Mixed Methods Multiple Case Study Research Articles

Feedback seeking abilities of L2 writers using ChatGPT: a mixed method multiple case study

PurposeThe study investigated the feedback seeking abilities of learners in L2 writing classrooms using ChatGPT as an automated written corrective feedback (AWCF) provider. Specifically, the research embarked on the exploration of L2 writers’ feedback seeking abilities in interacting with ChatGPT for feedback and their perceptions thereof in the new learning environment.Design/methodology/approachThree EFL learners of distinct language proficiencies and technological competences were recruited to participate in the mixed method multiple case study. The researcher used observation and in-depth interview to collect the ChatGPT prompts written by the participants and their reflections of feedback seeking in the project.FindingsThe study revealed that: (1) students with different academic profiles display varied abilities to utilize the feedback seeking strategies; (2) the significance of feedback seeking agency was agreed upon and (3) the promoting factors for the development of students’ feedback seeking abilities are the proactivity of involvement and the command of metacognitive regulatory skills.Research limitations/implicationsAdditionally, a conceptual model of feedback seeking in an AI-mediated learning environment was postulated. The research has its conceptual and practical implications for researchers and educators expecting to incorporate ChatGPT in teaching and learning. The research unveiled the significance and potential of using state-of-the-art technologies in education. However, since we are still in an early phase applying such tools in authentic pedagogical environments, many instructional redevelopment and rearrangement should be considered and implemented.Originality/valueThe work is a pioneering effort to explore learners' feedback seeking abilities in a ChatGPT-enhanced learning environment. It pointed out new directions for process-, and student-oriented research in the era of changes.

Engaging children in developing algorithmic thinking and debugging skills in primary schools: A mixed-methods multiple case study

AbstractThis study examined the developmental process of children’s computational thinking using block-based programming tools, specifically algorithmic thinking and debugging skills. With this aim, a group of children (N = 191) from two primary schools were studied for two years beginning from the fourth grade, as they engaged in our block-based programming curriculum in their primary schools. A mixed-methods multiple case study was designed with pre- and posttests, classroom observations and postintervention interviews. The statistical results showed that students’ algorithmic thinking and debugging skills significantly increased through our intervention, with girls gaining more on algorithmic thinking. During the students’ learning process, we found that they demonstrated behavioral, affective, and cognitive engagement while acquiring these skills in schools. This study presents the key to student engagement contributing to the process of computational thinking development, with implications for the design of future computational learning in primary school.

Understanding “patient deterioration” in psychotherapy from depressed patients’ perspectives: A mixed methods multiple case study

Objective: This study scrutinizes the meaning of deterioration in psychotherapy beyond the widely used statistical definition of reliable symptom increase pre-to-post treatment. Method: An explanatory sequential mixed-methods multiple case study was conducted, combining quantitative pre–post outcome evaluation of self-reported depression symptoms and qualitative analysis of patients’ interviews. In a Randomized Controlled Study on the treatment of Major Depression, three patients showing reliable increase in symptom severity on the BDI-II pre-to-post therapy were selected. An interpretative phenomenological analysis (IPA) was performed on individual interviews conducted pre-, peri- and post-treatment. Results: Cross-case outcome experiences were: (1) uncontrollable complaints; (2) remaining questions and uninternalized insights and (3) persisting interpersonal difficulties. Within-case idiosyncratic differences revealed that the statistical classification of “deterioration” not necessarily corresponds to a “deteriorated experience,” nor univocally indicates unwanted therapy effects. Our findings point at the influences of the patient’s (lack of) agency in the process, a discrepancy between patients’ expectations and the therapy offer, the therapeutic relationship, interpersonal difficulties, and contextual influences. Conclusion: The meaning of symptomatic deterioration should be interpreted within a patient’s idiosyncratic context. The multi-faceted nature of deterioration requires further research to rely on multiple perspectives and mixed methods.

