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PubMed1984

Medical student interactions with cancer patients: evaluation with videotaped interviews.

In order to evaluate the impact of a block in cancer medicine upon student interactions with cancer patients, a group of 32 students have been videotaped during interviews with simulated and genuine cancer patients before and after the block. The videotapes were scored and analyzed for frequencies and patterns of interactions by the method of Reciprocal Category Analysis. This disclosed significant decreases in purely factual questions by the students, with corresponding increases in discussion of emotional aspects of illness, following the course. The temporal pattern of interaction also changed with less of a tendency to delay or avoid addressing emotional aspects of disease noted. In addition to demonstrating changes in student interactions with cancer patients following a didactic course, this study exemplifies an approach offering more direct assessment of physician-patient interactions than has been practical using questionnaires.

Attitude of Health Personnel↗
PubMed2004

Nurse prescribers' experiences of prescribing.

BACKGROUND: Nurse prescribing has advanced rapidly over the previous decade and is clearly on the agenda for the future. Previous research considers nurse prescribing from the patient's perspective, the medical professions' stance and the legal and ethical implications. However, there is a paucity of literature that explores the experiences of nurse prescribers' within their current role. These experiences need investigating to ensure nurse prescribing is able to advance in ways that provide benefit to nurses and thus provides the impetus for the study. AIM: To explore and review nurse prescribers' experiences of prescribing. DESIGN METHODS: A purposeful sample of seven nurse prescribers currently prescribing within a West Midlands Community Trust underwent minimally structured interviews in this qualitative study. Transcribed interviews were analyzed using thematic analysis. FINDINGS: Four themes were generated from analysis of the interviews, 'patient centred care', 'benefits of nurse prescribing', 'support and role satisfaction' and finally 'prescribing difficulties'. CONCLUSIONS: Nurse prescribers' perceive prescribing as a predominantly positive experience, frequently asserting the advantages that prescribing saves the patient and nurse time, is more convenient for the patient and increases the nurses' autonomy and role satisfaction. However, negative experiences of restrictions to practice as a result of nurse prescribers' formulary limitations and duplication of documentation were also described. RELEVANCE TO CLINICAL PRACTICE: Nurse prescribing is a rapidly evolving area of practice with the potential to advance nursing roles. This research aims to provide an insight into the experiences of current nurse prescribers that may then be disseminated and applied to future practice.

Attitude of Health Personnel↗
PubMed2006

Chance, choice and control: lay debate on prenatal social sex selection.

Assisted reproductive technologies are typically positioned as increasing the range of choices open to the healthcare consumer, thereby enhancing 'reproductive freedom'. In this paper, we question the equivalence of reproductive choice and personal freedom in ethical theory, using results from a project investigating how lay people make ethical evaluations about the new genetic and reproductive technologies. We took the topic of social sex selection by preimplantation genetic diagnosis (PGD), and used group discussions and interviews in the north-east of England to trace how lay people develop and express their ethical evaluations, and to identify the implicit or explicit normative framework that gave rise to their opinions on prenatal sex selection. There was a striking level of ambivalence towards choice in general and reproductive choice in particular. Participants offered few positive statements and numerous reasons why reproductive choice might be problematic. Our participants' argumentation shares with mainstream bioethical analysis the weighing of the possible harms of prenatal sex selection for social reasons against the harm of restricting reproductive freedom. However, unlike most secular-liberal bioethicists, many of our participants concluded that prenatal sex selection is undesirable because it is an expression of parental preference instead of a response to the future child's need. Our interpretation of their reasoning is that they work from an ideal of "good parents", one of the features of which is the relinquishing of control over their children, except to protect them from harm. This voluntary self-limitation does not indicate reduced autonomy, because parental autonomy can only operate within the limits set by this relational framework. We suggest that a model of relational autonomy captures our lay participants' framing of the problem better than a more traditional understanding of autonomy. Our study also shows that in appropriately structured discussion of bioethical issues, lay people can articulate reasons for their opinions that are grounded in sophisticated and morally relevant concepts.

