Physician Focus Groups Research Articles

Optimizing the Analytical Value of Oncology-Related Data Based on an In-Memory Analysis Layer: Development and Assessment of the Munich Online Comprehensive Cancer Analysis Platform.

BackgroundMany comprehensive cancer centers incorporate tumor documentation software supplying structured information from the associated centers’ oncology patients for internal and external audit purposes. However, much of the documentation data included in these systems often remain unused and unknown by most of the clinicians at the sites.ObjectiveTo improve access to such data for analytical purposes, a prerollout of an analysis layer based on the business intelligence software QlikView was implemented. This software allows for the real-time analysis and inspection of oncology-related data. The system is meant to increase access to the data while simultaneously providing tools for user-friendly real-time analytics.MethodsThe system combines in-memory capabilities (based on QlikView software) with innovative techniques that compress the complexity of the data, consequently improving its readability as well as its accessibility for designated end users. Aside from the technical and conceptual components, the software’s implementation necessitated a complex system of permission and governance.ResultsA continuously running system including daily updates with a user-friendly Web interface and real-time usage was established. This paper introduces its main components and major design ideas. A commented video summarizing and presenting the work can be found within the Multimedia Appendix.ConclusionsThe system has been well-received by a focus group of physicians within an initial prerollout. Aside from improving data transparency, the system’s main benefits are its quality and process control capabilities, knowledge discovery, and hypothesis generation. Limitations such as run time, governance, or misinterpretation of data are considered.

"Quality of life": parent and neonatologist perspectives.

ObjectiveTo assess how physicians and families understand quality of life (QOL) for NICU patients, and to explore the feasibility of developing a standardized definition for QOL.Study designSurveys were developed and administered to neonatologists and eligible families. Quantitative analysis was conducted using standard statistical methods. Qualitative analysis was conducted using NVivo software. Focus groups were conducted with the same groups, and audio recordings were obtained and analyzed for recurring themes.ResultsBoth parents and physicians value QOL as a metric for guiding care in the NICU. Parents were more likely to accept higher levels of disability, while neonatologists were more likely to accept higher levels of dependence on medical equipment. In relation to infant QOL, predominant themes expressed in the parent focus groups were stress levels in the NICU, advocating as parents, and the way in which long-term outcomes were presented by the medical team; in the physician focus group, the ambiguity of predicting outcomes and thus QOL was the main theme.ConclusionsBoth parents and physicians recognize the importance of QOL in the decision-making process for critically ill infants, but the two groups differ in their assessment of what QOL means in this context. These data suggest that QOL cannot be adequately defined for standardized use in a clinical context, and as such, should be used thoughtfully by neonatologists in discussions of end- of-life care.

Feasibility of alcohol screening and brief intervention in primary health care in Kazakhstan: study protocol of a pilot cluster randomised trial

BackgroundIdentifying and addressing heavy drinking represents a major public health priority worldwide. Whilst the majority of alcohol screening and brief intervention (ASBI) research has been conducted in western, high-income countries, evidence is growing that ASBI can also impact positively on heavy drinkers in low- and middle-income country populations. This mixed methods study aims to assess the feasibility of conducting a fully randomised controlled trial of the effectiveness of ASBI in primary care in Kazakhstan and explore the feasibility and acceptability of implementing ASBI in this setting from patients’ and physicians’ perspectives.MethodsSix primary health care units in the region of Pavlodar will be cluster randomised to either an intervention (WHO manualised 5 min alcohol brief intervention plus alcohol leaflet) or control group (simple feedback plus alcohol leaflet). Primary feasibility measures will be rates of participation at baseline and retention of eligible patients at the 3-month follow-up point. Patient/physician questionnaires and physician focus groups will assess additional dimensions of feasibility, as well as acceptability, according to the RE-AIM framework: Reach (rates of eligible patients screened/received advice); Effectiveness (change in AUDIT-C score); Adoption (rate/representativeness of participating physicians); Implementation (quality of ASBI/barriers and facilitators to delivery); and Maintenance (potential sustainability of intervention).DiscussionThis is the first trial of the feasibility and acceptability of ASBI in Kazakhstan. As the planning and assessment of implementation determinants is based on the RE-AIM framework, the project outcomes will be relevant for the future development, tailoring and implementation of ASBI in Kazakhstan.Trial registrationDRKS, DRKS00015882, Registered 17 December 2018.