Exploring new models for implementing sustainable integrated health access for people in vulnerable positions: Research protocol for a mixed methods multiple case study (Preprint)

Exploring new models for implementing sustainable integrated health access for people in vulnerable positions: Research protocol for a mixed methods multiple case study (Preprint)

Cultural competence in NHS hearing aid clinics: a mixed-methods case study of services for Deaf British sign language users in the UK

BackgroundThis study identified and explored how National Health Service (NHS) hearing aid clinics address cultural competence concerning Deaf British Sign Language (BSL) users. This was approached by (i) investigating how organisational processes meet the needs of Deaf signers from a hospital and hearing aid clinic perspective, (ii) analysing policies and guidelines to investigate if they equip practitioners to meet the needs of Deaf signers and (iii) exploring with practitioners who work in hearing aid clinics about their experiences of working with Deaf signers.MethodsThis study utilised a mixed-methods multiple case study design, incorporating documentary analysis and semi-structured interviews. Interview analysis was conducted using Reflexive Thematic Analysis (RTA). The research encompassed two hearing aid clinics in separate hospitals, producing 19 documents and eight interviews (four at each site) with audiologists ensuring a representative mix of professional experience levels.ResultsFour themes emerged from the integrated analysis: (1) Understanding Deaf signers; (2) Communicating with Deaf signers; (3) Barriers and Facilitators and (4) Service improvement. A noticeable gap in understanding BSL as both a language and a cultural system was apparent across various policies, strategies, training programmes and staff expertise. Over-reliance on interpreters provided a false sense of accessibility and most participants felt tentative to engage directly with Deaf signers. Positive practices observed at Sites A and B encompassed accurate identification of patients as Deaf signers, improved interpreter availability, communication methods, enhanced training and the encouragement of professional self-awareness.ConclusionThis is the first study that explores cultural competence of hearing aid clinics and its staff concerning Deaf signers in the UK. The results show both clinics require development to become an effective provider for culturally Deaf signers. Examples of how to design culturally competent practices have been provided to assist hearing aid clinics. The findings may be applicable to other underrepresented groups who are not typical users of conventional, acoustic hearing aids provided by the NHS.

Dynamic fluctuations in foreign language enjoyment during cognitively simple and complex interactive speaking tasks

Despite evidence on the interaction between cognitive individual differences (IDs) and task complexity, our knowledge of how affective IDs, such as foreign language enjoyment (FLE), interact with task complexity and other factors is limited. Since tasks and activities were found by Dewaele and MacIntyre (2014) to be most relevant to FLE, and since task complexity might interact with learners’ perceptions of task difficulty, it is important to investigate how task complexity impacts FLE changes. Informed by the complex dynamic systems theory, this study employed a mixed-methods multiple case study design to study patterns and causes of high and low FLE arousals. The participants were four pairs of Taiwanese high-intermediate EFL university students who were engaged in simple or complex storytelling tasks with speech acts of refusals. The speakers’ interactions were triangulated with an individual learner’s rating of FLE on a per-second scale and stimulated recalls. Results revealed idiosyncratic patterns of FLE fluctuations of peer interlocutors and a high degree of overlap in sources of low and high FLE in both groups. Speakers reported high FLE as a result of interesting storylines inherent in task design and created by peers, the use of picture prompts, peer collaboration, and task performance. Performance problems, failure to retrieve appropriate vocabulary, task design, and lack of ideas led to low FLE arousals. The findings suggest that task complexity combined with other task-induced, social, and individual factors to affect the fluctuations of FLE. Implications for task design and oral communication instruction to promote FLE are discussed.

Implementation of a multicomponent family support intervention in adult intensive care units: study protocol for an embedded mixed-methods multiple case study (FICUS implementation study)

BackgroundThe implementation of complex interventions is considered challenging, particularly in multi-site clinical trials and dynamic clinical settings. This study protocol is part of the family intensive care units (FICUS) hybrid...

