mostly members of patient organisations, and 19 general practitioners with expertise in either chronic disease management or experience with patient surveys. MAIN MEASURES: Aspects of general practice care considered important for the delivery of good quality care that emerged from focus group interviews; the relevance of evaluations of 41 aspects of care for patients explored through the written consensus procedure. Those aspects of general practice care agreed to be both important and relevant by patients and general practitioners were considered to be suitable indicators for patient assessment of the quality of care. RESULTS: Patients and general practitioners differed to some extent in their assessment of the aspects of care that they considered important for quality. They agreed that most indicators of care that related to the ¿doctor-patient relation¿ and to ¿information and support¿ were relevant and therefore suitable as indicators for patient assessment of health care quality. There was less agreement about the relevance of indicators of ¿medical and technical care,¿ ¿availability and accessibility,¿ and ¿organisation of services.¿ CONCLUSIONS: Several indicators of the quality of general practice care of patients with chronic illness were thought to be suitable for the patient assessment of healthcare quality, but other indicators were not, mainly because of reservations by general practitioners. IMPLICATIONS: Qualitative methods can contribute to the selection of indicators for assessment of the quality of health care in areas where scientific evidence is limited or where patients' and providers' preferences are particularly important.

Chronic Disease↗
PubMed2005

Promoting health in type 2 diabetes: nurse-physician collaboration in primary care.

The purpose of this study is to examine effects of a nurse-physician collaborative approach to care of patients with type 2 diabetes and to determine possible effect sizes for use in computing sample sizes for a larger study. Forty patients from a family practice clinic with type 2 diabetes were randomly assigned to control or experimental groups. The control group received standard care, whereas the experimental group received standard care plus home visits from a nurse, as well as consultation with an exercise specialist and/or nutritionist. Follow-up continued for 3 months. Clinical end points included standard measures of diabetes activity as well as quality-of-life indicators. Focus group interviews were used to explore patients' responses to the program. Although findings were not statistically significant, a trend toward small to moderate positive effect sizes was found in glycosylated hemoglobin and blood pressure. Quality of life measures also showed a trend toward small to moderate, but nonsignificant, improvements in physical functioning, bodily pain, vitality, social and global functioning, energy, impact of diabetes, and health distress. Focus group interviews indicated a very positive response from patients, who expressed feelings of empowerment. In this study, patients treated with nurse-physician collaboration demonstrated small, but nonsignificant, improvements in blood chemistry after only 3 months. Physical and social functioning, energy, and bodily pain also showed a small improvement. Changes in awareness of effects of diabetes on health and an expressed sense of self-efficacy suggest that effects could be sustainable over the longer term.

Aged↗
PubMed1999

Towards a feasible model for shared decision making: focus group study with general practice registrars.

OBJECTIVES: To explore the views of general practice registrars about involving patients in decisions and to assess the feasibility of using the shared decision making model by means of simulated general practice consultations. DESIGN: Qualitative study based on focus group interviews. SETTING: General practice vocational training schemes in south Wales. PARTICIPANTS: 39 general practice registrars and eight course organisers (acting as observers) attended four sessions; three simulated patients attended each time. METHOD: After an introduction to the principles and suggested stages of shared decision making the registrars conducted and observed a series of consultations about choices of treatment with simulated patients using verbal, numerical, and graphical data formats. Reactions were elicited by using focus group interviews after each consultation and content analysis undertaken. RESULTS: Registrars in general practice report not being trained in the skills required to involve patients in clinical decisions. They had a wide range of opinions about "involving patients in decisions," ranging from protective paternalism ("doctor knows best"), through enlightened self interest (lightening the load), to the potential rewards of a more egalitarian relationship with patients. The work points to three contextual precursors for the process: the availability of reliable information, appropriate timing of the decision making process, and the readiness of patients to accept an active role in their own management. CONCLUSIONS: Sharing decisions entails sharing the uncertainties about the outcomes of medical processes and involves exposing the fact that data are often unavailable or not known; this can cause anxiety to both patient and clinician. Movement towards further patient involvement will depend on both the skills and the attitudes of professionals, and this work shows the steps that need to be taken if further progress is to be made in this direction.

Attitude of Health Personnel↗