Adolescent↗
PubMed2002

The making of a grounded theory: after death communication.

Qualitative research provides understanding of phenomena with a depth and richness that cannot be generated through quantitative approaches. Qualitative methods, however, can often appear difficult, if not confusing. In this article, the authors take the reader through the grounded theory process using Devers's research, Experiencing the Deceased: Reconciling the Extraordinary (1994), a study of after death communication (ADC), to illustrate the use of this particular qualitative method. The authors hope that this article will leave the reader with a better understanding of grounded theory method and stimulate an interest in using it for studying other death-related topics.

Communication↗
PubMed1997

Videotaped interviewing of non-English speakers: training for medical students with volunteer clients.

In a multicultural society such as Australia, with over 20% of its population born overseas, interpreters are often required to facilitate medical interviews. However, where a patient has some proficiency in English, medical interviews are sometimes conducted across the boundaries of culture and language. This is a report of an educational innovation to teach interviewing skills to pre-clinical medical students with the assistance of volunteers of non-English-speaking backgrounds. Pre-clinical students interviewed community volunteers on topics of general life history in a sequence of 16 tutorials. Each student conducted two interviews. Teaching methods included feedback from the volunteers, tutorial discussion facilitated by playback of videotapes, and modelling of skills by the teachers. Evaluations by volunteers and students indicated high satisfaction with the teaching methods and outcomes. Students gained confidence in interviewing people from different cultures. Evaluation of students' pairs of videotapes by an independent rater achieved satisfactory reliabilities and indicated significant gains in inquiry skills and the communication of positive attitudes. Skills in communicating empathy and in using simple language did not improve measurably.

Adult↗
PubMed2002

[National survey of dermatologists].

OBJECTIVE: The purpose of this survey was to ascertain current management practices of French dermatologists treating immunocompetent patients with cutaneomucosal herpes (ocular herpes excluded) as a prelude to the French consensus conference on this topic. METHOD: A random sample of French dermatologists were invited to respond to a telephone interview: 928 dermatologists were contacted. RESULTS: The 216 dermatologists who responded to the telephone interview provided care for five persons per month (pregnancy excluded) who consulted for orofacial or genital herpes. Nearly half of the dermatologists stated they do not talk about herpes spontaneously with their patients. When a suspect lesion is seen for the first time, 48 p. 100 of the dermatologists order one or two complementary exams. Their advice on prevention between partners basically concerns use of preservatives. Therapeutic attitudes vary depending on the type of herpes or the number of recurrences per year: 84 p. 100 of the dermatologists prescribe a specific antiviral treatment for patients with solar herpes. Virological proof of infection is not acquired in 84 p. 100 of the cases before initiating a long-term treatment for recurrence. The most widely used agents are valaciclovir 500 and aciclovir 200. CONCLUSION: This survey demonstrates a certain degree of divergence from the recommendations of the consensus conference. The participation rate appears to be satisfactory, but herpes serology is ordered too often and antiviral agents are not used in compliance with current guidelines. This survey will be redone after diffusion of the guidelines in order to evaluate their impact.

Acyclovir↗
PubMed1997

Models of hospital drug policy in the UK.

OBJECTIVES: Pharmacists in UK National Health Service (NHS) hospitals have a long tradition of involvement in the development of drug policy. This paper describes various approaches that have been employed in the development and implementation of drug policy in hospitals and examines the evidence for their effectiveness and acceptability in the context of a changing health service. METHODS: A series of focused interviews was conducted with a range of staff, including doctors, nurses, pharmacists and managers at eight hospitals. Interview sites were selected on the basis of a national survey of clinical pharmacy roles and were broadly representative of UK NHS hospitals. Interview data were analysed using constant comparison and analytic induction. RESULTS: Three models used in the development of drug policy were identified: a 'traditional' model, in which a drug and therapeutics committee establishes a hospital-wide formulary which is implemented by pharmacists; a 'combined' model, in which there is much more emphasis on tailoring policies and feedback to specialties or clinical directorates; and a 'medical control' model, in which prescribing decisions are made by individual doctors without reference to explicit policies and with little active pharmacy involvement. Pharmacy involvement was seen as vital to the development of effective policies but hospital-specific factors influenced the choice of model at particular sites. CONCLUSIONS: Hospitals may be moving towards the 'combined' model which could have advantages in the current internal market within the NHS. However, evaluations of the various approaches to drug policy should help inform this decision.