Young children as citizens: Learning from practice in the early childhood setting

This paper examines enactments of young children’s citizenship in early childhood settings in England, which is an under researched area, in this study young children are positioned as social actors, competent and capable of making decisions and enacting citizenship. Values, child rights and citizenship are interconnected and often inseparable in practice. A mixed methods multiple-case study was conducted in England across several early childhood settings in the private and independent sector. Our findings indicate that young children enact citizenship through micro acts embedded into their day-to-day activities; such acts are often spontaneous in response to events or interactions. These are often pro-social in nature comprised as behaviours such as helping or showing concern for others. Our findings give visibility to the distinctive ways in which young children may enact citizenship including, for example, physical expressions.

Distance Learning in an Inclusive Preschool Focused on Autism During the COVID-19 Pandemic

Despite the widespread use of distance learning during the coronavirus disease-2019 (COVID-19) pandemic, little is known about the developmental appropriateness of this instructional format for preschoolers, particularly when implemented in inclusive settings. The current research was implemented in a university-affiliated, state-funded inclusive preschool classroom focused on autism spectrum disorder (ASD) where parents were given the option to enroll in a full distance program (FDP) during the first 9 weeks of the 2020/21 school year. Parents of four children, including two children with ASD, selected the FDP option. Synchronous whole group, small group, and individual online sessions were recorded using screen capture and coded for children's maintained attention and directed communication. Further, parents and teachers completed exit interviews or a focus group, which were transcribed and analyzed using qualitative research methods. This is the first study to use observational methods to measure child engagement during preschool FDP sessions. Results from this mixed-method multiple case study paint a rich picture of both opportunities and limitations inherent in distance learning when implemented in inclusive preschool settings. General conclusions, future directions, and study limitations are discussed.

The role of the physical environment in stroke recovery: Evidence-based design principles from a mixed-methods multiple case study.

Hospital design can impact patient outcomes, but there is very little healthcare design evidence specific to stroke rehabilitation facilities. Our aim was to explore, from the patient perspective, the role of the physical environment in factors crucial to stroke recovery, namely, stroke survivor activity (physical, cognitive, social), sleep, emotional well-being, and safety. We conducted a mixed-methods multiple-case study at two inpatient rehabilitation facilities in Victoria, Australia, (n = 20 at Case 1, n = 16 at Case 2) using "walk-through" semi-structured interviews, behavioural mapping, questionnaires, and retrospective audit. Four interrelated themes emerged: 1) entrapment and escape; 2) power, dependency, and identity in an institutional environment; 3) the rehabilitation facility is a shared space; and 4) the environment should be legible and patient-centred. Quantitative data revealed patterns in patient activity; stroke survivors spent over 75% of their time in bedrooms and were often inactive. Convergent mixed methods analysis was used to generate a new conceptual model of the role of the physical environment in stroke survivors' behaviour and well-being, highlighting the importance of variety and interest, privacy without isolation, and patient-centred design. This model can be used by designers, healthcare providers, and policy makers to inform the design of rehabilitation environments.

Research Roundup.

International Journal of Palliative NursingVol. 29, No. 6 Research RoundupResearch RoundupLaura GreenLaura GreenLecturer in Nursing, University of Manchester, UKSearch for more papers by this authorLaura GreenPublished Online:20 Jun 2023https://doi.org/10.12968/ijpn.2023.29.6.299AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Iten R, O'Connor M, Cuddeford, Gill F. Care management trajectories of infants with life-limiting conditions who died before 12 months of age. J Pediat Nurs. 2023; 70(1):e22–e31. https://doi.org/10.1016/j.pedn.2022.11.014 Crossref, Medline, Google ScholarGott M, Wiles J, Mason K, Moeke-Maxwell T. Creating ‘safe spaces’: a qualitative study to explore enablers and barriers to culturally safe end-of-life care. Palliat Med. 2023; 37(4):520–529. https://doi.org/10.1177/02692163221138621 Crossref, Medline, Google ScholarFrench M, Keegan T, Preston N. Facilitating equitable access to hospice care in socially deprived areas: a mixed methods multiple case study. Palliat Med. 2023; 37(4):508–519. https://doi.org/10.1177/02692163221133977 Crossref, Medline, Google ScholarHoffmann F, Schnakenberg R, Silies K et al.. Effects of advance care planning in care dependent community-dwelling older persons (STADPLAN): a cluster-randomised controlled trial. Palliat Med. 2023; (epub head of print). Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 June 2023Volume 29Issue 6ISSN (print): 1357-6321ISSN (online): 2052-286X Metrics History Published online 20 June 2023 Published in print 2 June 2023 Information© MA Healthcare LimitedPDF download

Missed opportunities in mixed methods EdTech research? Visual joint display development as an analytical strategy for achieving integration in mixed methods studies.

