Qualitative Analysis Of Free-text Responses Research Articles

Information needs in breast reconstruction after mastectomy: a qualitative analysis of free-text responses from 2077 women.

For many, breast reconstruction following mastectomy (BR) forms an integral part of breast cancer survivorship. For those considering BR, provision of information is essential to allow informed decisions. Using free-text responses from a survey of breast cancer survivors, this study aims to understand current gaps in information regarding BR. At the end of an online survey assessing BR experiences, participants were asked the open-ended question: "Thinking about women who may experience BR in the future, is there anything you think needs to change so that they have a better experience?". Responses were analysed to identify common themes. 3384 people completed the survey with 2,077 (61%) responding to the open-ended question. Three themes were identified: (1) content of information, (2) managing expectations, and (3) information sources, each associated with multiple subthemes. Information wanted in theme (1) covered a range of topics including BR options, risks, recovery and 'going flat.' Information on BR's psychological impact was also needed, with comments indicating many were not prepared for this. Theme (2) stressed the importance of realistic information about BR outcomes and processes to reduce discrepancies between expectations and experiences. In theme (3), peer insights and photos were important sources of realistic information. Multiple gaps exist in BR-related information available to women. BR information needs to be comprehensive, realistic, and provided at the right time to allow informed decision-making. Developing strategies to strengthen existing information provision as well as new resources to fill information gaps might enhance BR experiences.

“I felt like I had been put on the shelf and forgotten about” – lasting lessons about the impact of COVID-19 on people affected by rarer dementias

BackgroundThe public health measures imposed in many countries to contain the spread of COVID-19 resulted in significant suspensions in the provision of support and care for people with dementia. The negative effects of these measures have been extensively reported. However, little is known about the specific impact on people with young onset, non-memory-led and inherited dementias. This group may have experienced different challenges compared to those with late onset dementia given their non-memory phenotypes and younger age. We explored the impact of the first COVID-19 lockdown on people living with familial Alzheimer’s disease, behavioural variant frontotemporal dementia, familial frontotemporal dementia, dementia with Lewy bodies, posterior cortical atrophy and primary progressive aphasia and their carers in the UK and their self-reported strategies for coping.MethodsThis was a mixed methods study. An online survey was administered to people with dementia and family carers recruited via Rare Dementia Support. Free-text responses were analysed using framework analysis to identify key issues and themes.Results184 carers and 24 people with dementia completed the survey. Overall, people with dementia experienced worsening of cognitive symptoms (70%), ability to do things (62%), well-being (57%) and changes to medication (26%) during lockdown. Carers reported a reduction in the support they received (55%) which impacted their own mental health negatively. Qualitative analysis of free-text responses shed light on how the disruption to routines, changes to roles and responsibilities, and widespread disconnection from friends, family and health and social care support varied according to phenotype. These impacts were exacerbated by a more general sense that precious time was being lost, given the progressive nature of dementia. Despite significant challenges, respondents demonstrated resilience and resourcefulness in reporting unexpected positives and strategies for adapting to confinement.ConclusionsThis study has highlighted the specific impacts of the COVID-19 restrictions on people with young onset, non-memory-led and inherited dementias, including behavioural variant frontotemporal dementia, primary progressive aphasia and posterior cortical atrophy, and their carers. The specific challenges faced according to diagnosis and the self-reported strategies speak to the importance of – and may inform the development of – tailored support for these underrepresented groups more generally.Visual abstract

Factors affecting speech-language pathologists’ language assessment procedures and tools – challenges and future directions in Sweden