Perceptions of and Barriers to Lung Cancer Screening Among Physicians in Puerto Rico: A Qualitative Study.

Low-dose computed tomography (LDCT), an accepted U.S. screening tool for early lung cancer detection, is not widely-used in Puerto Rico. We investigated knowledge and attitudes about LDCT in focus groups of primary care physicians (PCP) and individuals at high risk for lung cancer (HRI) in Puerto Rico. Transcribed/translated audio-recorded discussions were analyzed with the constant comparison method. Both groups had limited knowledge about LDCT and concerns regarding insurance coverage. Most HRIs had never had a provider recommend LDCT and believed that having symptoms was necessary to obtain LDCT screening. Perceived barriers included fears about results and the procedure; a perceived benefit was having early detection and possibly being cured. Few PCPs had ever recommended LDCT to a patient, with those who had basing their decision on symptoms/smoking history but having challenges with insurance. More education on LDCT is needed among HRIs, and U.S. Preventive Services Task Force guidelines should be widely distributed to encourage physician recommendations.

Drivers of preventable high health care utilization: a qualitative study of patient, physician and health system leader perspectives.

A small percentage of patients account for the bulk of population health care utilization and costs in many countries including the United States (US). In the US, 5% of the population has high health care utilization accounting for nearly 50% of health care costs. A subset of this utilization is deemed preventable, and thus potentially cost saving to patients as well as to the health care system. This study sought to identify drivers of preventable utilization from the perspectives of three stakeholder groups in the US: health system leaders; high-need, high-cost (HNHC) patients or their primary caregivers; and physicians. We performed a qualitative study using interviews of health system leaders and focus groups of HNHC patients, caregivers and physicians. We used a mixed inductive deductive approach to analyse transcripts and identify themes. We identified three key drivers of preventable high health care utilization: (1) unmet behavioural health needs, (2) socio-economic determinants of health and (3) challenges associated with accessing health care delivery systems. To be potentially more effective, interventions to reduce preventable high health care utilization should incorporate the perspectives of patients, health system leaders and physicians. Particularly important to stakeholders is increased access to mental-health resources, support for patients with low socio-economic resources and systemic changes that reduce wait times for primary care visits and allow providers more time during patient visits.

Adaptation of the MISSCARE Survey to the Maternity Care Setting

Missed nursing care is an important measure of nursing care quality that is sensitive to nurse staffing and is associated with patient outcomes in medical–surgical and pediatric inpatient settings. Missed nursing care during labor and birth has not been studied, yet childbirth represents the most common reason for hospitalization in the United States. The Missed Nursing Care (MISSCARE) Survey, a measure of medical–surgical nursing quality with substantial evidence for validity and reliability, was adapted to maternity nursing care using data from focus groups of labor nurses, physicians, and new mothers and an online survey of labor nurses. Content validity was evaluated via participant feedback, and exploratory factor analysis was performed to identify the factor structure of the instrument. The modified version, the Perinatal Missed Care Survey, appears to be a feasible and promising instrument with which to evaluate missed nursing care of women during labor and birth in hospitals.

