First Round Of Interviews Research Articles

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PIN7 Qualitative Research Methods to Evaluate Healthcare Provider and Adult Vaccine Recipient Attitudes, Barriers, and Facilitators to Completing the Recombinant Zoster Vaccine Regimen in Canada

The National Advisory on Canadian Immunizations recommends the two-dose recombinant zoster vaccine (RZV) for prevention of herpes zoster in adults ≥50 years old. Research shows only 65%–75% of vaccine recipients in Canada complete the RZV series, the reason for which is unclear. Literature on factors influencing multi-dose vaccine completion among adults is limited as most adult vaccines are single-dose. Qualitative research from the perspectives of healthcare providers (HCPs) and vaccine recipients can provide insights on multi-dose vaccine compliance and completion through the generation of rich and nuanced data. The qualitative research methodology that will be used to explore HCP and vaccine recipient attitudes, barriers, and facilitators related to completing the RZV regimen is described. Two rounds of one-on-one semi-structured concept elicitation (CE) interviews will be conducted via telephone/webcam. CE is commonly used in qualitative research to better understand a condition, disease, or treatment experience. The first round of interviews will involve up to 12 HCPs. The second will examine up to 40 healthy adults ≥50 years old, who have received ≥1 RZV doses. Concepts identified in HCP interviews will be incorporated into subsequent interviews with vaccine recipients. Sample size will be determined when saturation of concepts, i.e. the point at which no new concepts emerge from interviews, is reached. All interview transcripts will be coded and analyzed using a two-part thematic analysis approach incorporating both codes developed in advance and those developed and refined in an on-going manner as transcripts are reviewed and analyzed. This mix of coding methods will ensure aspects of interest are addressed while leaving room to consider new concepts, descriptions, and experiences. This qualitative study will yield insights that may help inform relevant stakeholders of novel approaches to improve RZV series completion to optimize protection against herpes zoster and offer a basis for future research.

Exploring Opportunities with Experimental Use of Communicative Spaces to Overcome Defensive Routines and Increase Information Systems Utilization

Both organizations and the information technology (IT) community have long worked to overcome the common problem of dissatisfaction with IT investments’ outcomes in multiple ways. Much attention has been on users’ involvement in IT design, while users’ engagement in later further utilization of IT is less explored. This paper reports on action research (AR) that sought to stimulate local learning processes and increase the exploitation of a case-handling system. The experiment is done in a county administration where the senior management has, for some time, felt that the IT is not fully utilized. The local intervention was based on an awareness of a need to overcome defensive routines to establish communicative spaces to facilitate communication between various units with strong local identities. The AR project was carried out in three local interventions and presented as an experimental approach. We could not guarantee that the design could overcome the issues identified after the first round of interviews with senior management and department managers. The intervention process espoused various defensive routines, even some that the communicative space approach could not overcome. The outcomes from the three experiments are, therefore, mixed. The results indicate that creating communicative spaces is a viable approach to engaging users in systems development. Nevertheless, defensive routines, reluctant managers, and communities of practices hamper the development of communicative spaces.

Hongi, Harirū and Hau: Kaumātua in the time of COVID-19

ABSTRACT Kaumātua have key leadership responsibilities within their communities and are crucial in curbing the spread of COVID-19. Yet kaumātua are also among the most vulnerable to the disease, given compromised health, living situations and reliance on whānau and others for care. Our study explored kaumātua concerns and reactions to COVID-19. We aimed to understand how kaumātua understand the tapu of the body and tikanga relevant to the spread of COVID-19. We are interested in how kaumātua navigate the challenges presented by COVID-19 in light of evolving advice and regulations regarding personal distancing, self-isolation and gatherings. We used digital technologies and cellphones to communicate with Ngātiwai and Waikato kaumātua on a regular basis over a six-week period. Drawing on rich kōrero from our first round of interviews we will share findings from the study to assist Māori communities, policy makers and health providers.