Mixed methods research is becoming more prevalent in educational technology due to its potential for addressing complex educational problems by integrating qualitative and quantitative data and findings. At the same time, a growing chorus of researchers laments the quality and rigor of research in this field. Mixed methods studies which demonstrate explicit integration in educational technology research are scarce, and even fewer apply integration strategies recommended in the literature, such as visual joint displays. Failure to address the challenge of comprehensive integration may result in missed opportunities for deeper insights. To address this methodological problem, the purpose of this paper is to shed light on the procedures, opportunities, and practical challenges associated with mixed methods integration through the use of visual joint displays as an analytical tool for data interpretation and reporting in these types of designs. Using an exploratory sequential mixed methods multiple case study design as an illustrative example, we will (1) provide step-by-step guidance on how to develop a visual joint display to conduct an integrated analysis in a complex mixed methods design; (2) demonstrate how to use a display of this type to integrate meta-inferences previously generated through a series of interconnected joint displays; and (3) illustrate the benefits of integrating at the literature review, theoretical, analysis, interpretation, and reporting levels in mixed methods studies. This methodological article aims to advance knowledge in educational technology research by addressing the integration challenge in mixed methods studies and assisting researchers in this field in achieving comprehensive integration at multiple levels.

An evaluation of a custom intervention programme to address problematic mobile phone use of youth athletes in Singapore: a hybrid mixed-methods research design

ABSTRACT The study sought to evaluate a custom intervention programme, informed by the Theory of Planned Behaviour, which aimed to help youth athletes reduce their problematic mobile phone use. A hybrid mixed-methods design was employed in this study, involving a one-group pretest–posttest design and a mixed-methods multiple case study design. 23 Singaporean youth athletes (aged 13–19 years) participated in the intervention programme, and were assessed at pre, post, and follow-up timepoints for their objective and subjective measures of mobile phone use. After the intervention programme had concluded, a smaller sample of eight participants were selected to participate in semi-structured interviews to get their views and feedback on the intervention programme. The results showed that while there were no significant differences in the objective measures of mobile phone use (i.e., duration and frequency) between the timepoints, there was a significant reduction in the subjective measure (i.e., SAS-SV) of problematic mobile phone use in both post and follow-up timepoints. This was supported by the multiple case study analysis, which found that participants were able to implement the various strategies that were taught during the intervention programme, and that those strategies were able to help them reduce their level of problematic mobile phone use. Overall, participant feedback for the intervention programme was positive, with participants stating that it was fun, interactive, relatable, and informative. There were still some barriers that prevented participants from reducing their problematic mobile phone use, and suggestions were given on how to improve the intervention programme in future.

Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study.

Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.

Facilitating equitable access to hospice care in socially deprived areas: A mixed methods multiple case study

Background: There is uncertainty about the factors influencing inequities in access to palliative care in socially deprived areas, including the role of service models and professional perceptions. Aim: To explore the relationship between social deprivation and access to hospice care, including factors influencing access and professional experiences of providing care. Design: A mixed-methods multiple case study approach was used. Hospice referrals data were analysed using generalised linear mixed models and other regression analyses. Qualitative interviews with healthcare professionals were analysed using thematic analysis. Findings from different areas (cases) were compared in a cross-case analysis. Setting: The study took place in North West England, using data from three hospices (8699 hospice patients) and interviews with 42 healthcare professionals. Results: Social deprivation was not statistically significantly, or consistently, associated with hospice referrals in the three cases (Case 1, Incidence Rate Ratio 1.04, p = 0.75; Case 2, Incidence Rate Ratio 1.09, p = 0.15, Case 3, Incidence Rate Ratio 0.88, p = 0.35). Hospice data and interviews suggest the model of hospice care, including working relationship with hospitals, and the local nature of social deprivation influenced access. Circumstances associated with social deprivation can conflict with professional expectations within palliative care. Conclusion: Hospice care in the UK can be organised in ways that facilitate referrals of patients from socially deprived areas, although uncertainty about what constitutes need limits conclusions about equity. Grounding professional narratives around expectations, responsibility, and choice in frameworks that recognise the sociostructural influences on end-of-life circumstances may help to foster more equitable palliative care.