Purpose: National surveys of speech-language pathologists’ (SLP) practices play an important role in professional development, and previous research show that many challenges faced by the profession are similar across the globe. This study aims to describe Swedish SLP assessment practices, examine factors that may affect this practice, and discuss the results in the light of international studies. Methods: Data from 584 SLPs were collected through an online questionnaire with multiple choice and open-ended questions. A mixed-method design was deployed where a deductive qualitative analysis of free-text responses complemented quantitative data. Results: In line with previous results from English-speaking countries, both standardized discrete skill tests and contextualized assessments were used by the respondents but fewer used language sample analysis and dynamic assessment procedures, despite international recommendations. There were few differences based on experience, work setting, proportion of multilingual assessments and socio-economic status of the health catchment area. Main challenges reported were lack of time and difficulty prioritizing, and assessment and/or diagnosis of multilingual/L2 children, which is similar to challenges faced by SLPs in other countries. Swedish SLPs also reported lack of national clinical guidelines as a main challenge. Factors contributing to better assessments included experience, and the combination of many sources of information, including professional and interprofessional discussions. Conclusions: The accumulated evidence from this and previous studies show that to address challenges and build on strengths, changes on a systemic level are needed. This includes more time and resources for continuing education and implementation of recommended assessment methods, as well as professional and interprofessional collaborations.

Burnout Among Respiratory Therapists Amid the COVID-19 Pandemic.

Burnout is a major challenge in health care and is associated with poor overall well-being, increased medical errors, worse patient outcomes, and low job satisfaction. There is scant literature focused on the respiratory therapist's (RT) experience of burnout, and a thorough exploration of RTs' perception of factors associated with burnout has not been reported. The aim of this qualitative study was to understand the factors associated with burnout as experienced by RTs amid the COVID-19 pandemic. We performed a post hoc, qualitative analysis of free-text responses from a survey of burnout prevalence in RTs. There were 1,114 total and 220 free-text responses. Five overarching themes emerged from the analysis: staffing, workload, physical/emotional consequences, lack of effective leadership, and lack of respect. Respondents discussed feelings of anxiety, depression, and compassion fatigue as well as concerns that lack of adequate staffing, high workload assignments, and inadequate support from leadership contributed to feelings of burnout. Specific instances of higher patient acuity, surge in critically ill patients, rapidly evolving changes in treatment recommendations, and minimal training and preparation for an extended scope of practice were reported as stressors that led to burnout. Some respondents stated that they felt a lack of respect for both the RT profession and the contribution of RTs to patient care. Themes associated with burnout in RTs included staffing, workload, physical and emotional exhaustion, lack of effective leadership, and lack of respect. These results provide potential targets for interventions to combat burnout among RTs.

Enhancing medication risk communication in developing countries: a cross-sectional survey among doctors and pharmacists in Malaysia

BackgroundMedication risk communication is essential to ensure the safe use of medicines. However, very few nations worldwide have established effective risk communication systems. To date, the effectiveness of risk communication among healthcare professionals in Malaysia has never been evaluated. Our study aimed to (i) evaluate doctors’ and pharmacists’ awareness of regulatory risk communication methods; (ii) identify factors predicting the usefulness of these methods; and (iii) compare respondents’ preferences for risk communication to outline suggestions for enhancement.MethodsWe conducted a nationwide cross-sectional survey covering four commonly used risk communications, namely a national drug bulletin, safety alerts, Direct Healthcare Professional Communication letters (DHPCs), and educational materials. Multiple logistic regression analysis was used to determine the association between independent variables and the usefulness of risk communication. We performed qualitative analysis of free-text responses to gain insights on respondents’ perspectives on risk communication.ResultsOf the 1146 responses received, 650 were from pharmacists (56.7%). Among the four methods surveyed, 71.5% of respondents were aware of educational materials, while awareness of the other three methods ranged from 20.7 to 53.9%. Pharmacists had higher awareness of all four methods compared to doctors. Private sector respondents were more aware of DHPCs compared to those from the public sector. The strongest predictors for finding risk communication useful were being a pharmacist [odds ratio (OR) = 18.2; 95% CI: 10.98–30.07; p < 0.001], having ≥30 years’ work experience [OR = 4.9; 95% CI: 1.98–12.08; p < 0.001], and working in the pharmaceutical industry [OR = 4.6; 95% CI: 1.08–19.72; p = 0.039]. Both doctors and pharmacists preferred risk communication in the English-language and electronic format. However, other preferences differed between the professions and sectors. Analysis of free-text comments revealed five core themes to guide risk communication enhancement strategies.ConclusionsRisk communication awareness differed between public and private sector doctors and pharmacists depending on communication source. Integrating our findings with the theory of effective communication, we provide suggestions for developing strategic plans on enhancing risk communication. Public-private sector collaboration is key in ensuring risk communication effectiveness.

