Constant Comparative Technique Research Articles

Essential items for reporting of scaling studies of health interventions (SUCCEED): protocol for a systematic review and Delphi process

BackgroundThe lack of a reporting guideline for scaling of evidence-based practices (EBPs) studies has prompted the registration of the Standards for reporting studies assessing the impact of scaling strategies of EBPs (SUCCEED) with EQUATOR Network. The development of SUCCEED will be guided by the following main steps recommended for developing health research reporting guidelines.MethodsExecutive Committee. We established a committee composed of members of the core research team and of an advisory group.Systematic review. The protocol was registered with the Open Science Framework on 29 November 2019 (https://osf.io/vcwfx/). We will include reporting guidelines or other reports that may include items relevant to studies assessing the impact of scaling strategies. We will search the following electronic databases: EMBASE, PsycINFO, Cochrane Library, CINAHL, Web of Science, from inception. In addition, we will systematically search websites of EQUATOR and other relevant organizations. Experts in the field of reporting guidelines will also be contacted. Study selection and data extraction will be conducted independently by two reviewers. A narrative analysis will be conducted to compile a list of items for the Delphi exercise. Consensus process. We will invite panelists with expertise in: development of relevant reporting guidelines, methodologists, content experts, patient/member of the public, implementers, journal editors, and funders. We anticipated that three rounds of web-based Delphi consensus will be needed for an acceptable degree of agreement. We will use a 9-point scale (1 = extremely irrelevant to 9 = extremely relevant). Participants’ response will be categorized as irrelevant (1–3), equivocal (4–6) and relevant (7–9). For each item, the consensus is reached if at least 80% of the participants’ votes fall within the same category. The list of items from the final round will be discussed at face-to-face consensus meeting. Guideline validation. Participants will be authors of scaling studies. We will collect quantitative (questionnaire) and qualitative (semi-structured interview) data. Descriptive analyses will be conducted on quantitative data and constant comparative techniques on qualitative data.DiscussionEssential items for reporting scaling studies will contribute to better reporting of scaling studies and facilitate the transparency and scaling of evidence-based health interventions.

Organizational learning in consciousness-based education schools: a multiple-case study

PurposeAn innovative technology called consciousness-based education (CBE) is being introduced in schools worldwide. The approach includes both an experiential and an intellectual component. However, research studies exploring learning in CBE are rare. The purpose of the paper is to explore how organizational learning takes place in schools, which adopt CBE in addition to their ordinary curriculum. Moreover, the ambition of the approach regarding quality is examined.Methodology/approachA multiple-case study has been carried out. Four schools using CBE have been studied: a private school in Fairfield, Iowa, USA; a governmentally funded free school in Skelmersdale, United Kingdom; an independent school in Melbourne, Australia, and a primary school in Lelystad, the Netherlands. In total, 26 in-depth interviews have been performed, mainly with teachers and students but also with principals and experts in the CBE pedagogy. In addition, three focus-group interviews with primary school pupils were conducted and observation during classes was included. The data were analyzed by the constant comparative technique from the grounded theory approach.FindingsCategories characterizing organizational learning in the CBE schools have been identified. These findings are related to theories of the learning organization, resulting in a framework depicting different components of learning.Research limitation/implicationThe study provides a framework illustrating organizational learning in schools that utilize CBE which affords an overview of the technology and can serve as a vantage point for further research. Since this is a qualitative case study, the effectiveness of the CBE approach and its impact on learning outcomes were not assessed, and the possibilities to generalize the findings are limited.Originality/valueCBE has not previously been studied from an organizational learning perspective.

1222: Healthcare provider perspectives on barriers and facilitators to care for low-income pregnant women with diabetes