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014. To evaluate the effect of hospital global budgets on health care utilization and expenditures. Quantitative analyses used a difference-in-differences design modified for nonparallel baseline trends, comparing trend changes from a 3-year baseline period to the first 3 years after All-Payer Model implementation for Maryland and a matched comparison group. Hospitals in Maryland and matched out-of-state comparison hospitals. Fee-for-service Medicare beneficiaries residing in Maryland and comparison hospital market areas. Medicare claims were used to measure total Medicare expenditures; utilization and expenditures for hospital and nonhospital services; admissions for avoidable conditions; hospital readmissions; and emergency department visits. Qualitative data on implementation were collected through interviews with senior hospital staff, state officials, provider organization representatives, and payers, as well as focus groups of physicians and nurses. Total Medicare and hospital service expenditures declined during the first 3 years, primarily because of reduced expenditures for outpatient hospital services. Nonhospital expenditures, including professional expenditures and postacute care expenditures, also declined. Inpatient admissions, including admissions for avoidable conditions, declined, but, there was no difference in the change in 30-day readmissions. Moreover, emergency department visits increased for Maryland relative to the comparison group. This study provides evidence that hospital global budgets as implemented in Maryland can reduce expenditures and unnecessary utilization without shifting costs to other parts of the health care system.

2399-PUB: Multidisciplinary Clinic-Based Model for Mild Ketosis and Dehydration Management in Youth with Diabetes

Background: Diabetic ketoacidosis (DKA) is a major cause of emergencies in youth with type 1 diabetes constituting a health burden. Nonadherence and knowledge gaps are key contributors. Patients with mild ketosis and dehydration are typically managed in the EC without multidisciplinary evaluation. Objective: We developed a quality improvement initiative to improve access and reduce emergency center (EC) visits for pediatric patients with type I diabetes with mild ketosis not tolerating oral intake, and to deliver family centered multidisciplinary education addressing diabetes knowledge gaps and psychosocial barriers. Methods: A multidisciplinary focus group of physicians, nurses, certified diabetes educators (CDE), and social workers (SW), determined criteria for patients who could be cared for in Urgent Care Bay (UCB) rather than EC. Eligible patients with type 1 diabetes were >5 years old who could not tolerate oral intake, and had low-to-moderate ketones. SW identified and addressed psychosocial barriers to optimal diabetes management. CDE assessed and provided structured education addressing knowledge gaps. Results: Of 17 referred patients, 9 were seen in UCB (8 by CDE; 7 by SW). None required transfer to EC. SW referred 4 patients to psychology: 2 seen in UCB, 2 referred to community psychology. Time spent in multidisciplinary UCB visit was not longer than traditional EC-managed visits. Conclusion: This multidisciplinary approach may help pediatric patients with diabetes with mild ketosis who are not tolerating oral intake. Multidisciplinary teaching and psychosocial interventions provided while patients are only mildly sick may help patients avoid future admissions. It remains to be seen whether this comprehensive model of education and hydration of mildly sick patients with diabetes will provide cost effectiveness in terms of overall EC admissions. Disclosure G.K. Kim: None. A. Mixon: None. M.A. Marshall: None. M.E. Taub: None. M. Jaramillo: None. D. Scroggins: None. N. Bansal: None. L. Karaviti: None. S. Mckay: None.

Content validity of the SOS-WRIST questionnaire for timely identification of wrist overuse in young athletes

ABSTRACTObjectives: Young athletes do not always seek medical help for overuse wrist injuries, risking invalidating long-term consequences resulting from late diagnosis. This study aimed to develop a questionnaire to identify overuse wrist injuries in young athletes.Methods: According to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria, items were collected from literature and 6 focus groups of sports physicians and of young athletes with (previous) overuse wrist injuries. An expert panel and 40 Delphi study participants performed item reduction. Young athletes evaluated comprehensiveness during interviews and English translation was performed according to linguistic validation guidelines.Results: In total 323 items were generated and 110 were marked important by focus group participants. The resulting questionnaire consists of 18 multiple-choice questions about wrist pain during sports (e.g. pain during training, skipping training sessions/elements) and daily life activities (e.g. writing, turning a key), and other symptoms (e.g. reduced strength, swelling).Conclusion: The SOS-WRIST questionnaire for identification of overuse wrist injuries in young athletes has good content validity. It can be used to promote awareness and timely treatment of overuse wrist injuries in young athletes.