US medical student perspectives on asian american patient inclusion in medical education: a qualitative Study

BackgroundAsian American (AsAm) representation is lacking in conversations surrounding cultural humility in healthcare. We aimed to investigate US medical student perspectives on AsAm patient inclusion in cultural humility training in medical education.MethodsThis qualitative study analyzed free-text responses to an optional, open-ended question presented at the conclusion of an online survey assessing medical student experiences with and perceptions regarding AsAm patients in their medical education. This survey was distributed to a convenience sample of nine US medical schools. Medical students who completed at least one clinical rotation were eligible to participate in the survey. Qualitative analysis of free-text responses was conducted in an iterative process to generate emergent themes.ResultsThere was a total of 195 optional free-text responses from 688 participants (28%). Motivation to learn about AsAm population included shared identity and desire to better serve the AsAm population in their local community and future careers. Topics of interest included healthcare-related cultural preferences, healthcare delivery strategies, and health disparities for the AsAm population and other minority patients. Students reported that they drew on personal experiences and some pre-clinical or clinical exposures to learn about AsAm patients. Respondents cited the lack of exposure in the medical school curriculum and clinical experiences as the main challenge to learning about AsAm health and provided suggestions for the delivery of this education in their pre-clinical and clinical education. Respondents emphasized that AsAms are treated as a monolith in medical education and healthcare, despite their heterogeneity.ConclusionsMedical students identified a need and interest for greater inclusion of AsAm topics in medical education on cultural humility and minority health.

Standing out or fitting in: A latent projective content analysis of discrimination of women and 2SLGBTQ+ anesthesiologists and providers

IntroductionDiscrimination toward sex and gender minority anesthesiologists and anesthesia trainees exists. Potential reasons for this discrimination are unclear and incompletely characterized. This study sought to better understand what discrimination looks like for sex and gender minorities in anesthesiology and the culture within anesthesiology that allows this discrimination to occur. Materials and methodsWith institutional research ethics board approval and informed consent, we performed a qualitative analysis of free-text responses from a previously-published internet-based cross-sectional survey distributed to Canadian anesthesiology residents, fellows, and staff. The purpose of this survey was to characterize intersections between respondent gender or sexuality with experiences of discrimination in the workplace. Separate analysis of qualitative and quantitative components of this survey was planned a priori, and the quantitative component was published elsewhere. Free-text responses were independently coded by two researchers and subsequently synthesized into emerging themes using latent projective content analysis sensitized by Butler's theory of performativity. ResultsOut of 490 free-text responses from 171 respondents [140 (81.9%) identifying as heterosexual], two themes emerged: i) fitting in: performativity reinforcing the status quo, and ii) standing out: performativity as a means of disruptive social change. Power structures were observed to favour individuals who “fit in” with the normative performances of gender and/or sexuality. DiscussionOur study illuminates how individuals whose performances of gender and sexuality “fit in” with those expected normative performances reinforce a workplace culture that advantages them, whereas individuals whose performances of gender and sexuality “stand out” disproportionately experience discrimination. The dismantling of bias and discrimination in the anesthesiology workplace requires individuals (a) who are empowered within their workplace because they “fit in” with the majority; (b) who recognize discrimination toward communities of their peers and/or colleagues; and (c) who actively choose to “stand out”.

Patient-Reported Outcomes After Chemoradiation in Patients With Anal Cancer: A Qualitative Analysis