Treatment of gestational diabetes mellitus and type 2 diabetes mellitus during pregnancy can improve maternal and neonatal outcomes, yet self-care burdens for pregnant women with diabetes are high, particularly for low-income and minority women. Though prior studies have investigated patient-perceived barriers and facilitators to diabetes self-management during pregnancy, little work investigates healthcare providers’ perspectives. The objective was to investigate healthcare providers’ perspectives on barriers and facilitators of diabetes care during pregnancy. In this qualitative investigation, focus groups were conducted using a semi-structured interview guide designed to elicit provider perspectives on patient barriers and facilitators to successful diabetes-related self-management during pregnancy and their experiences of providing care. Providers included physicians, nurses, health educators, and other personnel who care for low-income pregnant women with diabetes. Transcripts were analyzed using the constant comparative technique to identify themes and subthemes, using the Social Ecological Model as a theoretical framework. Participants (N=29) identified barriers and facilitators to women’s achievement of optimal diabetes self-care according to five levels: environment, access, institution, interpersonal, knowledge, and individual (Figure). Example subthemes include inflexible work schedule (environment), poor medication and supply access (access), overburdened clinic (institution), perceived patient “policing” (interpersonal), and low health literacy (knowledge) (Table). Individual factors that influenced barriers and facilitators included self-efficacy, motivation, and engagement. Providers identified barriers, but not facilitators, for each theme. Providers described facilitators and barriers to diabetes care at all levels of the Social Ecological Model. These data can inform interventions to dismantle barriers patients face in order to create meaningful healthcare interventions to improve outcomes for low-income pregnant women with diabetes.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Role of Stigma Management in HIV Treatment Adherence.

Social stigma is linked to improper HIV treatment adherence, but how stigma impairs adherence outcomes is poorly understood. This study included 93 people living with HIV in the United States who participated in focus groups or one-on-one interviews regarding how stigma might affect medication management. Latent content analysis and constant comparative techniques of participant responses that were produced three thematic groupings that described how participants (a) orient to HIV stigma, (b) manage HIV stigma in ways that directly impair treatment adherence, and (c) manage HIV stigma in ways that may indirectly impair adherence. These findings illustrate the need to understand how patients orient to HIV stigma when prescribing medications and the complications that are inherent to such assessments. In addition, these findings provide a simple framework for organizing the different ways in which stigma management strategies may disrupt treatment adherence. Conceptually, these findings also offer a paradigm shift to extent theories on disclosure and concealment, in which only disclosure has been cast as an active process. These findings demonstrate how concealment is far from a passive default, often requiring enormous effort. Ultimately, these findings may guide intervention programs that help to entirely eliminate HIV by promoting optimized counseling and subsequent treatment adherence.

Initiation is recognized as a fundamental early phase of integrated knowledge translation (IKT): qualitative interviews with researchers and research users in IKT partnerships

BackgroundHealth care researcher-research user partnerships, referred to as integrated knowledge translation (IKT), have been adopted on an international basis, and are an effective means of co-generating and implementing evidence into policy and practice. Prior research suggests that an initiation period is essential for establishing functional partnerships. To characterize IKT initiation and describe determinants of IKT initiation success, this study explored IKT initiation processes, enablers, and barriers among researchers and research users involved in IKT partnerships.MethodsA descriptive qualitative approach was used compliant with COREQ standards. Canadian researchers and research users in research collaborations were identified on publicly-available directories and web sites, and referred by those interviewed. They were asked to describe how partnerships were initiated, influencing factors, the length of initiation, and interventions needed to support initiation. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team.ResultsIn total, 22 individuals from 6 provinces were interviewed (9 researchers, 11 research users, 2 connectors). They confirmed that IKT initiation is a distinct early phase of partnerships. The period ranged from 6 months to 2 years for 75.0% of participants in pre-existing partnerships, to 6 years for newly-formed partnerships. High-level themes were: Newly identifying and securing partners is an intensive process; Processes and activities take place over a protracted period through multiple interactions; Identifying and engaging committed partners is reliant on funding; and Partnership building is challenged by maintaining continuity and enthusiasm. Participants underscored the need for an IKT partner matching forum, IKT initiation toolkit, and funding for non-research activities required during IKT initiation to establish functional researcher-research user partnerships. Themes were largely similar regardless of participant years of experience with IKT or being involved in a new versus pre-existing partnership.ConclusionsIKT initiation is a recognized and important early phase of IKT that establishes functional partnerships, and once established, ongoing partnership for subsequent projects is likely. Further research is needed to develop and evaluate approaches recommended by participants for stimulating IKT initiation.