Closing well: national and international humanitarian workers\u2019 perspectives on the ethics of closing humanitarian health projects

Project closure is a core feature of humanitarian action. However, how decisions to end projects are made, and how closure is planned and implemented, has implications for upholding ethical commitments, and can have positive or negative consequences for affected communities, local stakeholders, and humanitarian organizations and their staff. To better understand the ethical dimensions of closing humanitarian projects, we undertook an investigation of national and international humanitarian workers’ experiences.Guided by interpretive description methodology, we conducted an exploratory qualitative study with two rounds of semi-structured interviews. Four national and five international staff of non-governmental organizations with experience of humanitarian health project closure took part. The participants had diverse professional roles and disciplinary backgrounds. All participants took part in the first round of interviews which focused on experiences and perceptions of ethics and project closure. Analysis of these interviews contributed to the development of a draft “ethics guidance note.” Five of the participants took part in the second round of interviews which focused on receiving feedback on the draft guidance note. We used constant comparative techniques and a recursive approach to data collection and analysis. In this article, we draw on both rounds of interviews to present findings related to how participants understood and experienced ethical responsibilities, challenges, and opportunities for humanitarian project closure.We identified six recurrent ethical concerns highlighted by interviewees regarding closure of humanitarian projects: respectfully engaging with partners and stakeholders, planning responsively, communicating transparently, demonstrating care for local communities and staff during project closure, anticipating and acting to minimize harms, and attending to sustainability and project legacy. We present these ethical concerns according to the temporal horizon of humanitarian action, that is, arising across five phases of a project’s timeline: design, implementation, deciding whether to close, implementing closure, and post-closure.This exploratory study contributes to discussions concerning the ethics of project closure by illuminating how they are experienced and understood from the perspectives of national and international humanitarian workers. The interview findings contributed to the development of an ethics guidance note that aims to support project closures that minimize harms and uphold values, while being mindful of the limits of ethical ideals in non-ideal circumstances.

Parental understanding of crucial medical jargon used in prenatal prematurity counseling

BackgroundParent-clinician shared decision making is the recommended model for the care of premature infants; thus, clinicians provide prenatal prematurity counseling to parents in the event of a mother’s hospitalization for premature birth. However, parental understanding of medical jargon commonly used during prematurity counseling is unknown.MethodsWithin an overall research agenda to develop and test an educational aid for prenatal prematurity education, we designed the Parental Knowledge of Premature Birth questionnaire. To evaluate parental comprehension of the medical jargon contained within the questionnaire, we conducted cognitive interviews, a formal method for evaluating comprehension and response to questionnaire items. Parents were recruited from a Level IV Neonatal Intensive Care Unit; purposeful recruitment ensured diversity with respect to gender, race, literacy level, and child’s gestational age. Data collection and analysis followed standard qualitative methods for cognitive interviewing. We report on the insights gained from these cognitive interviews regarding parental understanding of crucial medical jargon commonly used during prenatal prematurity counseling.ResultsParticipants included 10 women and 6 men who ranged in age from 23 to 38 years and represented Black/African-American (38%), Asian (6%), and white (56%) backgrounds. Five participants (31%) had less than a high school education or reading level below 9th grade (Wide Range Achievement Test version 4 reading subtest). In the first round of interviews, parents of all education and literacy levels had difficulty with medical jargon commonly used in prematurity counseling. Terms that parents found difficult to understand included “gestational age”, “mild or no developmental problems”, and “neonatologist”. Modified terms tested in a second round of interviews showed improved comprehension.ConclusionCognitive interviews provided empirical testing of parental understanding of crucial medical jargon and highlighted that language commonly used during prenatal prematurity counseling is not understood by many parents. For parents to participate in shared decision making, plain language should be used to maximize their understanding of medical information.

Development of a Comprehensive Questionnaire Evaluating Knowledge, Attitudes, and Practices Regarding University Student Food Access Resource Use