A Novel Quality of Life Instrument for Patients with an Abdominal Aortic Aneurysm

The surveillance and treatment of abdominal aortic aneurysms (AAAs) may impact patient quality of life (QOL). A novel AAA specific QOL instrument was developed and validated to quantify the impact of AAA surveillance on QOL. The study was performed in two phases: development (2011-2013) and validation (2013-2014) of a survey instrument. Content was informed by focus groups at three centres (22 patients) and two multidisciplinary physician focus groups (6 vascular surgeons, 7 primary care providers). Cognitive interviews (17 patients) ensured questions were understood as intended. The final survey was mailed to AAA patients at six US institutions. Patients were scored on two AAA specific domains of QOL: emotional impact (EIS) and behavioural change (BCS), range 0-100 with higher scores indicating worse quality of life. Test retest reliability and internal consistency were assessed. Discriminant validity was determined by comparing scores between patients under surveillance vs. those who had undergone AAA repair. Scores were externally validated by correlation with the Short Form (SF)-12. A total of 1,008 (73%) of 1,373 patients returned surveys: 351 (35%) were under surveillance, 657 (65%) had undergone repair (endovascular, 414; open, 179; unsure, 64). Median EIS was 11 (range 0-95; IQR 7-26). Median BCS was 13 (range 0-100; IQR 9-47). To test reliability, 337 patients repeated the survey after four weeks with no significant differences between scores over time. EIS and BCS demonstrated good internal consistency (Cronbach's Alpha 0.85 and 0.75 respectively). There was strong correlation between scores (r=0.53) and both related moderately to SF-12 scores (r=0.45 and r=0.39, respectively). Patients under AAA surveillance had worse EIS than repair patients (22 vs. 13; p<.001). Patients with a higher perceived rupture risk had a worse EIS (45 vs. 12; p<.001) and BCS (30 vs. 13; p<.001). An AAA specific QOL instrument was successfully created and validated. The range of impact on QOL by AAA surveillance is broad. For most patients the impact is minimal, but for some, especially those with a greater perceived rupture risk, it is severe.

Participant perspectives of a home-based palliative approach for people with severe multiple sclerosis: A qualitative study.

BackgroundWe performed a qualitative study to investigate the experiences of participants in a multicentre randomized controlled trial on a home-based palliative approach (HPA) for adults with severe multiple sclerosis (MS) and their caregivers. Our aim was to explore the strengths and challenges of the intervention, and circumstances that may have influenced its efficacy.MethodsParticipants to the qualitative study were the patients, their caregivers, patient referring physicians, and the teams who delivered the HPA intervention. We performed semi-structured one-on-one interviews with 12 patients and 15 informal caregivers chosen using a maximum variation strategy, two focus group meetings with patient referring physicians (4 participants each), and one with the HPA teams (9 participants).ResultsFrom data analysis (framework method) 38 sub-categories emerged, which were grouped into 10 categories and 3 themes: 'expectations,' 'met and unmet needs', and 'barriers’. Intervention benefits were improved control of symptoms and reduced sense of isolation of the patient-caregiver dyads. Limitations were: factors related to experimental design (difficulty of dyads in identifying examiner and team roles, additional burden for caregivers); team issues (insufficient team building /supervision, competing priorities); limitations of the intervention itself (insufficient length, lack of rehabilitation input); and external factors (resource limitations, under-responsive services/professionals). The referring physician focus groups provided little experiential data.ConclusionsThe HPA reduced patient symptoms and sense of isolation in patients and caregivers. The indirect role of the HPA teams, and insufficient length of the intervention were key limitations. The experimental design imposed additional burdens on the dyads. Key barriers were the paucity of available services, the demanding administrative procedures, and lack of networking facilities. These findings suggest that two major requirements are necessary for home palliative care to be effective in this patient population: HPA teams well-connected with MS rehabilitation services, and care delivered over the long-term, with variable intensity.Trial registrationCurrent Controlled Trials ISRCTN73082124 (Registered 19/06/2014).

