Identify Core Themes Research Articles

P0044 / #597: LIVED EXPERIENCE OF DELIRIUM IN CRITICALLY ILL CHILDREN: PROTOCOL FOR A QUALITATIVE STUDY

Aims & Objectives: Delirium is a common yet under-recognized problem in the pediatric intensive care unit (PICU) that negatively impacts patient outcomes. The objective of this study is to describe the lived experience of delirium, by evaluating patient-recall and caregiver perception of delirium in critically ill children. Methods: This is a two center, descriptive, qualitative study. Eligible subjects include critically ill children 0-18 years old diagnosed with delirium during their PICU stay, and/or their caregivers (both family and healthcare providers). Operational definition of delirium for this study is a Cornell Assessment of Pediatric Delirium (CAPD) score of ≥ 9 for at least 48 hours. Face-to-face, semi-structured interviews will be conducted on subjects at different time-points: during the index hospitalization (after delirium resolution), and up to 12 months after PICU discharge. Interview transcripts will be examined using inductive content analysis, whereby codes and recurrent themes are derived directly from data. Themes and subthemes derived from the qualitative analyses will be presented. Enrollment goal is approximately 15 interviews, or until thematic saturation is achieved. NVIVO software will be used for analyses. Results: Preliminary interviews have been completed on one patient, one parent and two health care providers. An open coding process has been conducted by all five investigators, to develop codes, and a codebook has been reviewed and finalized. Conclusions: This study will identify core themes regarding the lived experience of pediatric delirium. This novel data will be used in future prospective interventional trials designed to limit the long-term impact of delirium on PICU survivors and their families.

A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study.

BackgroundDespite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals.ObjectiveThrough a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible.MethodsA face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding.ResultsAll participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits.ConclusionsWe demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization.

Coach awareness, knowledge and practice in relation to growth and maturation and training load in competitive, young gymnasts

Growth-related and overuse injuries are commonly reported in young gymnasts. Two risk factors of these injuries are growth and maturation, and training load. However, little is known regarding current coaching knowledge and practice in relation to these risk factors. To help understand current knowledge and practice, 44 coaches of competitive, young gymnasts, from 3 gymnastics disciplines (men’s artistic, women’s artistic, trampoline) took part in focus groups. The focus groups explored the awareness, experience and practice of coaches in relation to growth and maturation, training load and injury in competitive, young gymnasts. Data were analysed manually using an inductive thematic approach to identify core themes. The findings showed that coaches were aware of the physical changes and injuries that occur during the adolescent growth spurt. Both psychological changes and skill loss/confusion were also identified as challenges during this time. The knowledge and practice of monitoring growth and maturation, and training load did however differ between disciplines. Sports science and medicine practitioners were recognised as key stakeholders in helping manage and reduce the risk of injuries during growth. There appears to be gap between coach knowledge of growth and maturation, and training load, and practices such as monitoring training load and growth. Educating coaches and further research in these areas will aid coaches in reducing the risk of injuries in young, competitive gymnasts.

Physician‐faculty perceptions towards teaching incentives: A case study at a children’s hospital

PurposeThis exploratory study examines affiliate physician‐faculty perceptions and attitudes regarding a teaching incentive programme at a free‐standing children's hospital in the United States. We describe the compensation model and present faculty interpretations of its influence on the institutional culture.MethodsA case study methodology was applied to understand the sociological aspects of academic productivity interventions. In‐depth interviews, direct observation of leadership meetings, teaching activity logs, organisational theoretical lens and survey results were used for methodological triangulation. Data from these multiple sources were coded and discussed between investigators iteratively to identify core themes.ResultsOf the faculty eligible for the incentive, 32 engaged in in‐depth interviews (N = 32/107; 30%) and 88 (interviewees included) in the survey (N = 88/107; 82%). Findings suggest that while the implementation made some strides in mitigating barriers for some, for others gaps were identified that suggest further exploration within this domain of study is warranted. The incentive implementation was perceived as strategic, intending to encourage the academic culture of the hospital, though participants commonly expressed confusion about the rationale behind the omission of teaching allocations in formal contracts. However, high satisfaction levels for the programme as a conduit to change were evident. There was a perception of a shift in the collective faculty morale that reflected an evolving institutional culture that increased enthusiasm for teaching. Finally, faculty noted their perception that institutions that employ teaching incentives could positively influence faculty recruitment.ConclusionWe found a modest incentive‐based reward for teaching activity was successful in informing the perceptions of faculty regarding their institution's academic prestige goals and teaching recognition. Such programmes, while requiring a small investment of time and resources by institutional leadership, can convey that the educational mission remains a priority in this era of increasing clinical and administrative pressure and an institutional culture that may positively influence faculty morale and dedication to teaching.