Pre-service teachers learning through service-learning in a low SES school

ABSTRACTBackground and purpose: The purpose of this research was to understand the experiences of pre-service teachers in a service-learning program. The research questions that guided this research were: (1) How does an after-school service-learning program that utilizes pre-service teachers develop students’ pedagogy? (2) What are the experiences of pre-service teachers teaching in low SES schools through a service-learning approach?Methods: During the 2016–2017 school year, nine pre-service physical education students took part in a service-learning program. The REACH program was a free after-school physical education and literacy program for 5th and 6th grade students at a low SES school. This program consisted of two-hour sessions, twice per week, for 30-weeks starting in the Fall and ending in the Spring. Data consisted of interviews, pre-service teachers’ journals, researcher journals, and researcher field notes. In total, 500 pages of data were analyzed using the constant comparative technique. Two researchers independently coded these data and a peer reviewer then separately reviewed the data and findings.Results: Three themes emerged from the data analysis. Theme 1 – Developing pedagogies in real-world settings. Theme 2 – Connecting with students and learning how to manage behavior. Theme 3 – Teaching in a low SES school: A wake-up call.Conclusions and implications: Pre-service teachers in this study were able to practice their pedagogy in a real-world environment and gain valuable experience in developing classroom and behavior management skills. The REACH program provides a model for a service-learning approach where pre-service students can practice and refine their teaching skills through extended involvement in an after-school program that served students in a low SES community.

Recommendations to improve patient‐centred care for ductal carcinoma in situ: Qualitative focus groups with women

BackgroundPatient‐centred care (PCC) improves health‐care experiences and outcomes. Women with ductal carcinoma in situ (DCIS) and clinicians have reported communication difficulties. Little prior research has studied how to improve communication and PCC for DCIS.ObjectiveThis study explored how to achieve PCC for DCIS.DesignCanadian women treated for DCIS from five provinces participated in semi‐structured focus groups based on a 6‐domain cancer‐specific PCC framework to discuss communication about DCIS. Data were analysed using constant comparative technique.Setting and ParticipantsThirty‐five women aged 30 to 86 participated in five focus groups at five hospitals.ResultsWomen said their clinicians used multiple approaches for fostering a healing relationship; however, most described an absence of desired information or behaviour to exchange information, respond to emotions, manage uncertainty, make decisions and enable self‐management. Most women were confused by terminology, offered little information about the risks of progression/recurrence, uninformed about treatment benefits and risks, frustrated with lack of engagement in decision making, given little information about follow‐up plans or self‐care advice, and received no acknowledgement or offer of emotional support.Discussion and ConclusionsBy comparing the accounts of women with DCIS to a PCC framework, we identified limitations and inconsistencies in women's lived experience of communication about DCIS, and approaches by which clinicians can more consistently achieve PCC for DCIS. Future research should develop and evaluate informational tools to support PCC for DCIS.

The coach-parent relationship in Canadian competitive figure skating: An interpretive description

ObjectivesThe purpose of this study was to understand the nature of the coach-parent relationship in Canadian competitive figure skating. DesignQualitative, interpretive description. MethodData were collected using individual semi-structured interviews with 12 mothers of competitive figure skaters and 12 coaches (M years of experience = 25). All interviews were transcribed verbatim and analysed inductively using conventional content analysis and constant comparative techniques. ResultsFindings indicated that parents described a range of experiences of the coach-parent relationship, from negative and distant, to positive and enjoyable, while coaches described their experiences as mostly positive and enjoyable but with the potential for the relationship to be challenging and contentious. Participants’ descriptions of their experiences clustered around three configurations that represented different views about the nature of the coach-parent relationship, including (a) collaborative, (b) coach-athlete centric, and (c) contractual. These configurations are discussed in light of three prominent themes that characterized the relationship: expertise, communication, and trust. ConclusionsThis study highlights the unique features of the coach-parent relationship in Canadian competitive figure skating, including the different ways that parents and coaches relate with one another, and draws parallels with other relationships in sport. Understanding the coach-parent relationship not only extends the extant literature on interpersonal relationships in sport, but is also important for facilitating positive youth sport environments and youth development in competitive sport.

STUDENTS’ PERCEPTION OF LEARNING STEM-RELATED SUBJECTS THROUGH SCIENTIST-TEACHER-STUDENT PARTNERSHIP (STSP)

Science education is facing an immense challenge due to students’ lack of engagement with science education. This issue calls for a collaborative and integrative teaching strategy such as the Scientist-Teacher-Student Partnership (STSP). This research employed a qualitative research methodology supported by quantitative data, to explore students’ perceptions of learning science through STSP. It involved 125 students in Grade 10 from four schools, eight science teachers and seven scientists from a university situated in Kuala Lumpur. The data were collected through survey questionnaire and interviews. The collected qualitative data were analysed using constant comparative techniques and the quantitative data arising from the responses of the survey were calculated as mean scores and standard deviations. The findings showed that the tripartite collaboration brings educational benefits to all groups. Based on the student’ perspective, four (4) main themes emerged. The students found that 1) the partnership enriched their learning experiences, 2) they acquired procedural skills through hands-on experiments, 3) they had the opportunity to explore emerging topics in science, and 4) they were exposed to various career opportunities in STEM-related fields. This research has promoted greater articulation of STSP as a mechanism for educational reform in STEM. Keywords: authentic science, qualitative methodology, Scientist-teacher-student partnership (STSP), STEM.