PurposePelvic chemoradiation therapy (CRT) is the curative therapy for non-metastatic anal cancer, resulting in excellent survival rates. However, anal cancer survivors may experience diminished quality of life (QOL) due to late toxicities from pelvic CRT. Few studies use patient-reported QOL, and few include thematic analyses of the patient experience in their own words. We conducted a survey study with qualitative analysis of free-text responses to explore themes of patient perceptions of their QOL during and after pelvic CRT to inform future interventions, reform patient education, and improve outcomes. Methods and MaterialsWe surveyed 248 patients with anal cancer treated with definitive intensity modulated radiation and concurrent chemotherapy from 2010 to 2018 who were alive and without recurrence. The survey included the Functional Assessment of Cancer Therapy General 7 item version, questions about satisfaction with preparation and patient education, and an optional free-text response question. Survey free response data were analyzed using the constant comparative method of qualitative analysis. Representative themes were generated. ResultsOne-hundred and twelve patients (45%) completed surveys. Of these respondents, 84 (75%) answered the free-text question. The median (interquartile range) Functional Assessment of Cancer Therapy General 7 item version score for survey responders (N = 112) was 21 (range, 15-24). Three themes most mentioned by respondents were persistent toxicity effecting QOL (82%), insufficient upfront information about CRT (56%), and gratitude toward care received (35%). ConclusionsPatients described late toxicities that affect QOL after pelvic CRT for anal cancer. This may be partially due to insufficient preparative information and post-treatment support. This study contributes to the literature supporting improved patient education and side effect management to augment long-term QOL for survivors of anal cancer.

Covid-19 Coping Survey: an In-depth Qualitative Analysis of Free-Text Responses from People With and Without Existing Health Conditions in the UK

BackgroundThere is currently a lack of qualitative research exploring how cognitive and emotional reactions to the threat of SARS-CoV-2 affected the health behaviours of people living with and without pre-existing mental and physical health conditions. We aimed to investigate how the threat of SARS-CoV-2 influenced the thoughts, feelings and health behaviours of people with and without pre-existing health conditions in the UK.MethodsA cross-sectional online survey of UK adults (aged 18 and over). Free-text responses were analysed using a qualitative framework approach guided by the Common-Sense Model of Self-Regulation.ResultsOf the 9110 respondents, 2763 participants provided at least one free-text response. Three main themes were derived from the data. Theme one, locus of control, reports on the extent to which people felt in control during the first wave of the pandemic. Theme two, emotional impact, conveys how individuals felt and how people’s personal circumstances made them more vulnerable to experiencing negative emotions during the pandemic. Theme three, coping strategies, describes common health-protective and health-threatening behaviours performed by individuals, as well as the importance of social connectedness, the social context and the need for collective action during the first national lockdown.ConclusionComplex psychological interventions including behaviour change are required to mitigate the psychological burden of the SARS-CoV-2 pandemic and increase autonomy in people with and without pre-existing conditions during this highly uncertain time. Behavioural scientists can support governments and public health agencies to develop evidence-based communication and behaviour change strategies that support people to address unhelpful beliefs and emotions and strengthen coping abilities as the UK moves through and beyond the SARS-CoV-2 pandemic.

SARS-CoV-2 vaccine acceptability among caregivers of childhood cancer survivors.

ObjectiveTo explore willingness/hesitancy to vaccinate self and children against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) among caregivers of childhood cancer survivors (CCS).MethodsA 19‐question survey was sent to caregivers of CCS and completed between February 25 and April 13, 2021. Logistic regression was used to investigate relationships between willingness/hesitancy to vaccinate (a) self and (b) CCS, and demographic variables, confidence in the government and medical community's responses to coronavirus disease 2019 (COVID‐19), and factors specific to the CCS community (e.g., previous participation in an investigational therapeutic trial).ResultsCaregivers (6% male) from 130 unique families completed the survey. Mean CCS age at survey was 15 years (SD 6.4). Mean CCS age at diagnosis was 4.3 years (SD 4.3). Mean time from CCS diagnosis to survey completion was 10 years (SD 6.2). Twenty‐one percent of caregivers expressed hesitancy to vaccinate themselves and 29% expressed hesitancy to vaccinate their CCS. Caregivers expressing confidence in the federal government's response to COVID‐19 were six‐fold likelier to express willingness to self‐vaccinate (p < .001) and were three‐fold likelier to express willingness to vaccinate their CCS (p = .011). Qualitative analysis of free‐text responses revealed three general themes, including (a) confidence in science, medicine, and vaccination as a strategy for health promotion, (b) confidence in SARS‐CoV‐2 vaccination and belief that CCS are at greater risk of COVID‐19 complications, and (c) concerns about the swiftness of COVID‐19 vaccine development and insufficient safety/efficacy data in children and CCS.ConclusionsResults underscore the need for COVID‐19 vaccination education and outreach, even among families highly engaged with the medical community, and emphasize the importance of updating these families as relevant data emerge from vaccine trials and registries.