Constraints that discourage participation in the labour market by female carers of older relatives in Santiago, Chile.

Providing care for older people who have support needs is mainly a familial and female responsibility in Chile. Despite Chile's development level, the participation of females in the workforce lags behind (at around 50%), and 72% of female carers of an older relative are not in the labour force. This paper explores the reasons why in Latin America adult children remain out of the labour force while caring for an older parent or parent-in-law who has support needs. It draws on 30 in-depth interviews of family carers from low- to high-income households. The interviews were carried out in Chile in 2017, and were analysed using an inductive thematic analysis to identify core themes related to the subjects' reasons for remaining out of the labour force. Four factors hinder the combination of paid work and caring for a parent or parent-in-law with support needs: (a) externalised care was too expensive; (b) finding non-precarious, flexible work was difficult; (c) their perception of femininity or womanhood conflicted with the idea of combining care and paid work; and (d) they experienced a lack of public and/or social support.

Time for revolution? Enhancing meaningful involvement of people living with HIV and affected communities in HIV cure-focused science

IntroductionInvolving affected communities and people living with HIV (PLHIV) in HIV cure-focused clinical trials has ethical and practical benefits. However, there can be barriers to meaningful involvement of ‘lay people’ in scientific research meaning community consultation is often limited or tokenistic. This paper reports on an Australian project, the INSPIRE project (Improve, Nurture and Strengthen education, collaboration, and communication between PLHIV and Researchers), which aimed to explore barriers and enablers to enactment of the principles of meaningful involvement of PLHIV (MIPA) and affected communities in HIV cure-focused research. MethodsThe project involved a workshop attended by 40 stakeholders involved in HIV care, research or advocacy including PLHIV, community organizations, basic scientists, and clinicians. The workshop involved a facilitated discussion about community involvement in a hypothetical HIV cure-focused clinical trial. Data were collected through notetaking and video recordings. Qualitative, thematic analysis was undertaken to organize the data and identify core themes related to MIPA. ResultsWorkshop discussions revealed community stakeholders often feel their involvement in HIV clinical research is undervalued, evidenced by limited financial remuneration and minimal capacity to influence the research design or processes. Building long-term, formal and informal relationships between community organizations, PLHIV, researchers and research teams or laboratories was identified as a strategy to support MIPA at all stages of a clinical trial, from design to dissemination of findings. ConclusionsEnacting MIPA principles in HIV cure-focused research requires a better understanding of the potential to improve research outcomes and ensure quality in the research process.

Collaborating with health economists to advance implementation science: a qualitative study

BackgroundImplementation research infrequently addresses economic factors, despite the importance of understanding the costs of implementing evidence-based practices (EBPs). Though partnerships with health economists have the potential to increase attention to economic factors within implementation science, barriers to forming these collaborations have been noted. This study investigated the experiences of health economists and implementation researchers who have partnered across disciplines to inform strategies to increase such collaborations.MethodsA purposeful sampling approach was used to identify eight health economists and eight implementation researchers with experience participating in cross-disciplinary research. We used semi-structured interviews to gather information about participants’ experiences with collaborative research. Thematic analysis was conducted to identify core themes related to facilitators and barriers to collaborations.ResultsHealth economists and implementation researchers voiced different perspectives on collaborative research, highlighting the importance of increasing cross-disciplinary understanding. Implementation researchers described a need to measure costs in implementation studies, whereas many health economists described that they seek to collaborate on projects that extend beyond conducting cost analyses. Researchers in both disciplines articulated motivations for collaborative research and identified strategies that promote successful collaboration, with varying degrees of convergence across these themes. Shared motivations included improving methodological rigor of research and making a real-world impact. Strategies to improve collaboration included starting partnerships early in the study design period, having a shared interest, and including health economists in the larger scope of the research.ConclusionsHealth economists and implementation researchers both conduct research with significant policy implications and have the potential to inform one another’s work in ways that might more rapidly advance the uptake of EBPs. Collaborative research between health economists and implementation science has the potential to advance the field; however, researchers will need to work to bridge disciplinary differences. By beginning to develop strong working relationships; increasing their understanding of one another’s disciplinary culture, methodology, and language; and increasing the role economists have within research design and execution, both implementation researchers and health economists can support successful collaborations and robust and informative research.