How Clinician-Family Interactions Potentially Impact Clinicians' Conceptualization and Discussions Regarding Prognostic Uncertainties.

Little is known about how clinicians perceive prognostic uncertainty. Our study objective was to identify factors that influence how prognostic uncertainty is viewed by physicians, as it relates to their communications with families. Thirty semi-structured interviews with qualitative content analysis (9 surgeons, 16 intensivists, 3 nurse practitioners, and 2 "other" clinicians). We analyzed interviews using qualitative description with constant comparative techniques. Open medical, surgical, neurosurgical, and cardiovascular intensive care units (ICUs) in a 900-bed academic, tertiary Houston hospital. None. We identified 2 main factors that influence how clinicians perceive prognostic uncertainty and their perceptions about whether and why they communicate prognostic uncertainties to families: (1) Communicating Uncertainty to "Soften the Blow"; and (2) Communicating Uncertainty in Response to Clinicians' Interpretations of Surrogate Decision Makers' Perceptions of Prognostic Uncertainty. We also identified several subthemes. Clinician-family interactions influence how clinicians perceive prognostic uncertainty in their communications with patients or families. We discuss ethical and clinical implications of our findings.

Improving patient-centred care for persons with Parkinson's: Qualitative interviews with care partners about their engagement in discussions of "off" periods.

ObjectiveThis study explored how care partners (CPs) of persons with Parkinson's (PwP) are engaged in discussions of “off” symptoms.MethodsDuring qualitative interviews, CPs of PwP sampled by convenience through the Michael J Fox Foundation online clinical trial matching service were asked to describe their familiarity with “off” symptoms, how “off” symptoms were discussed with clinicians, and the impact of “off” symptoms on them. Data were analysed using constant comparative technique by all members of the research team.ResultsA total of 20 CPs were interviewed. Compared with PwP, they were more likely to describe “off” symptoms to clinicians. CPs identified important aspects of patient‐centred care for PD: establishing a therapeutic relationship, soliciting and actively listening to information about symptoms, and providing self‐management support to both PwP and CPs. CPs said that clinicians did not always engage CPs, ask about “off” symptoms or provide self‐management guidance, limiting their ability to function as caregivers.ConclusionBy not engaging and educating CPs, “off” symptoms may not be identified or addressed, leading to suboptimal medical management and quality of life for PwP. These findings must be confirmed on a broader scale through ongoing research but suggest the potential need for interventions targeted at clinicians and at CPs to promote patient‐centred care for PwP.

ANALISIS EFEKTIVITAS DAN EFISIENSI PELAPORAN TENAGA KERJA DENGAN MENGGUNAKAN SISTEM MANUAL DAN SISTEM ONLINE (STUDI KASUS BPJS KETENAGAKERJAAN CABANG GRESIK)

This study aims to determine the effectiveness and efficiency of employment reporting in the office BPJS Employment Ketenagakerjaan Gresik. Using 6 informants from BPJS Ketenagakerjaan employee and 4 informants from the participant to know comparison of effectiveness and efficiency of reporting in BPJS Ketenagakerjaan of Gresik. The analysis was done by using constant comparative analysis technique. The results show that Online reporting application meets the indicators of effectiveness and efficiency.

ANALISIS EFEKTIVITAS DAN EFISIENSI PELAPORAN TENAGA KERJA DENGAN MENGGUNAKAN SISTEM MANUAL DAN SISTEM ONLINE (STUDI KASUS BPJS KETENAGAKERJAAN CABANG GRESIK)

This study aims to determine the effectiveness and efficiency of employment reporting in the office BPJS Employment Ketenagakerjaan Gresik. Using 6 informants from BPJS Ketenagakerjaan employee and 4 informants from the participant to know comparison of effectiveness and efficiency of reporting in BPJS Ketenagakerjaan of Gresik. The analysis was done by using constant comparative analysis technique. The results show that Online reporting application meets the indicators of effectiveness and efficiency.