Opening access to privilege: the enactment of the IB in public schools in Costa Rica and Peru

ABSTRACT The influence of the International Baccalaureate (IB) has grown impressively on a global scale. In Latin America, the IB has been mainly introduced in private schools that cater for the most affluent sectors of society and, consequently, has been mostly interpreted as contributing to processes of social reproduction and the widening of inequalities However, since the mid-2000s the IB has been promoted in state schools in countries such as Ecuador, Peru, Costa Rica and in the City of Buenos Aires in Argentina. This paper analyses the enactment of the IBDP in public schools in Costa Rica and Peru drawing on a mixed methods multiple case study. It shows how, in countries with significant socioeconomic disparities, the possibility of offering the IBDP to students at public schools was mostly justified as a matter of equity, understood as opening access to an educational programme that was only available to the most privileged sectors of society. By problematising the notions of privilege and eliteness, we discuss the complex relations between inequalities and educational opportunities and question the extent to which these programmes are affecting social structures in Costa Rica and Peru.

The Health Impact of Social Community Enterprises in Vulnerable Neighborhoods: Protocol for a Mixed Methods Study.

BackgroundThis 4-year research project focuses on 6 social community enterprises (SCEs) that operate in 5 neighborhoods in a Dutch city. Residents of these neighborhoods face problems such as poor average levels of physical and mental health, high unemployment rates, and weak social cohesion. SCEs offer residents social, cultural, and work-related activities and are therefore believed to help these persons develop themselves and strengthen the social ties in the community. Because of a lack of empirical evidence; however, it is unclear whether and how SCEs benefit the health and well-being of participants.ObjectiveThis paper outlines a protocol for an evaluation study on the impact of SCEs, aiming to determine (1) to what extent SCEs affect health and well-being of participating residents, (2) what underlying processes and mechanisms can explain such impact, and (3) what assets are available to SCEs and how they can successfully mobilize these assets.MethodsA mixed methods multiple-case study design including repeated measurements will be conducted. Six SCEs form the cases. An integrated model of SCE health intervention will be used as the theoretical basis. First, the impact of SCEs is measured on the individual and community level, using questionnaires and in-depth interviews conducted with participants. Second, the research focuses on the underlying processes and mechanisms and the organizational and sociopolitical factors that influence the success or failure of these enterprises in affecting the health and well-being of residents. At this organizational level, in-depth interviews are completed with SCE initiators and stakeholders, such as municipal district managers. Finally, structurally documented observations are made on the organizational and sociopolitical context of the SCEs.ResultsThis research project received funding from the Netherlands Organization for Health Research and Development in 2018. Data collection takes place from 2018 until 2022. Data analysis starts after the last round of data collection in 2022 and finalizes in 2024. Expected results will be published in 2023 and 2024.ConclusionsDespite the societal relevance of SCEs, little empirical research has been performed on their functioning and impact. This research applies a variety of methods and includes the perspectives of multiple stakeholders aiming to generate new empirical evidence. The results will enable us to describe how SCE activities influence intermediate and long-term health outcomes and how the organizational and sociopolitical context of SCEs may shape opportunities or barriers for health promotion. As the number of these initiatives in the Netherlands is increasing rapidly, this research can benefit many SCEs attempting to become more effective and increase their impact. The findings of this research will be shared directly with relevant stakeholders through local and national meetings and annual reports and disseminated among other researchers through scientific publications.International Registered Report Identifier (IRRID)DERR1-10.2196/37966

Education leads to increased adherence to the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’