Abstract Objectives To develop a comprehensive questionnaire which assesses food security and knowledge, attitudes, and practices (KAPs) regarding food access resources at a large public university. Methods A comprehensive food security and food resource questionnaire was developed by a panel of nutrition and survey design experts for use with university students. The questionnaire underwent two rounds of cognitive interviews with a diverse group of university students to ensure questions were understood as intended. Feedback from the first round of cognitive interviews was used to inform changes and improve clarity. The second round of cognitive interviews was used to clarify changes made to the questionnaire during the first round of interviews. Following the cognitive interviews, the questionnaire was reviewed by the panel of nutrition and survey design experts and finalized. Results Following a systematic approach, a comprehensive questionnaire was developed and finalized for use with university students. The initial questionnaire contained 40 questions. Following the first round of cognitive interviews (n = 15 students) 34 questions were revised, 7 questions were added and 1 question was removed. Following the second round of cognitive interviews (n = 10 students), Likert-scale questions were edited for simplicity, and question formatting was edited to emphasize differences in questions that were otherwise identical. Before distribution, 7 questions about food choice were added, food security screening questions were added, and skip-logic was incorporated into the questionnaire and tested. Conclusions The final questionnaire evaluates food resource KAPs and contains 68 items, including questions from the 10-item USDA Food Security Module, and newly developed questions regarding student food choice motivations, sugar-sweetened beverage consumption habits, knowledge/awareness of food access resources, perceptions of food access resources, current student concerns/stressors, and financial considerations. This newly developed questionnaire has been distributed to 10,000 University of California, Davis students. Future applications for this questionnaire include distribution at other universities and colleges within California. Funding Sources This project was funded by an internal University of California, Davis research grant.

Patient's Perspective on Disease Burden, Remission Definition, and Symptoms Associated With Treatment Seeking: A Qualitative Study in Adult and Adolescent Patients With Crohn's Disease.

Disease burden, a definition of remission, and symptoms that drive treatment seeking were explored in a Crohn's disease (CD) population. A qualitative semistructured interview guide was developed, informed by published literature. Clinicians identified adolescents and adult patients with CD. Face-to-face interviews were audio-recorded and transcribed. Two rounds of interviews were conducted with patients. Transcripts were analyzed using thematic methods facilitated by ATLAS.ti. Twenty-four patients participated in the first round of interviews (n = 16 adults, mean age 50.3 years; n = 8 adolescents, mean age 15.6 years). Abdominal pain (n = 24), urgent bowel movements (n = 24), diarrhea (n = 23), and frequent bowel movements (n = 21) were the most frequently reported symptoms. CD affected patients' physical functioning, daily activities, emotional wellbeing, social functioning, work/education, and relationships. No major difference in disease burden was observed between adolescents and adults. Twenty-three patients (96%) reported they would seek or had sought medical treatment for at least one symptom including abdominal pain (n = 19), diarrhea (n = 12), and blood in stools/rectal bleeding (n = 9). On a 0-10 scale (0 = no symptom and 10 = symptom at its worst possible), most patients (87%, 20/23) answered they would seek/had sought treatment when the symptom's severity was at least 7. In the second round of interviews (n = 6 adults, mean age 51.5 years), 5/6 patients described that they did not require a complete absence of abdominal pain or loose/watery stools to consider their CD to be in remission. CD is associated with substantial disease burden. Worsening of some symptoms drives treatment seeking. To some patients, remission is not defined as a complete absence of symptoms.

Türkiye’de Yabancı Dil Ağırlıklı Beşinci Sınıf İngilizce Dersi Öğretim Programının Uygulanması: Nitel Bir Değerlendirme

This qualitative evaluation study aims to investigate the implementation process of a current educational reform on teaching English to young learners in Turkey, the Intensive English Language Program in the Fifth Grade, from English as a foreign language (EFL) teachers’ viewpoints. Seven EFL teachers at pilot schools in the city-center of Erzincan were interviewed twice. The results of the first round of interviews indicated that despite the challenges arising from the pilot program, the teachers had positive attitudes regarding the potential advantages of the program. However, the final interview results painted a different picture in that although the main principles of the policy were seen as beneficial for young learners, the teachers faced a variety of challenges, such as a heavy compulsory curriculum in terms of content, lack of professional development support on the new program and scarcity of suitable language teaching materials. Based on both these problems and the benefits of the program, the teachers offered several suggestions for improving the quality of the program; these targeted elements including poor design of the program and unsatisfying professional development support. This study takes a snapshot of the implementation of the current EFL reform and presents suggestions for policymakers and teachers.