Physiotherapists and patients report positive experiences overall with telehealth during the COVID-19 pandemic: a mixed-methods study.

QuestionWhat were the experiences of physiotherapists and patients who consulted via videoconference during the COVID-19 pandemic and how was it implemented?DesignMixed methods study with cross-sectional national online surveys and qualitative analysis of free-text responses.ParticipantsA total of 207 physiotherapists in private practice or community settings and 401 patients aged ≥ 18 years who consulted (individual and/or group) via videoconference from April to November 2020.MethodsSeparate customised online surveys were developed for physiotherapists and patients. Data were collected regarding the implementation of videoconferencing (cost, software used) and experience with videoconferencing (perceived effectiveness, safety, ease of use and comfort communicating, each scored on a 4-point ordinal scale). Qualitative content analysis was performed of physiotherapists’ free-text responses about perceived facilitators, barriers and safety issues.ResultsPhysiotherapists gave moderate-to-high ratings for the effectiveness of and their satisfaction with videoconferencing. Most intended to continue to offer individual consultations (81%) and group classes (60%) via videoconferencing beyond the pandemic. For individual consultations and group classes, respectively, most patients had moderately or extremely positive perceptions about ease of technology use (94%, 91%), comfort communicating (96%, 86%), satisfaction with management (92%, 93%), satisfaction with privacy/security (98%, 95%), safety (99% both) and effectiveness (83%, 89%). Compared with 68% for group classes, 47% of patients indicated they were moderately or extremely likely to choose videoconferencing for individual consultations in the future. Technology was predominant as both a facilitator and barrier. Falls risk was the main safety factor.ConclusionPatients and physiotherapists had overall positive experiences using videoconferencing for individual consultations and group classes. The results suggest that videoconferencing is a viable option for the delivery of physiotherapy care in the future.

Evaluating a large-scale introductory interprofessional education workshop for developing interprofessional socialisation in medical, nursing and pharmacy students: A quasi-experimental pre-test post-test study

BackgroundTraditionally, healthcare students have been educated in discipline-specific silos with minimal interprofessional socialisation. Interprofessional education is fundamental for interprofessional socialisation and is an essential component of healthcare education. ObjectivesTo evaluate the effect of a large-scale interprofessional workshop implemented for first year medical, nursing and pharmacy students on changes in attitudes towards interprofessional socialisation and its perceived value. DesignA quasi-experimental study design using pre and post questionnaires. SettingA Faculty of Medicine and Health at a large university in Australia. Participants1008 students from the 2018 and 2019 cohorts of pre-qualification first year medical students (n = 444), nursing (n = 461) and pharmacy (n = 103) enrolled in a graduate entry degree program participated in the workshop. Complete data sets were collected from 37.1% (n = 374) of the participants. MethodsThe short-form Interprofessional Socialisation and Valuing Scale (ISVS-9) was administered before and after the IPE workshop. Linear mixed models were used to compare both the within group and between group pre- and post- questionnaire data. Percentages and frequencies were used to analyse data pertaining to participants' perceptions and experience of the workshop. Descriptive qualitative analysis of free-text responses was undertaken. ResultsFindings indicated that 80.8% (n = 440) of participants rated their workshop experience as good/very good. 64.6% (n = 352) of participants reported that it had changed how they considered other health professionals. Significant higher (p < 0.001) post questionnaire mean scores were demonstrated for nursing (5.63, SE0.05) and pharmacy students (5.82, SE 0.11). ConclusionFindings provide support for the implementation of IPE for nursing, and pharmacy students. It is recommended that these initiatives are introduced at an early stage in their education to promote interprofessional socialisation and are repeated throughout the curricula.

Hospice Access and Scope of Services for Undocumented Immigrants: A Clinician Survey.

Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Setting/Subjects: Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Measurements: Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chi-square analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. Results: A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; p = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Conclusions: Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.

Technological Capabilities to Assess Digital Excellence in Hospitals in High Performing Health Care Systems: International eDelphi Exercise.