A qualitative exploration of the impact of COVID-19 on individuals with eating disorders in the UK

COVID-19 may have substantial impact on the mental health at a population level, but also has the potential to significantly affect those with pre-existing mental health difficulties such as eating disorders. This qualitative study explores the impact of COVID-19 and associated public health measures on adults with eating disorders within the UK. We conducted 10 in depth interviews with adults (24–38 years) with a self-reported eating disorder during lockdown. Data were analysed using an inductive thematic analysis approach. We identified core themes related to social restrictions (social isolation, changes in accountability to others, and increased responsibility for self and others), functional restrictions (lack of routine and structure, a need to intentionally plan activity, a desire for secrecy particularly around food shopping) and restrictions in access to mental health services. Overall, the impact of the lockdown was experienced as a catalyst for either increased disordered eating behaviours or for a drive for recovery, depending on individual circumstances going into these restrictions. This study is the first in depth interview approach with adults with mixed eating disorder presentations in the UK during COVID-19. Findings have important implications for post lockdown intervention care and practice.

Transformative Teams in Health Care

This paper describes social work pedagogy and outcomes in a multi-year longitudinal interprofessional education (IPE) course incorporating B.S.W, and M.S.S.W. students. Social work students participated in an IRB-approved mixed-method study designed to evaluate individual growth and identity transformation throughout the two-semester course. Students’ semi-structured reflection papers (n=113) were analyzed qualitatively to identify core themes. Students voluntarily completed Interprofessional Assessment Scale (IPAS) surveys, a measure of core competencies in interprofessional care, before and after the class (n=48). Social work students reported that they developed increased personal and interprofessional confidence, awareness of social work role in health care, increased social work skills and leadership to use their voice in interprofessional health care teams. All levels of social work students can and should be incorporated into IPE education. Social work educators and practitioners should continue to take leadership in IPE education at all levels of curriculum design and implementation.

Learning Postdisruption: Lessons from Students in a Fully Online Nonmajors Laboratory Course

Students and instructors bring varying levels of experience and expectations to online learning. This became even more apparent in March 2020 when the pandemic disrupted face-to-face instruction and required rapid conversion to remote teaching. In this study, mixed methods were used to understand how students perceived these instructional changes and to examine the effects of remote learning on their approach to subsequent coursework and faculty interactions. First, open-ended survey data collected from students enrolled in a summer 2020 nonmajors asynchronous laboratory course were analyzed to learn more about students’ spring 2020 remote learning experiences. The questions directly addressed remote learning experiences and emphasized study strategies learned, faculty communication modes, and students’ perceived ability at taking online courses. Second, four consecutive years of survey data—including both Likert-type scale surveys and open-ended questions—were analyzed to identify core themes and to measure variations between cohorts. These data present a unique opportunity in that they allow for critical analyses and document differences in online learning experiences for student cohorts pre- (2017–2019) and post- (2020) the COVID-19 disruption. The findings from the survey data can be used to inform how faculty may better focus their teaching efforts while promoting student learning and engagement during a time of continued teaching disruption and uncertainty. The overall results of this study are applicable to all levels of chemistry courses. In addition, the established nonmajors online laboratory course model presented in this study provides a strong example for others who are developing new online or hybrid chemistry courses.