PGI46 DISEASE BURDEN, SYMPTOMS ASSOCIATED WITH TREATMENT-SEEKING AND REMISSION DEFINITION: A QUALITATIVE STUDY IN ADULT AND ADOLESCENT PATIENTS WITH CROHN'S DISEASE

To assess disease burden and the symptoms that drive patients to seek treatment, and explore remission definition in adolescents and adults with Crohn’s disease (CD). A qualitative semi-structured interview guide was developed, informed by published literature. Clinicians identified adolescents and adult patients with CD. Face-to-face interviews were audio-recorded and transcribed. Two rounds of interviews were conducted. Transcripts were analyzed using thematic methods facilitated by ATLAS.ti. Twenty-four patients participated in the first round of interviews (n=16 adults, mean age 50.3 years; n=8 adolescents, mean age 15.6 years). Most patients (66.67%; n=16) had clinician-reported moderate disease severity; 70.83% (n=17) received biologic treatment. Abdominal pain (n=24), urgent bowel movements (n=24), diarrhea (n=23), and frequent bowel movements (n=21) were the most frequently reported symptoms. CD affected patients’ physical functioning, daily activities, emotional wellbeing, social functioning, work/education, and relationships. No major difference in disease burden was observed between adolescents and adults. Twenty-two patients (92%) reported they would seek or had sought medical treatment for at least one symptom including abdominal pain (n=19), frequent bowel movements (n=12), diarrhea (n=11) and blood in stools/rectal bleeding (n=8). Eight patients would seek medical help if they experienced a ‘flare up’ or a combination of symptoms. On a 0-10 scale (0=no symptom and 10=symptom at its worst possible), most patients (86%, 19/22) answered they would seek/had sought treatment when the symptom’s severity was ≥7. In the second round of interviews (n=6 adults, mean age 51.5 years), 5/6 of the patients described they did not require a complete absence of abdominal pain or loose/watery stools to consider their CD to be in remission. Adolescent and adult patients experience multiple symptoms which impact their functioning and daily activities. Exacerbations in symptom severity or frequency drive patients to seek treatment. Generally, remission is not defined by patients as a complete absence of symptoms.

672 Defining Meaningful Attributes for the Treatment of IBD From Patients' Perspective

INTRODUCTION: Crohn's disease (CD) and ulcerative colitis (UC) are chronic, debilitating inflammatory bowel diseases (IBD). Medications used to treat IBD pts have distinct characteristics. Research into patient preferences indicates values regarding medical treatment may vary depending on clinical disease phenotype.1–4 We present a descriptive system that includes the most relevant attributes for IBD treatment focusing on the patient perspective. METHODS: A three-step approach was used to develop the descriptive system. First, a literature review was performed and an initial list of attributes was developed and classified within domains and categories. Second, a focus group meeting was conducted with eight patient representatives and nine gastroenterologists. Using feedback elicited from the focus group meeting, the research team constructed an initial draft of the descriptive system, including a subset of domains and attributes. Third, all participants of the focus group meeting participated in two-rounds of structured online interviews. The structured interviews were used to refine the wording used for naming and defining each attribute and the levels of those attributes in the initial descriptive system. RESULTS: We identified 32 eligible publications and a list of 127 attributes grouped into 7 domains (effectiveness, side-effects, health related quality of life [HRQoL], well-being, available evidence, administration/convenience, and other) was developed. This list was discussed in the focus group meeting and a draft of the descriptive system containing 16 relevant attributes was constructed. The same attributes were defined for UC and CD while taking into consideration that the relative weights for each disease may differ. During the first round of interviews, patients ranked all attributes included in the descriptive system and based on the second round of interviews, the final descriptive system containing a total of 3 domains, 10 attributes, and their corresponding levels was developed (Table 1). CONCLUSION: This qualitative research shows which attributes within the domains of efficacy, complications/risk, and HRQoL patients value most when making treatment decisions. We developed a descriptive system that outlines the IBD treatments by means of the 10 most relevant attributes, which should be considered by physicians and nurses when discussing treatment options with a patient. These attributes will be weighted in a future study based on patient preferences.

A Fall Risk mHealth App for Older Adults: Development and Usability Study.