Background Occupational therapy competency standards provide an evidence-base to inform clinical best practice, however it is not known whether education about competency standards will increase occupational therapists’ adherence to their use. Aims/objectives To investigate if education about the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’ leads to increased adherence to the competency standards in the clinical practice of occupational therapy driver assessors. Materials and methods A mixed methods multiple case study design was used to evaluate 5 occupational therapy driver assessors’ adherence to the competency standards. An audit of 25 client files and interviews were conducted to evaluate practice against the competency standards prior to an education session, followed by an audit of a further 25 files, interview and feedback after education. Results Qualitative and quantitative analyses suggest that education about the ‘Australian Competency Standards for Occupational Therapy Driver Assessors’ was associated with increased adherence to the competency standards in clinical practice. The results also support the use of competency standards in clinical practice. Conclusions and significance Competency standards can be used to inform and guide clinical practice, and individualised education and feedback of practice against the competency standards can increase occupational therapists’ adherence to these standards.

Organizational Readiness for Patient-Facing Mobile Teledermatology to Care for Established Veteran Patients in the United States.

Purpose: To improve patient access to skin care, the Department of Veterans Affairs (VA) developed a patient-facing asynchronous mobile teledermatology application (app), which allows patients to follow up remotely with dermatologists. To understand how the app would be received in VA, we examined Organizational Readiness for Change (ORC), an important prelude to effective implementation, which includes the shared resolve and collective ability of organizational members to implement a change. Methods: We used a mixed-methods multiple case study approach to assess ORC at three VA facilities. Data derived from a site process call, surveys, and semistructured telephone interviews of VA staff, field notes, and administrative data. Results: Participants at all three facilities supported the intervention and recognized the value of using the app to increase patients' access to dermatologists, but expressed concerns largely related to disruption of the pre-existing clinical workflow. Participants at the facility most actively using the app had the highest overall ORC score and reported the most facilitators. Facility leadership support when guided by a clinical champion minimized barriers by recognizing the complexities of health care provision at specialty clinics. Discussion: While provider buy-in remained a barrier, leadership, guided by the clinical champion, played a critical role instituting implementation strategies. The strong association between the ORC survey score and the presence of facilitators and barriers suggests that the ORC survey may be a rapid, convenient, and effective tool for health care systems to identify favorable sites for wider implementation of mobile telehealth care. Clinical Trials Identifier: NCT03241589.

Clinical variation in the organization of clinical pathways in esophagogastric cancer, a mixed method multiple case study

BackgroundAmong esophagogastric cancer patients, the probability of having undergone treatment with curative intent has been shown to vary, depending on the hospital of diagnosis. However, little is known about the factors that contribute to this variation. In this study, we sought to understand the organization of clinical pathways and their association with variation in practice.MethodsA mixed-method study using quantitative and qualitative data was conducted. Quantitative data were obtained from the Netherlands Cancer Registry (e.g., outpatient clinic consultations and diagnostic procedures). For qualitative data, thematic content analysis was performed using semi-structured interviews (n = 30), observations of outpatient clinic consultations (n = 26), and multidisciplinary team meetings (MDTM, n = 16) in eight hospitals, to assess clinicians’ perspectives regarding the clinical pathways.ResultsQuantitative analyses showed that patients more often underwent surgical consultation prior to the MDTM in hospitals associated with a high probability of receiving treatment with curative intent, but more often consulted with a geriatrician in hospitals associated with a low probability of such treatment. The organization of clinical pathways was analyzed quantitatively at three levels: regional, local, and patient levels. At a regional level, hospitals differed in terms of the number of patients discussed during the MDTM. At the local level, the revision of radiological images and restaging after neoadjuvant treatment varied. At the patient level, some hospitals routinely conduct fitness tests, whereas others estimated the patient’s physical fitness during an outpatient clinic consultation. Few clinicians performed a standard geriatric consultation in older patients to assess their mental fitness and frailty.ConclusionSurgical consultation prior to MDTM was more often conducted in hospitals associated with a high probability of receiving treatment with curative intent, whereas a geriatrician was consulted more often in hospitals associated with a low probability of receiving such treatment.