The journey to professional mental health support: a qualitative exploration of the barriers and facilitators impacting military veterans’ engagement with mental health treatment

ABSTRACT Background: It is often claimed that military veterans are reticent to seek help for mental disorders, even though delayed treatment may impair recovery and impact the wellbeing of those close to the veteran. Objective: This paper aims to explore the barriers and facilitators to accessing professional mental health support for three groups of veterans who met criteria for a probable mental health disorder and: (1) do not recognize a probable mental disorder; (2) recognize they are affected by a mental disorder but are not seeking professional support; or (3) are currently seeking professional mental health support. Method: Qualitative telephone interviews were conducted with 62 UK military veterans. Thematic analysis identified core themes along an illustrative journey towards professional mental health support. Results: Distinct barriers and facilitators to care were discussed by each group of veterans depicting changes as veterans moved towards accessing professional mental health support. In contrast to much of the literature, stigma was not a commonly reported barrier to care; instead care-seeking decisions centred on a perceived need for treatment, waiting until a crisis event occurred. Whilst the recognition of treatment need represented a pivotal moment, our data identified numerous key steps which had to be surmounted prior to care-seeking. Conclusion: As care-seeking decisions within this sample appeared to centre on a perceived need for treatment future efforts designed to encourage help-seeking in UK military veterans may be best spent targeting the early identification and management of mental health disorders to encourage veterans to seek support before reaching a crisis event.

Violence Prevention: Technology-Enabled Therapeutic Intervention

Nurses are disproportionately prone to experience incidents of violent victimization. Despite the vast literature on violence in healthcare settings, few studies have identified effective violence prevention interventions. The aim of the study was to explore the experiences of nurses regarding the implementation of technology-based violence prevention interventions. Qualitative data were collected through semi-structured focus groups and interviews with 11 nurses at Humber River Hospital. Interviews were audiotaped, transcribed and subjected to a content analysis to identify core themes from the data. Three themes were identified: reassurance of safety, an increase in proactive measures and limitations of technology. Nurses held positive perceptions of the impact of technology-based interventions on violent incidents. The interventions were regarded as effective for the detection of potentially violent patients as well as for providing assistance from security staff when a violent incident occurs or appears imminent. However, nurses also acknowledged that patient-related violence was "unavoidable" and that technology cannot fully prevent violence from occurring. The findings from this study support the replication of these interventions in other healthcare facilities. Engaging staff, patients and families in this unique digital and technology-enriched environment has been critical for the successful implementation of the violence prevention electronic flagging system. Patient and family education and communication were essential for addressing concerns related to "labelling."

The Development of the INFEWS-ER: A Virtual Resource Center for Transdisciplinary Graduate Student Training at the Nexus of Food, Energy, and Water

Problems at the nexus of Food, Energy and Water Systems (FEWS) are among the most complex challenges we face. Spanning simple to complex temporal, geographic, social, and political framings, the questions raised at this nexus require multi-disciplinary if not transdisciplinary approaches. Answers to these questions must draw from engineering, the physical and biological sciences, and the social sciences. Practical solutions depend upon a wide community of stakeholders, including industry, policy-makers, and the general public. Yet there are many obstacles to working in a transdisciplinary environment: unfamiliar concepts, specialized terminology, and countless 'blind' spots. Graduate education occurs in disciplinary 'silos', often with little regard for the unintended consequences of our research. Existing pedagogical models do not usually train students to understand neighboring disciplines, thus limiting student learning to narrow areas of expertise, and obstructing their potential for transdisciplinary discourse over their careers. Our goal is a virtual resource center—the INFEWS-ER—that provides educational opportunities to supplement graduate students, especially in their development of transdisciplinary competences. Addressing the grand challenges at the heart of the FEWS nexus will depend upon such competence. Students and scholars from diverse disciplines are working together to develop the INFEWS-ER. To date, we have sponsored both a workshop and a symposium to identify priorities to design the initial curriculum. We have also conducted surveys of the larger community of FEWS researchers. Our work confirms a widespread interest in transdisciplinary training and helps to identify core themes and promising pedagogical approaches. Our curriculum now centers upon several 'Cohort Challenges', supported by various 'Toolbox Modules' organized around key themes (e.g., communicating science). We plan to initiate the first cohort of students in October of 2018. Students who successfully complete their Cohort Challenges will be certified as the FEW Graduate Scholars. In this paper, we describe the development of this curriculum. We begin with the need for training in transdisciplinary research. We then describe the workshop and symposium, as well as our survey results. We conclude with an outline of the curriculum, including the current Cohort Challenges and Toolbox Modules.