BackgroundFalls are the leading cause of injury-related death in older adults. Due to various constraints, objective fall risk screening is seldom performed in clinical settings. Smartphones offer a high potential to provide fall risk screening for older adults in home settings. However, there is limited understanding of whether smartphone technology for falls screening is usable by older adults who present age-related changes in perceptual, cognitive, and motor capabilities.ObjectiveThe aims of this study were to develop a fall risk mobile health (mHealth) app and to determine the usability of the fall risk app in healthy, older adults.MethodsA fall risk app was developed that consists of a health history questionnaire and 5 progressively challenging mobility tasks to measure individual fall risk. An iterative design-evaluation process of semistructured interviews was performed to determine the usability of the app on a smartphone and tablet. Participants also completed a Systematic Usability Scale (SUS). In the first round of interviews, 6 older adults participated, and in the second round, 5 older adults participated. Interviews were videotaped and transcribed, and the data were coded to create themes. Average SUS scores were calculated for the smartphone and tablet.ResultsThere were 2 themes identified from the first round of interviews, related to perceived ease of use and perceived usefulness. While instructions for the balance tasks were difficult to understand, participants found it beneficial to learn about their risk for falls, found the app easy to follow, and reported confidence in using the app on their own. Modifications were made to the app, and following the second round of interviews, participants reported high ease of use and usefulness in learning about their risk of falling. Few differences were reported between using a smartphone or tablet. Average SUS scores ranged from 79 to 84.ConclusionsOur fall risk app was found to be highly usable by older adults as reported from interviews and high scores on the SUS. When designing a mHealth app for older adults, developers should include clear and simple instructions and preventative strategies to improve health. Furthermore, if the design accommodates for age-related sensory changes, smartphones can be as effective as tablets. A mobile app to assess fall risk has the potential to be used in home settings by older adults.

Advance care planning in community dwellers: A constructivist grounded theory study of values, preferences and conflicts

Background: Most laypeople have not engaged in any advance care planning. Yet they are expected to articulate choices for life-sustaining interventions when they need admission to an acute care hospital in Canada. Aim: To describe how laypeople understand and make decisions for life-sustaining interventions when engaging in advance care planning. Design: Semi-structured interviews using constructivist grounded theory methodology and purposive sampling. Setting: Mid-size Canadian urban community Participants: In total, 20 healthy laypeople, 55 years and older, participated in in-depth semi-structured face-to-face interviews. Theoretical sampling was used to explore findings from the first round of interviews. Ten participants were invited for repeat interviews. Results: Four major themes were identified. Most participants claimed at the outset that they had engaged in advance care planning, but they were unfamiliar with contemporary life-sustaining interventions and had not factored these into their decisions. Participants’ confidence in their substitute decision makers precluded them from having explicit discussions with these individuals. Participants expressed their values and preferences in terms of unacceptable functional outcomes from serious illness, rather than desired interventions. The process of articulating their preferences within the interviews was subject to decision conflicts, which in turn helped them re-evaluate and refine their decisions. Conclusion: Advance care planning for the healthy older adult is challenging. Meaningful engagement may lead to conflicts in decision-making. Efforts to improve engagement must reflect what patients know and understand, their focus on unacceptable negative outcomes rather than interventions, and the need for iterative discussions with health-care providers.

Relational Contracting Conceptual Model for Public Sector Construction Organisations: An Indian Context

Adoption of relational contracting in public sector construction organisations is more difficult than in private sector organisations due to the inherent rigidity of public sector. Therefore, implementation of the relational contracting processes should be treated as an organisational change management process in public sector organisations. The purpose of this paper is to develop a relational contracting conceptual model (RCMM) by integrating success factors for positive change management in public sector organisations. A qualitative research methodology comprising two rounds of expert interviews was used. The first round of interviews was conducted to gauge the present level of relational contracting in public sector construction organisations. The second round of interviews was conducted to validate the relational contracting conceptual model by integrating success factors of change management in public sector organisations. The relational contracting model highlighted the importance of a need to develop a vision for partnering, stakeholder analysis and consensus building among them, empowerment of operational level employees and their participation in plan execution, time bound review meetings of top management on site to show commitment, resolution of disputes and fast decision making along with publication of the performance reports. The paper presents a critical insight on relational processes of public sector construction organisations in India in the context of organisational change management model which has not been the focus in majority of the previous research studies.