Cost as the Main Driver of T2D Treatment Patterns—Lessons from Real-World Data and Physician Focus Groups

This two-phased study consists of a decision tree model built from real-world claims data to determine factors related to physician choice of 2nd line therapy for type 2 diabetes (T2D) patients after metformin, followed by a physician focus group study to validate results of the data-driven approach. We identified 58patients in the U.S. who initiated sulfonylurea (SU), DPP-4 inhibitor, GLP-1-RA, or insulin after metformin during 2012-2014 from the HealthCore Integrated Research Database. Claims-derived factors, such as demographics, clinical characteristics, and prior healthcare utilization and costs, were selected from a classification and regression tree (CART) model that minimized classification errors. Of factors most predictive of 2nd line drug assignment, patients’ cost sharing for antidiabetic drugs (Relative Importance, RI=1) was 3 times more important than HbA1c level (RI=0.3), and 10 times more important than age, comorbidity, and kidney status (GFR) (RI=0.1). SU was most likely to be assigned to patients with lowest drug spending, moderate HbA1c control, abnormal kidney function, or no comorbid conditions. Similar themes were identified from the four physician focus groups (consisting of 8 endocrinologists and 10 PCPs in NYC and LA) and supported the findings. This study identified a gap in diabetes care where patients often receive SU due to lack of access to other treatment options. Disclosure S. Wu: None. A.D. Raval: None. J.J. Stephenson: None. X. Peng: Employee; Self; Eli Lilly and Company. H. Weisman: Employee; Self; Anthem, Inc. D.E. Faries: Employee; Self; Eli Lilly and Company.

A Clinical Decision Support Tool for Familial Hypercholesterolemia Based on Physician Input.

ObjectiveTo develop clinical decision support (CDS) for familial hypercholesterolemia (FH), based on physician input obtained by a mixed methods approach.IntroductionAwareness, detection, and control of FH—a relatively common genetic disorder—is low. Clinical decision support could address knowledge gaps and provide point-of-care guidance for the management of FH.MethodsA 16-question survey that assessed familiarity with FH and sought input on potential content of the CDS tool was emailed to 1161 clinicians including 208 cardiologists. In addition, 4 physician focus groups were held to gather input on the structure and form of the CDS tool. This study took place between September 12, 2016, and January 16, 2017.ResultsThe response rate to the survey was 18.1%. Clinicians were overwhelmingly (97.6%) in favor of a CDS tool that assists in managing patients with FH at the point of care and this was confirmed in the focus group discussions. Key themes emerged during the focus groups including providers' knowledge and understanding of FH, facilitators and barriers to implementing a CDS tool, and suggestions for its design and content.ConclusionClinicians were supportive of development of a CDS tool to assist with the evaluation and treatment of FH and provided feedback related to the design and implementation of such a tool.

PDB71 - A Qualitative Physician Focus Group Study to Determine How Physicians Decide What Second-Line Therapy to Prescribe for Patients with Type 2 Diabetes (T2DM)

PDB71 - A Qualitative Physician Focus Group Study to Determine How Physicians Decide What Second-Line Therapy to Prescribe for Patients with Type 2 Diabetes (T2DM)

Introducing Primary Care Telephone Visits: An Urban Safety-Net Community Clinic Experience.

Background: Telephone consultation is widely used in primary care and can provide an effective and efficient alternative for the in-person visit. Gouverneur Health, a safety-net primary care practice in New York City serving a predominately immigrant population, evaluated the feasibility and physician and patient acceptability of a telephone visit initiative in 2015. Measures: Patient and physician surveys, and physician focus groups. Results: Though only 85 of 270 scheduled telephone visits (31%) were completed, 84% of patients reported being highly satisfied with their telephone visit. Half of physicians opted to participate in the pilot. Among participating physicians, all reported they were able to communicate adequately and safely care for patients over the telephone. Conclusions: Participating patients and physicians in a linguistically and culturally diverse urban safety-net primary care clinic were highly satisfied with the use of telephone visits, though completion of the visits was low. Lessons learned from this implementation can be used to expand access and provision of high-quality primary care to other vulnerable populations.