“Alone with our interpretations”: Uncertainty in child abuse intervention among healthcare professionals

The purpose of this article is to provide an insider's view and analysis of the way Israeli healthcare professionals give meaning to their work in cases related to child abuse and how they experience and cope with the inherent uncertainty of these complex situations. Conducted from a social constructivist perspective, this qualitative analysis is based on 20 in-depth, semi-structured interviews with a purposeful sample of healthcare professionals including doctors (11), healthcare administrators (2), nurses (5), and social workers (2). Data analysis included initial identification of the units of meaning, followed by cross-case analysis aimed at identifying core themes. The findings indicate that healthcare professionals who treat child abuse in Israel do so under a cloud of uncertainty, which can be observed on a number of levels, including the definition of abuse and dilemmas concerning reporting. The professionals who participated in this study exhibited varying perspectives, from viewing their work as a pioneering effort that lacks social and professional support, to viewing the future of child abuse assessment and treatment as part of an interdisciplinary effort. The findings reflect the limitations of an individualistic, emergency medical model of care and suggest how this model may be enhanced through a reflective, holistic view within an interdisciplinary framework that addresses a broader social and psychological context.

Developing effective social media messages: Insights from an exploratory study of industry experts

AbstractAs consumers are increasingly utilizing the social network and media platforms for prepurchase information, managers are confronted with producing effective social media messages that can favorably influence buyers’ attitudes and behavioral intentions towards brands. A qualitative, in‐depth, elite interview investigation with social media marketing experts was undertaken to develop awareness of the factors influencing the effectiveness of social media marketing. Adopting a thematic analysis approach, this study establishes the three overriding themes of interactivity, credibility, and infotainment as being valuable in determining how social media marketing can enhance brand performance. Attitude theory and the hierarchy‐of‐effects model is utilized to support understanding and explain the decision making of social media users in this context. Overall, this study provides managers with a thorough explanation of the effects of the identified core themes on social media attitudes and intentions. Implications for social media marketing theory and practice are presented based upon the depth and breadth of knowledge attained from the analysis of the expert interview data.

Predicting security incidents in high secure male psychiatric care

PurposeThe contribution of environmental and organisational factors in predicting security incidents within a high secure male psychiatric setting is considered using a series of connected studies; a systematic literature review comprising 41 studies and five inquiries (Study 1) to identify core themes of likely importance; application of these themes to incident data through assessment of the ward culture, as perceived by 73 male psychiatric patients and 157 staff (Study 2); and detailed examination of noted relevant factors in the form of interpersonal style, meaningful activity and physical environmental characteristics in a study comprising 62 patients and 151 staff (Study 3). It was predicted that security incidents would be identified through inclusion of environmental and organisational factors. ResultsThe systematic review demonstrated the importance of accounting for staff characteristics, patient interactions, physical environment and meaningful activity. The subsequent study noted the importance of only specific aspects of the social environment, with the final study demonstrating that incidents were associated with controlling interpersonal styles of staff, lower perceived fairness, and less involvement in off-ward activities. Perception of fair treatment and off-ward activities mediated the staff interpersonal style and security incident relationship. ConclusionsThe research proposes a preliminary framework - the McKenna Framework for understanding Incidents in Secure Settings (M-FISS) – to explain the occurrence of security incidents in secure psychiatric care.

Affect theory and the concept of atmosphere

ABSTRACTThe concept of atmosphere is a way of emplacing affect and affect theory. Work in contemporary social geography has done much to demonstrate how elemental forces become enveloped in atmospheres. However, it tends to under-theorise the role of historically structured socio-cultural forces and the modes of engagement of persons with the atmospheric. In this paper we identify core themes in the literature – the inbetweeness of atmospheres, tuning space, the folding of space-times and modes of engagement. We then develop these themes further through an encounter with work in anthropology, architecture and ecological psychology. Reflections on fieldwork in a medium-secure forensic psychiatric hospital are then used to illustrate the application of atmospheric thinking to a particular setting. We conclude with a call for a renewed ‘ontographic imagination’.