Academic Librarians Perceive Duration and Social Interaction as Important Elements for Professional Development

A Review of: Attebury, R. I. (2017). Professional development: A qualitative study of high impact characteristics affecting meaningful and transformational learning. The Journal of Academic Librarianship, 43(3), 232-241. http://dx.doi.org//10.1016/j.acalib.2017.02.015 Abstract Objective – To understand the characteristics of meaningful and transformational professional development experiences of academic librarians. Design – Qualitative analysis of in-depth interviews using a hermeneutic phenomenological approach. Setting – Public and private colleges and universities in the United States of America. Subjects – 10 academic librarians. Methods – The researcher selected 10 participants using an initial survey distributed through national library electronic mail lists. Two rounds of semi-structured, in-depth interviews were conducted over Skype during fall 2014 and spring 2015. The first round of interviews began with background questions about participants’ careers, then moved on to questions about professional development experiences that were meaningful and/or transformational. The responses from this first round of interviews were used to develop questions for a second round of interviews with the same participants. After completing the interviews, the researcher sent follow-up emails to participants in order to gather feedback on summaries and interpretations of interviews. The transcribed interviews were used to create an initial set of codes and then imported into NVivo for analysis using a hermeneutic phenomenological approach. Main Results – All participants reported on professional development experiences that they found to be meaningful. Half of the participants discussed professional development experiences that were transformational for their perceptions and practice of librarianship. The themes of duration and interaction were identified in every participant’s discussions of meaningful or transformational professional development. Reflection, discomfort, and self-awareness were also identified as prominent themes. Conclusion – The study found that two of the most important ingredients for meaningful and transformational professional development are activities that are sustained over time and that include social interaction. The participants perceived long-term, interactive professional development activities as opportunities to identify and address gaps in their professional knowledge, which benefits themselves and their organizations. On-the-job learning, single-theme workshops or institutes, and professional committee work were particularly promising forms of meaningful professional development. The author recommends that academic librarians who are interested in meaningful or transformational professional development look for activities that are sustained and interactive, that promote reflection, and that provide opportunities to increase self-awareness of gaps in knowledge. Facilitators of professional development activities should include interactive components and ensure that participants have a chance to stay in contact after the event in order to encourage long-term interaction and reflection.

Reforming the Portuguese mental health system: an incentive-based approach

BackgroundTo promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices.MethodsWe performed a comprehensive review of healthcare providers’ payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way.ResultsWe designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness.ConclusionsThe implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

P079: Transition to practice: evaluating the need for formal training in supervision and assessment techniques among senior emergency medicine residents and new to practice emergency physicians

Introduction: Final year emergency medicine residents may be transitioning to practice with little to no training on how to effectively supervise and assess trainees. It remains unclear how comfortable final year residents and new-to-practice physicians are with these competencies. The goal of our study was to examine physician comfort with supervision and assessment, whether there was a perceived need for formal training in these areas, and what gaps, barriers and enablers would exist in implementing it. Methods: Qualitative data were collected in two phases during September 2016-November 2017 through interviews of PGY5 emergency residents and new-to-practice staff at the University of Toronto and McMaster University in Ontario, Canada. A semi-structured interview guide was developed and used during the first round of interviews at the University of Toronto during phase one. Results from phase one were used to refine the interview guide, to be used in phase two, to ensure that all potential areas of thematic generation were touched upon. Phase two occurred at the University of Toronto and McMaster University using the refined interview guide. All transcripts were coded, analyzed, and collapsed into themes. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Results: Thematic analysis revealed five themes. Residents and staff alike described acquiring the skills of supervision and assessment passively, primarily through modeling the behaviours of others; the training that is available in these areas is variably used, creating a diversity of physician comfort levels within these two competencies; the many competing priorities in the emergency department represent significant barriers to improving supervision and assessment; providing negative feedback is universally difficult and often avoided, sometimes resulting in struggling trainees not being identified until late in residency; the move towards competency based education (CBE) will act as an impetus for more formal curriculum being required in these areas. Conclusion: As residency programs transition to a CBE model, there will be a greater need for formal training in supervision and assessment to achieve a standard level of comfort and competence among senior residents physicians in independent practice. These competencies will also need an emphasis on how to identify struggling trainees, and how to approach negative and constructive feedback.