Yatılı Bölge Ortaokulu Öğrencilerinin STEM Alanlarına Yönelik Kariyer Farkındalığının Araştırılması

Bu araştırmada, yatılı bölge ortaokulu öğrencilerinin fen, teknoloji, mühendislik, matematik (STEM)) alanlarında kariyer geliştirmeye yönelik farkındalıkları, ilgileri ve bu ilgilerinin dayandığı unsurların belirlenmesi amaçlanmaktadır. Araştırmada karma yöntemler araştırma desenlerinden keşfedici ardışık desen kullanılmıştır. Araştırmanın çalışma grubunu yatılı bölge ortaokulunda (YBO) 8. sınıfta öğrenim gören 92 öğrenci oluşturmaktadır. Araştırmanın nitel verileri doküman (anket) ve odak grup görüşme yöntemi ile toplanmış, betimsel ve sürekli karşılaştırmalı analiz tekniği ile analiz edilmiştir. Nicel veriler “STEM Mesleklerine Yönelik İlgi Ölçeği” ile toplanmış ve betimsel istatistik tekniği ile analiz edilmiştir. Araştırmanın nitel verileri ile az sayıda öğrencinin STEM alanlarındaki mesleklere yönelmek istediğini, nicel veriler ise öğrencilerin STEM alanlarına kariyer geliştirmede ilgili olduğunu göstermiştir.

Curricular Monikers: What's in a Name?

This article was migrated. The article was not marked as recommended. Introduction: An increasing number of North American medical schools are assigning unique names ("monikers") to their undergraduate curricula, but it is unclear as to how often this occurs, and what kind of names schools are choosing. Method: A manual review of the 160 websites that corresponded to Schools of Medicine that were either fully or provisionally accredited by the Liaison Committee on Medical Education (LCME). Results: 31.5% of the 143 U.S. allopathic medical schools and only one (5.8%) of the 17 LCME accredited Canadian medical schools currently associate a unique curricular name with their undergraduate medical education programs. Use of a constant-comparative technique suggested that schools that did assign a curricular name to their programs had selected names that aligned to one of eight over-arching themes. Conclusions: While curricular names were somewhat less commonly applied in schools located in the western United States, no specific trends in thematic choices predominated in any geographic region. However, the impact of curricular themes on current and/or prospective medical students remains an area for continued exploration, as does the longitudinal question as to whether thematically named curricula succeed in delivering their intended results.

Creating a culture for sustainability and quality – a lean-inspired way of working

Even though much research has been carried out regarding various sustainability issues, the research into cultural aspects of sustainability and quality is very limited. The purpose of this study is to explore the culture of an award-winning company that is successfully working with sustainability and quality. The ambition is to contribute to the development of sustainable quality management. In order to identify and describe their ways of working, a case study was carried out at Sky Factory, an award-winning innovative manufacturing company which utilises Lean principles. In-depth interviews were performed with the CEO and a number of employees focusing on exploring their way of working as well as their value base, attitudes and practices regarding quality and sustainability. The data collection also included document studies and observation. The research was inductive, based on the Grounded Theory methodology and the data was analysed with the constant comparative technique. The analysis revealed a set of categories in the form of dimensions which, combined with theory, resulted in a tentative framework. One limitation is that the study only included a single company, which may limit the possibilities for generalisation. Nonetheless, the dimensions that were identified and the framework that integrates them should be useful as a vantage point for further research.

Overshadowed by Assessment: Understanding Trainee and Supervisor Perspectives on the Oral Case Presentation in Internal Medicine Workplace-Based Assessment.

The oral case presentation (OCP) is an essential part of daily clinical practice in internal medicine (IM) and a key competency in medical education. It is not known how supervisors and trainees perceive OCPs in workplace-based learning and assessment. Using a constructivist grounded theory approach, 26 semistructured interviews were held with trainees and supervisors (18 clinical clerks and first- through third-year postgraduate trainees, and 8 supervisors) on the IM clinical teaching unit at the University of Toronto, 2015-2016. Interviews focused on how the OCP was viewed by both trainees and supervisors in clinical practice as a tool for patient care, learning, and assessment. Iterative, constant comparative techniques were used to analyze the interviews and develop a framework to understand trainee and supervisor perspectives. Supervisors and trainees viewed the OCP as an important part of informal trainee assessment in IM. Supervisors used OCPs to understand the patient through trainee-demonstrated skills including the use of narratives, information synthesis, and management of uncertainty. However, because of awareness of assessment, trainees sought to control the OCP, viewing it as a performance demonstrating their competence, mediated by senior residents and tailored to supervisor preferences. Preoccupied with assessment around OCPs, trainees often lost sight of the valuable learning taking place. Use of OCPs in assessment necessitates optimization of the educational activity for trainees. Providing explicit direction to both trainees and supervisors, defining expectations, and clarifying the assessment activity of the OCP can optimize the encounter for best educational practice.