Drug Utilization Review↗
PubMed2002

[Qualitative methods in medical research--preconditions, potentials and limitations].

Qualitative research methods are appropriate for description and analysis of properties, contents, or experiences in the field of medicine. Textual data are drawn from interviews, observations, or written material. In the analysis, raw data are transformed into findings by interpretation and summarization of the material. Qualitative research methods employ well-known presumptions from the theory of science that are assumed to lead to systematic and reflexive construction of knowledge. The process is supposed to be accessible and contestable, and findings are supposed to reach beyond the local study context. Assessment of scientific quality is not confined to quantitative studies. Criteria such as relevance, validity, and reflexivity are proposed. Reflexivity deals with the presumptions surrounding the research process that play a part in shaping the results. The medical researcher who wants to apply qualitative methods must learn to handle the impact of the researcher's role, presumptions and consequences of sampling, and systematic organization and interpretation of the material. These are, however, challenges that must be overcome in all scientific pursuits, irrespective of the type of data used.

Data Collection↗
PubMedDate not supplied

Organizing for empowerment: an interview with AES's Roger Sant and Dennis Bakke. Interview by Suzy Wetlaufer.

The topic of empowerment is receiving a lot of attention, but how many employees are truly empowered? At the global electricity giant AES Corporation, the answer is all 40,000 of them. In this interview, chairman Roger Sant and CEO Dennis Bakke reflect on their trials and triumphs in creating an exceptional company and explain how their employee-run company works. When they founded AES in 1981, Sant and Bakke set out to create a company where people could have engaging experiences on a daily basis--a company that embodied the principles of fairness, integrity, social responsibility, and fun. Putting those principles into action has created something unique--an ecosystem of real empowerment. What does that system look like? Rather than having a traditional hierarchical chain of command, AES is organized around small teams that are responsible for operations and maintenance. Moreover, AES has eliminated functional departments; there's no corporate marketing division or human resources department. For the system to work, every person must become a well-rounded generalist--a mini-CEO. That, in turn, redefines the jobs of the people at headquarters. Instead of setting strategy and making the "the big decisions," Sant and Bakke act as advisers, guardians of the principles, accountability officers, and chief encouragers. Can other companies successfully adopt the mechanics of such a system? Not unless they first adopt the shared principles that have guided AES since its inception. "Empowerment without values isn't empowerment," says Sant. "It's just technique," adds Bakke.

Commerce↗
PubMedDate not supplied

Quality assessment of athletic trainers.

This paper reports the first published assessment of the quality of services provided by athletic trainers. Medical coverage for the 1985 Junior Olympic Games was provided by certified athletic trainers (ATC), physicians, and other health care personnel. This study assessed the services of the 30 attending ATCs who managed 121 significant injuries. Standard injury information was collected by the ATCs and separately collected by their physicians. Nine months after the Games, phone interviews were conducted with the injured participants and assessment questionnaires were given to the attending physicians. Results revealed that young, injured, Junior Olympic participants generally did not inform their parents about their injuries or medical contact while at the Games. Athletes and physicians overwhelmingly agreed that they were positively impressed with the capabilities of the ATCs with whom they had contact. About 70% recovered from the symptoms and limitations of injury, as determined by the athlete, within the month following the Games. About 17% sustained some type of injury recurrence to the same body part, and at 9 months about 97% of the athletes had fully recovered from their injuries. These data not only indicate that athletic trainers can accurately identify minor athletic injury but signify the importance of long-term followup in our athletic populations. Multisport events, such as the Junior Olympic Games, impose considerable problems to a communication effort. The athletic trainer, as an ever-present figure in collegiate and professional circles, can be the central focus of an adequate communication effort regarding the patient care of other athletic populations.