Examining the contraceptive decisions of young, HIV-infected women: A qualitative study

ABSTRACTThis study qualitatively examined factors that influenced contraceptive choices in a sample of young, HIV-infected women. Individual qualitative interviews were conducted among 30 vertically and horizontally HIV-infected women (n = 26 African American) from the ages of 14 to 24 years (Mean age = 20.9 years). We recruited sample groups with the following characteristics: (a) current contraceptive/condom use with ≥1 child (n = 11); (b) current contraceptive/condom use with no children (n = 12); and (c) no current contraceptive/condom use with no children (n = 7). A semi-structured interview guide was used to ask participants about factors influencing past and current contraceptive choices. Individual interviews were digitally recorded and transcribed verbatim; analyses to identify core themes were informed by the Grounded Theoretical approach. Young, HIV-infected women did not identify their HIV serostatus or disease-related concerns as influential in their contraceptive decisions. However, they reported that recommendations from health-care providers and input from family and friends influenced their contraceptive choices. They also considered a particular method’s advantages (e.g., menstrual cycle improvements) and disadvantages (e.g., increased pill burden) when selecting a method. Findings suggested that HIV-infected young women’s contraceptive decisions were influenced by factors other than those related to their infection.

"A tool doesn't add anything". The importance of added value: Use of observational pain tools with patients with advanced dementia approaching the end of life-a qualitative study of physician and nurse experiences and perspectives.

Observational pain tools (OPTs) are widely recommended in health care policies, clinical guidelines, and recommendations for pain assessment and management. However, it is unclear whether and how these tools are used for patients with advanced dementia approaching the end of life. To explore hospice, secondary, and primary care physicians' and nurses' use of OPTs with patients dying with advanced dementia and their perspectives on practice development and training needs. Twenty-three physicians and 24 nurses with experience of caring for people dying with advanced dementia were recruited from primary care surgeries (n=5), hospitals (n=6), hospices (n=4), and nursing homes (n=10). Semistructured, face-to-face interviews were conducted. Interviews were digitally recorded, transcribed verbatim, and thematic analysis applied to identify core themes. Three key themes emerged: (1) use of OPTs in this vulnerable patient population, (2) barriers to the use of OPTs and lack of perceived "added value", and (3) perspectives on practice development and training in pain assessment in advanced dementia at end of life. Just over one-quarter of participants (n=13) routinely used OPTs. Reasons for nonuse included perceived limitations of such tools, difficulties with their use and integration with existing practice, and lack of perceived added value. Most participants strongly emphasised a need for ongoing training and development which facilitated transfer of knowledge and multidisciplinary skills across professions and specialties. Health professionals require ongoing support in developing and integrating change to existing pain assessment protocols and approaches. These findings have important implications for health education, practice, and policy.

Don't Shoot the Messenger: Experiences of Delivering Prognostic Information in the Context of Advanced Cancer.

The study of prognostic understanding is imperative as the trend toward individualized medicine continues. However, without guidelines for discussing prognosis, palliative care clinicians face challenges presenting prognostic information in a way that optimizes patient understanding, psychological adjustment, and decision-making. The present study draws on the experiences of experts in the field of palliative care in order to examine the communication of prognostic information. Fifteen oncology, psycho-oncology, and palliative care professionals with expertise in doctor-patient communication participated in semi-structured interviews that focused on identifying the breadth of factors underlying prognostic understanding, as well as methods to identify and quantify this understanding. Three independent raters utilized a thematic content analysis framework to identify core themes that reflected unique aspects of prognostic understanding. Interviews yielded 2 types of information. Participants described the multifaceted nature of prognostic understanding and identified 5 distinct elements of prognostic understanding: understanding of current state of disease, life expectancy, curability, decline trajectory, and available treatment options. Participants also offered "best practice" techniques, including methods for determining a patient's preferences for and understanding of prognostic information, assessing patient fears and concerns, and communicating medical uncertainties. Results emphasize the need for clinicians to join with patients to ensure that prognostic information is well understood. These results highlight the salience of health information preferences and strategies to provide comprehensive prognostic information, compassionately and with respect for each individual patient.