BackgroundHospitals worldwide are developing ambitious digital transformation programs as part of broader efforts to create digitally advanced health care systems. However, there is as yet no consensus on how best to characterize and assess digital excellence in hospitals.ObjectiveOur aim was to develop an international agreement on a defined set of technological capabilities to assess digital excellence in hospitals.MethodsWe conducted a two-stage international modified electronic Delphi (eDelphi) consensus-building exercise, which included a qualitative analysis of free-text responses. In total, 31 international health informatics experts participated, representing clinical, academic, public, and vendor organizations.ResultsWe identified 35 technological capabilities that indicate digital excellence in hospitals. These are divided into two categories: (a) capabilities within a hospital (n=20) and (b) capabilities enabling communication with other parts of the health and social care system, and with patients and carers (n=15). The analysis of free-text responses pointed to the importance of nontechnological aspects of digitally enabled change, including social and organizational factors. Examples included an institutional culture characterized by a willingness to transform established ways of working and openness to risk-taking. The availability of a range of skills within digitization teams, including technological, project management and business expertise, and availability of resources to support hospital staff, were also highlighted.ConclusionsWe have identified a set of criteria for assessing digital excellence in hospitals. Our findings highlight the need to broaden the focus from technical functionalities to wider digital transformation capabilities.

Improving medical students' confidence in end-of-life consultations.

End-of-life discussions are associated with improved quality of care for patients. In the UK, the General Medical Council outlines a requirement for medical graduates to involve patients and their families in discussions on their care at the end-of-life. However medical students feel ill-equipped to conduct these discussions. In 2018, Sheffield Medical School introduced a small group role-play session on end-of-life discussions for all final year medical students. Scenarios were devised to improve confidence in the following learning domains: communicating prognosis with patients and family; ascertaining patient's goals, values and preferred place of death; discussing escalation of treatment, discussing do not attempt resuscitation orders, care in the dying phase of illness and pre-emptive prescribing. Evaluation was conducted over 16 weeks with a before and after questionnaire. Students rated their confidence in the above learning domains on a Likert-style scale and explained their ratings in free-text boxes. There was a 76% response rate to the questionnaire and analysis showed statistically significant improvements in confidence across all learning domains following the session. Qualitative analysis of free-text responses showed that prior to the sessions, students expressed low confidence due to lack of experience and fear of upsetting patients. After the session students felt they had gained skills but expressed persistent anxiety and a desire for further practice. Our innovation suggests that the opportunity to experience End-of-life discussions through role-play can significantly improve students' confidence in conducting these conversations. However, repeated sessions are likely necessary for students to feel prepared upon graduation.

Barriers to Firearm Injury Research

Firearm injuries and motor vehicle injuries are 2 leading causes of fatal injury in the U.S., each accounting for approximately 35,000 deaths annually. Research on firearm injuries is under-represented compared with research on motor vehicle collisions. This study seeks to identify perceived barriers to firearm injury research versus motor vehicle injury research. This was a mixed-methods survey of corresponding authors of a minimum of 1 study, archived in PubMed, related to firearm injury or motor vehicle injury between 2014 and 2018. Analyses were performed in 2019. Electronic surveys included both closed- and open-ended questions to assess barriers to research. Bivariable and multivariable logistic regression was performed to identify differences in perceptions to barriers between the 2 groups. Qualitative analysis of free-text responses was performed through inductive derivation of themes. Surveys were distributed to 113 firearm injury researchers (42% response rate) and 241 motor vehicle injury researchers (31.5% response rate). After adjustment, firearm injury researchers were less likely to cite institutional support (AOR=0.3, 95% CI=0.1, 0.8) as a factor contributing to their success, than motor vehicle injury researchers. Firearm injury researchers were more likely to report fear of personal threats (AOR=10.4, 95% CI=2.4, 44.4) and experiencing personal threats (AOR=16.1, 95% CI=1.6, 165.4). Thematic analysis revealed 4 themes: career, political, funding, and harassment. When compared with motor vehicle injury researchers, firearm injury researchers are significantly more likely to report limited support and threats to personal safety as barriers to research. Further research to understand the impact of these barriers and methods to overcome them is needed.

Creating space for Indigenous healing practices in patient care plans.