Athletic Injuries↗
PubMed2005

Quality criteria for patient advice and liaison services: what do patients and the public want?

BACKGROUND: Every NHS trust and Primary Care Trust (PCT) in England now has a Patient Advice and Liaison Service (PALS) which provides an identifiable person to whom service users can turn if they have a problem or need information while using the NHS. This paper reports data from a 2-year qualitative study of London PALS. OBJECTIVE: To develop patient-centred criteria by which to assess PALS. DESIGN: Data were generated from qualitative interviews with 15 PALS service users and 15 members of local user/carer organizations, and from a workshop with representatives of 14 user/carer organizations (national and London-wide). Emergent findings were circulated to other user/carer organizations (n = 32) for critique and comment. RESULTS: Findings suggest that users and their representatives want PALS to: be responsive to the needs and wishes of individuals; be accessible to all sections of the community, including older people, ethnic minorities and groups with special needs; offer clear, accurate and comprehensive information about local health and other services; work with their NHS organization to create a more patient-centred service; collaborate effectively with other organizations; be adequately resourced. CONCLUSIONS: These criteria resemble the national standards for PALS compiled by the Department of Health, with the exception of the need for adequate resourcing. They also resemble previous work on users' and carers' criteria for service delivery. Interestingly, PALS' lack of independence was not a major concern, though clients do need access to independent advocacy when 'insider' trouble-shooting fails. Although an alternative to the adversarial approach of complaints is welcome, PALS, like complaints procedures, may be under-used by marginalized or demoralized service users.

Consultants↗
PubMed1990

Continuity and change in preferred provider organizations.

This paper presents the results from a national survey of preferred provider organizations (PPOs) that was conducted in 1988. It is based on telephone interviews conducted by the authors with executives in over 170 PPOs in the United States. We compare the survey results with those obtained from similar surveys conducted in 1985 and 1986, allowing us to assess the extent to which PPOs have grown and changed. We found that PPOs have continued to grow at an extremely rapid rate. During the Summer and Fall of 1988, the time in which the survey took place, 37.6 million people were eligible to use PPO benefits, compared to the 16.5 million figure we obtained two years earlier. We did not find, however, that PPOs are moving in the direction of providing more innovative forms of health care cost containment. Most PPOs still rely on discounts from providers and utilization review to achieve savings. There is little trend towards using incentive reimbursement techniques and choosing preferred providers that have shown themselves to be cost-efficient. We conclude that in the coming years PPOs must demonstrate the ability to control rising health care costs. To accomplish this, they will need to put more pressure on providers to use resources more sparingly. Otherwise, they may lose their market share to other forms of managed care.

Capitation Fee↗
PubMed2003

Living in the face of death: interviews with 12 terminally ill women on home hospice care.

OBJECTIVE: To determine how home hospice patients deal with their impending death and whether there is a need for greater involvement of mental health professionals in the care of patients dying at home. METHOD: In a pilot study, 12 female home hospice patients with advanced cancer and a median survival time of 42 days were assessed using structured interviews and brief questionnaires. Topics of inquiry included facing death, fear of death, pain, fatigue, depression, and anxiety. Three key themes were extracted from the information reported by the women: (1) confronting the issue of death, (2) fear of dying and death and its correlates, and (3) spirituality/religious faith and its role in mitigating fear of death. RESULTS: First, all subjects reported thinking about their approaching death. For half of them, this thought was bothersome and these women were frequently troubled by unresolved issues and higher anxiety, pain, and fatigue. The majority of the subjects expressed a desire to actively discuss their impending death. Second, more than half of the patients reported being afraid of death and high death anxiety was associated with fear of dying in pain, high peak or usual pain, unresolved issues, and difficulty in parting with family in death. Third, most subjects experienced their religious faith as an important source of comfort and strength. SIGNIFICANCE OF RESULTS: A substantial subgroup of home hospice patients expressed problems dealing with their approaching death. These problems are amenable to psychological treatment, such as fear of death, unresolved issues, parting with family, and pain. The findings, thus, highlight the need for close collaboration of mental health professionals with home hospice institutions.