A Qualitative Examination of Physician Gender and Parental Status in Pediatric End-of-Life Communication

ABSTRACTIn this study we utilized the framework of patient-centered communication to explore the influence of physician gender and physician parental status on (1) physician-parent communication and (2) care of pediatric patients at the end of life (EOL). The findings presented here emerged from a larger qualitative study that explored physician narratives surrounding pediatric EOL communication. The current study includes 17 pediatric critical care and pediatric emergency medicine physician participants who completed narrative interviews between March and October 2012 to discuss how their backgrounds influenced their approaches to pediatric EOL communication. Between April and June of 2013, participants completed a second round of narrative interviews to discuss topics generated out of the first round of interviews. We used grounded theory to inform the design and analysis of the study. Findings indicated that physician gender is related to pediatric EOL communication and care in two primary ways: (1) the level of physician emotional distress and (2) the way physicians perceive the influence of gender on communication. Additionally, parental status emerged as an important theme as it related to EOL decision-making and communication, emotional distress, and empathy. Although physicians reported experiencing more emotional distress related to interacting with patients at the EOL after they became parents, they also felt that they were better able to show empathy to parents of their patients.

Improving health care professionals’ collaboration to facilitate patient participation in decisions regarding life-prolonging care: An action research project

Much improvement is needed to facilitate patient involvement in medical decision-making related to life-prolonging care. Prior research focuses mainly on the communication in the physician-patient dyad; few studies have identified how other professionals are involved. Using a Research Action design, two rounds of interviews with four interprofessional groups from various clinical settings of a health center in Quebec, Canada were conducted between 2009 and 2010. The 37 participants represented nine professions (nurse, dietitian, occupational therapist, orderly, pastoral worker, physician, physiotherapist, respiratory therapist and social worker). The first round of interviews confirmed that all of these professionals are involved, in various ways, in communicating with patients regarding their goals of care. Based on these results, the research group developed two communications tools (paper forms) to facilitate the documentation of patient care goals. The first form includes a designated area where all professionals can note patients’ comments regarding decisions related to life-prolonging care. The second is a prescription form to document in the medical file the patient’s goals of care. Both tools were submitted to, and fine-tuned by, the professionals in the second round of interviews. These results confirm that interprofessional collaboration to facilitate patient participation in goals-of-care decisions is both possible and valued.

Thyroid Cancer Study among Ukrainian Children Exposed to Radiation after the Chornobyl Accident

In collaboration with the Ukrainian Research Center for Radiation Medicine, the U.S. National Cancer Institute initiated a cohort study of children and adolescents exposed to Chornobyl fallout in Ukraine to better understand the long-term health effects of exposure to radioactive iodines. All 13,204 cohort members were subjected to at least one direct thyroid measurement between 30 April and 30 June 1986 and resided at the time of the accident in the northern parts of Kyiv, Zhytomyr, or Chernihiv Oblasts, which were the most contaminated territories of Ukraine as a result of radioactive fallout from the Chornobyl accident. Thyroid doses for the cohort members, which had been estimated following the first round of interviews, were re-evaluated following the second round of interviews. The revised thyroid doses range from 0.35 mGy to 42 Gy, with 95% of the doses between 1 mGy and 4.2 Gy, an arithmetic mean of 0.65 Gy, and a geometric mean of 0.19 Gy. These means are 70% of the previous estimates, mainly because of the use of country-specific thyroid masses. Many of the individual thyroid dose estimates show substantial differences because of the use of an improved questionnaire for the second round of interviews. Limitations of the current set of thyroid dose estimates are discussed. For the epidemiologic study, the most notable improvement is a revised assessment of the uncertainties, as shared and unshared uncertainties in the parameter values were considered in the calculation of the 1,000 stochastic estimates of thyroid dose for each cohort member. This procedure makes it possible to perform a more realistic risk analysis.