A Phenomenological Account of HIV Disclosure Experiences of Children and Adolescents from Northern and Southern Ghana.

Disclosure of HIV status to infected children, though challenged by caregiver dilemma, remains central in achieving the United Nations Programme on HIV and AIDS (UNAIDS) global goal of 90/90/90. This study explores children’s HIV disclosure experiences across Northern and Southern Ghana. A qualitative interpretative phenomenological design facilitated the recruitment of 30 HIV positive disclosed children and adolescents aged 9–19 years in 12 antiretroviral treatment (ART) centers in Northern and Southern Ghana between January 2017 and June 2018. Data was collected via in-depth interviews. We used phenomenological analysis applying concepts and categories identification, patterns and interconnections searching, mapping, theme building and constant comparative technique to draw conclusions. Disclosure of HIV status to children occurred with little or no preparation. Caregivers intentionally or out of dilemma often prolonged or postponed disclosure to when children aged older. Illness severity and disease progression principally defined the need for disclosure. Children preference for early status disclosure averaged at age 10 was demonstrated despite the initial disclosure experience of shock and disappointment. There was improved medication adherence despite the challenge of limited knowledge about HIV transmission, financial difficulty and food insecurity. Context and culturally adapted pre- and post- disclosure guideline laced with social protection package is needed to support HIV positive children.

Engaging people who inject drugs in hepatitis C virus testing and prevention through community-based outreach, in Sydney, Australia.

Increasing treatment uptake among people who inject drugs (PWID) with chronic hepatitis C virus (HCV) infection is integral to eliminating viral hepatitis. This study explored the role of community-based outreach in engaging and retaining Australian PWID in the testing component of the HCV care cascade. Semi-structured interviews were conducted with 28 PWID, including new initiates to injecting and those from culturally and linguistically diverse (CALD) backgrounds, who acquired HCV infection while enrolled in a community-based prospective observational study of hepatitis C vaccine preparedness in Sydney. Participants were interviewed at diagnosis and 12 months later. Transcripts were thematically analysed using constant comparative techniques. Community-based outreach was effective in engaging newly infected participants in HCV monitoring and decision-making about seeking interferon-based treatment. Key factors in the acceptability of outreach were privacy and discretion, and opportunities to build trust with non-judgmental staff. Retaining participants in the HCV cascade of care required more than a one-off session of post-test counselling. Ongoing discussions with staff enabled paced and tailored delivery of information about HCV prevention, testing and treatment. Increased understanding of the role of HCV ribonucleic acid viremia in determining the need for treatment, and access to this testing, was pivotal in making HCV monitoring salient for participants. Outreach is an effective strategy for engaging new initiates to injecting and CALD PWID in HCV testing and decision-making about treatment. Findings highlight the need to increase availability and access to HCV ribonucleic acid testing for PWID.

Hearing Loss: Effect on Hospice and Palliative Care Through the Eyes of Practitioners

ContextDiscussions regarding values and goals of care are central to providing quality palliative care. An inability to hear during these sensitive discussions may significantly impair the quality of care provided, yet hearing loss (HL) is not formally addressed in these settings or in programs designed to assist practitioners gain advanced communication skills. ObjectiveTo gain an understanding of hospice and palliative care practitioners' experiences with HL and its impact on the care provided. MethodSurveyMonkey questionnaire eliciting whether and how HL impacted care provided with an open-ended question asking for descriptions of a situation where HL created a problem in communication with an older patient. Responses were analyzed using constant comparative techniques. ResultsOf 510 respondents, 464 (91%) reported HL had some or great impact on the quality of care provided, 449 (88%) noted encountering a situation where HL impaired communication with an older adult, and 99 of these participants (22%) provided a specific example. The overarching theme was “Diagnostic and Treatment Uncertainty.” Nonmutually exclusive categories underpinning this theme included the following: unable to get needed information, misinterpreting level of understanding, patient misunderstanding of instructions, and goals-of-care errors. ConclusionHL impacts the quality of care provided to persons with serious illness by disrupting the identification, assessment, and treatment of the physical, psychosocial, and spiritual symptoms an individual is experiencing. HL should be formally addressed in programs designed to develop skills in conducting sensitive conversations. Practitioners should screen for HL, use practices that facilitate comprehension, and use assistive listening devices as needed.