Adaptation, Psychological↗
PubMed2006

Disparities in colorectal cancer screening: a guideline-based analysis of adherence.

PURPOSE: This study's primary objective was to describe colorectal cancer (CRC) screening disparities using a guideline-derived definition of CRC screening adherence while controlling for confounding factors associated with CRC screening. METHODS: This secondary data analysis of the 2000 National Health Interview Survey (NHIS) included 12,677 individuals age > or = 50 years. The primary outcome assessed was adherence to CRC screening guidelines, defined as a sigmoidoscopy or proctoscopy within the last five years, colonoscopy within the last 10 years, or home fecal occult blood test within the last 12 months. Age, race/ethnicity, gender, physical disability, household income, insurance status, education level, marriage status, rural or urban geographic area, and family history of CRC were analyzed as covariates in a logistic regression model. We assessed the association between these sociodemographic variables and receipt of physician recommendation for CRC screening among those respondents not adherent to CRC screening recommendations. RESULTS: In the multivariate model, the odds for being adherent with current CRC screening recommendations were lower for Hispanics (odds ratio [OR] 0.71, 95% confidence interval [CI] 0.59-0.86) and African Americans (OR 0.82, 95% CI 0.71-0.95) than for Whites. Residents of urban areas had higher odds (OR 1.19, 95% CI 1.06-1.34) of being up-to-date than rural residents. Among subjects who were not up-to-date with CRC screening, similar disparities were noted in receipt of physician recommendation for CRC screening. CONCLUSIONS: Certain groups are at increased risk of not receiving CRC screening or recommendations for screening from their physicians. Interventions to reduce these disparities should be an integral part of overall efforts to improve CRC prevention and control.

Black or African American↗
PubMed1993

Validation of 24-hour recalls assisted by food records in third-grade children. The CATCH Collaborative Group.

OBJECTIVE: The objective of the study was to validate the use of 24-hour recalls assisted by food records as a dietary assessment tool for use with third-grade children. DESIGN: Trained staff observed children during mealtime at school, and parents observed and recorded what children ate in their presence. The following day children participated in a 24-hour recall interview. Children's ability to recall what they consumed during a 24-hour period was compared with observational data collected during the same period. SETTING: All data were collected in elementary school settings at four sites involved in the Child and Adolescent Trial for Cardiovascular Health. SUBJECTS: The sample of 49 children was self-selected, based on parents' willingness to observe and record their child's food intake. MAIN OUTCOME MEASURES: Recalled and observed data for energy and nutrient levels were compared using mean energy and nutrient analysis and quartile classification. In addition, recalled and observed foods were compared by meal type and estimation of portion size. STATISTICAL ANALYSIS PERFORMED: Paired t tests, Pearson and Spearman correlations, and classification analysis were used to compare recalled and observed data. RESULTS: Comparison of observed and recalled food intakes showed no significant differences in percentage of energy from total fat, saturated fat, monounsaturated fat, and polyunsaturated fat or in the amount of sodium consumed, although there were differences in energy intakes. Spearman rank order correlations between recalled and observed nutrients ranged from .45 to .79. A 77.9% agreement was found across all meals in the food items children recalled having consumed compared with those adults actually observed them consuming. CONCLUSIONS: We conclude that the 24-hour recall assisted by food records is a valid method for assessing the dietary intake of children as young as 8 years old for the purpose of group comparison.

Age Factors↗