BackgroundThe Truth and Reconciliation Commission of Canada’s Calls to Action ask that those who can effect change within the Canadian healthcare system recognize the value of Indigenous healing practices and support them in the treatment of Indigenous patients.MethodsWe distributed a survey to the Canadian Rheumatology Association membership to assess awareness of Indigenous healing practices, and attitudes informing their acceptance in patient care plans.ResultsWe received responses from 77/514 members (15%), with most (73%) being unclear or unaware of what Indigenous healing practices were. Nearly all (93%) expressed interest in the concept of creating space for Indigenous healing practices in rheumatology care plans. The majority of support was for the use in preventive or symptom management strategies, and less as adjuncts to disease activity control. Themes identified through qualitative analysis of free-text responses included a desire for patient-centered care and support for reconciliation in medicine, but with a colonial construct of medicine, demonstration of an evidence bias, and hierarchy of medicines.ConclusionsOverall, respondents were open to the idea of inclusion of Indigenous healing practices in patient’s car plans, emphasizing importance for patient empowerment and patient-centered care. However, they cited concerns that provide the indication for further learning and reconciliation in medicine.

Feasibility of Intensive Ecological Sampling of Tinnitus in Intervention Research.

To assess whether adults with bothersome tinnitus will complete multiple ecological momentary assessments (EMAs) per day, including those during a therapeutic intervention trial. EMA is defined as repeated sampling of subjects' current behaviors and experiences in real time. Twelve-week longitudinal cohort study conducted from August 28, 2017, to December 14, 2017. Online only. Thirty adults with self-reported bothersome nonpulsatile tinnitus of >6 months' duration. Participants completed 2 weeks of EMA text surveys 7 times per day (preintervention), followed by 8 weeks of EMA questions 4 times per day (during intervention), concluding with 2 weeks of EMA questions 7 times per day (postintervention) for a total of 420 surveys over 12 weeks. During the 8-week intervention period, participants used a commercially available auditory-intensive online cognitive brain training program for 20 minutes per day, 5 times per week (total, 800 minutes). The primary outcome measures were compliance with EMA surveys, as measured by survey response rates, and participant-reported effects of EMA on their tinnitus bother. Of the 30 participants in this study (20 women and 10 men; median age, 54 years [range, 47-64 years]), 25 participants completed the study protocol (83%). Participants completed a median 87% of EMA surveys (range, 67%-99%). Qualitative analysis of free-text responses found that participants did not report negative side effects of the EMA. Excellent participant compliance can be achieved with multiweek temporally rigorous EMA sampling. EMA sampling can successfully be conducted during an intervention. EMA is a promising sampling methodology in tinnitus research.

Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes.

Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers. This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity. Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods. A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities. Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.

Understanding ownership of patient care: Adual-site qualitative study of faculty and residents from medicine and psychiatry.

IntroductionWith changes in duty hours and supervision requirements, educators have raised concerns about erosion of patient care ownership by resident physicians. However, the definition of ownership is unclear. This qualitative study investigated definitions of ownership in medicine and psychiatry faculty and residents.MethodsThe authors distributed an anonymous online survey regarding definitions of ownership to faculty and residents at the psychiatry and internal medicine residency programs at the University of Washington and the Harvard Longwood psychiatry residency and conducted a qualitative analysis of free-text responses to identify emergent themes.Results225 faculty (48.6%) and 131 residents (43.8%) across the three programs responded. Responses yielded themes in five domains: Physician Actions, Physician Attitudes, Physician Identity, Physician Qualities, and Quality of Patient Care. All groups identified themes of advocacy, communication and care coordination, decision-making, follow through, knowledge, leadership, attitudes of going ‘above and beyond’ and ‘the buck stops here’, responsibility, serving as primary provider, demonstrating initiative, and providing the best care as central to ownership. Residents and faculty had differing perspectives on ‘shift work’ and transitions of care and on resident decision-making as elements of ownership.DiscussionThis study expanded and enriched the definition of patient care ownership. There were more similarities than differences across groups, a reassuring finding for those concerned about a decreasing understanding of ownership in trainees. Findings regarding shared values, shift work, and the decision-making role can inform educators in setting clear expectations and fostering ownership despite changing educational and care models.