The value of cancer treatments: Patient and clinician perspectives.

e18320 Background: A number of frameworks for assessing the value of cancer treatments such as the National Comprehensive Cancer Network’s evidence blocks, Memorial Sloan Kettering Cancer Center’s Drug Abacus and ASCO’s value framework have been developed to help address the rising cost of cancer treatments. Yet the methodological basis for the inclusion of differing attributes, how to incorporate other contextual considerations and understand stakeholder trade-offs is unclear. This qualitative study aimed to identify contextual factors prioritized by stakeholders for inclusion in oncology value frameworks. Methods: A scoping review identified attributes currently included in value frameworks. Nominal group technique methods were then used in 3 focus groups representing cancer patients, oncology nurses, and physicians across a range of cancer specialties. Each group was tasked with ‘identifying important treatment features’ based on their own experience. Following discussions, participants ranked attributes in order of importance and group consensus identified the ‘top 6’ factors. Results: Twenty-one attributes were identified by the patient (n = 9), nurse (n = 10) and physician (n = 6) focus groups. All identified efficacy and safety/toxicity. Long-term adverse effects, alternative treatment options, quality of evidence and reputation of the treating oncologist/center were prioritized by patients. Nurse preferences centered on mode of administration, quality of life, communication and treatment innovation. Physicians focused on the burden and inconvenience of treatments to patients, functional outcomes, financial toxicity to patients, and societal costs. Conclusions: Although efficacy and safety/toxicity were prioritized in all groups, the prioritization of contextual factors across stakeholders highlights the need to further understand the relative value of possible ‘other’ attributes currently not reflected in frameworks thus, possibly failing to reflect the preferences of stakeholders.

Assessing the burden of treatment-emergent adverse events associated with atypical antipsychotic medications

BackgroundTreatment of schizophrenia and major depressive disorder (MDD) with atypical antipsychotics (AAPs) show improved efficacy and reduced side effect burden compared with older antipsychotic medications. However, a risk of treatment-emergent adverse events (TEAEs) remains. TEAEs are hard to quantify and perspectives on the importance of TEAEs differ across patients and between patients and physicians. The current study is a qualitative assessment that investigates TEAEs of AAPs from both patient and physician perspectives to provide better understanding of the occurrence and burden of TEAEs associated with these medications.MethodsFocus groups comprised of patients with MDD and interviews with patients with schizophrenia were conducted at two qualitative research facilities, along with a physician focus group at one of the facilities. Information collected from patients included an exhaustive list of TEAEs experienced, and the frequency and level of bother of each TEAE; from psychiatrists, information included an exhaustive list of TEAEs based on personal observations and patient report, frequency of TEAEs, clinically important TEAEs, and levels of patient-perceived bother. Standard qualitative analysis methods were used to identify, quantify, characterize, and summarize patterns found in the data collected.ResultsA total of 42 patients (25 with MDD and 17 with schizophrenia) and 4 psychiatrists participated in the study. TEAEs reported as bothersome across both patients groups included cognitive issues, weight gain and/or increased appetite, low energy, extrapyramidal symptoms (EPS), and need to sleep/excessive sleep/excessive sleepiness. TEAEs considered more bothersome by patients with schizophrenia were weight gain, low energy, EPS, mental anxiety, and increased positive symptoms; those considered more bothersome by patients with MDD were cognitive issues, somnolence/sedation, and flat/restricted affect. TEAEs considered most clinically important by psychiatrists included metabolic syndrome, weight gain, neutropenia, hyperglycemia, and QT prolongation; those TEAEs considered most bothersome to patients from physicians’ perspectives included weight gain, reduced sexual desire or performance, EPS, akathisia, and hormonal issues.ConclusionsThe wide range of TEAEs that are both frequent and bothersome and the variation in perceived burden according to diagnosis highlight the need for a tailored TEAE-awareness approach when choosing an AAP.

Unique Educational Opportunities for PCPs and Specialists Arising From Electronic Consultation Services

Health care reform should be driven by the goals of better patient experience, improved population health, lower per capita costs, and improved provider satisfaction. Electronic consultation (eConsult) services have been adopted by several jurisdictions in the United States, Canada, and Europe to improve access to specialists by primary care providers (PCPs) and are being heralded as a key component for delivery of coordinated care. The primary intent of an eConsult service is to provide PCPs with efficient, timely, direct access to specialist expertise to help guide the management of their patients, reduce the need for unnecessary face-to-face specialty consultations, and improve the quality of the initial face-to-face consultation when needed, through the preconsultative communication.In addition to improving access to care, eConsult services have been praised by PCPs and specialists for their educational value, in particular their ability to enrich practice-based learning. Less recognized, but equally important from the educational perspective, include the abilities of eConsult programs to promote reflection by PCPs and specialists, improve collegiality and professionalism between primary and specialist care, inform continuing professional development activities and maintenance of certification, and enhance training programs' teaching of effective communication and care coordination.As eConsult services become increasingly available, the medical community must leverage the educational opportunities inherent in eConsult programs to further improve the delivery of coordinated specialty care. The educational role of eConsults should be considered as a priority outcome in their evaluation and must be highlighted and optimized in next iterations of eConsult systems design.

Development and Validation of a Bronchoscopy Competence Assessment Tool in a Clinical Setting.

Flexible bronchoscopy is performed by clinicians representing multiple medical specialties in a variety of settings. Given the increasing importance of competency-based assessment in postgraduate training, it is important that this skill be assessed within a competency-based framework using a valid measurement tool. The purpose of this study was to design and validate a practical, competency-based bronchoscopy assessment tool that could be applied to trainees in a clinical setting. Focus groups of expert physicians were formed in Ottawa, Canada representing adult medical specialties routinely engaged in preparing trainees to perform flexible bronchoscopy (respiratory medicine, critical care, thoracic surgery and anesthesia). The focus groups were charged with identifying themes and items relevant to the assessment of competency in bronchoscopy. By an iterative process, a bronchoscopy assessment tool was developed, the Ontario Bronchoscopy Assessment Tool (OBAT). The tool was evaluated by first using it to assess learners in a pilot study, refining it based on the results, and then testing the OBAT again in a validation study. The initial tool consisted of 19 items, organized into the following groups: preprocedure planning, sedation and monitoring, technical skill, diagnostic skill, and post-procedure planning. The tool demonstrated high reliability (0.91) and discriminated junior from senior trainees. Based on the results of the pilot, the tool was simplified to a 12-item scale with three subscales: preprocedure planning, technical skills, and post-procedure planning. In the validation study, the assessment tool remained highly reliable (0.92) and discriminated junior from senior trainees with an estimated eight assessments per trainee. The OBAT demonstrates promise as a reliable tool to assess trainee competence for bronchoscopy in clinical settings.

Psychosocial Risk Evaluation in the Workplace: Expert-based Development of a Checklist for Occupational Physicians

The implementation of psychosocial risk assessment at the workplace often fails in practice. One reason is the lack of competence of those who are in charge of the process. We present a checklist for the effective implementation of psychosocial risk assessment at workplace. This tool shall support occupational physicians in the preparation, planning and implementation of a psychosocial risks assessment process. Based on a stepwise development and validation process, specific steps and factors for the successful implementation were identified qualitatively with 15 occupational physicians and experts. This was conducted in a 2-stage Delphi study. In the following, the identified steps and factors were transferred into a checklist. Subsequently, the checklist was evaluated in a focus group of occupational physicians (user evaluation). Thereafter, the contents were subjected to an expert evaluation. Our checklist for the effective implementation of the process of psychosocial risk management in the workplace aims to strengthen the competence of occupational physicians, especially in the implementation of risk assessments in small and medium-sized enterprises (SMEs).