Rigorous Qualitative Methods Research Articles

Where is democracy nestled? Reflections on organizational degeneration based on an artists’ cooperative

PurposeThis article presents a compelling case study of a workers’ cooperative in the cultural sector. It offers a unique opportunity to delve into the tensions between managerial and democratic control, particularly in the context of heightened artistic claims. The pivotal role of an accountant in management for nearly two decades sparks a thought-provoking question about the potential for cooperative degeneration.Design/methodology/approachOur research employs a rigorous qualitative method, utilizing semi-structured interviews of six key members and a comprehensive analysis of legal, accounting and other media documents.FindingsOur findings offer a significant perspective, refuting any indications of organizational degeneration. The decision-making processes continue to uphold democratic principles. While the manager and his administrative staff wield substantial authority, this is justified by their duty to preserve the collective. This duty is executed under democratic control, facilitated by information transparency. The low level of democratic participation poses a challenge, but the manager’s initiatives are aimed at addressing this. The effectiveness of this control, however, relies on the active participation of the members, which acts as a strong deterrent against organizational degeneration.Originality/valueThe originality of our contribution lies in our reference to Chester Barnard whose reflections on industrial democracy have been forgotten, reflections linked to his conception of managerial authority. We also highlight the importance of empowering individual members, which leads them to consider the consequences of their actions. As a result, the manager is not placed in a situation where he has to decide alone, as the scope of his unilateral powers is de facto delimited.

Stories of chronic illness: exploring qualitative data through poetic transcriptions

As a research technique, poetic transcription transforms people’s stories and enables deeper analysis and engagement between participants, readers and researchers. Chronic illness is often characterised as a ‘biographical disruption’, which...

Understanding health-related quality of life after hypospadias repair: A qualitative study with pre-adolescent males and parents

Hypospadias is a common disease that affects approximately 1 in every 200 live male births in the United States, and long-term studies of individuals who have undergone repair demonstrate complication rates of 15%-70%. The Hypospadias-Specific Health-related Quality of Life (HRQOL) Conceptual Framework for youth and adults suggests that additional morbidity may be incurred from poor psychological, social, and sexual health. The current study sought to clarify hypospadias-specific HRQOL and care priorities in a pre-pubertal population. This IRB-approved, semi-structured interview study used rigorous qualitative research methods. Eligible patients were English-speaking 8-12-year-old males with hypospadias and their parents. Families completed a demographic questionnaire and separate youth and parent 30-min telephone interviews. We used hybrid thematic analysis to develop an operational codebook, analyze participant responses, and generate conceptual themes. Mixed methods analysis was used to explore patterns of experiences across groups defined by socioeconomic level. We interviewed 10 parents and 8 children (Median age 9 years, Range 8-11). We generated three overarching themes: Penile Factors, Psychosocial Concerns, and Expectations of Surgery and the Healthcare Team. These highest-order themes were generated for youth, parent-proxy, and parent self-reported experiences, and there were different sub-themes for each participant type (Figure). Youth were focused on avoidance of disclosure and the psychological impact of self-comparisons and embarrassment, while the parental perspective centered on worries about future fertility, complications, psychological health, and normality. Some youth and parents from disadvantaged neighborhoods or those with public insurance indicated a need for more education on normal penile functions and provision of strategies for long-term self-monitoring and facilitation of long-term follow-up on mixed methods analysis. These findings add insight into the multifaceted experiences of pre-pubertal youth and families dealing with hypospadias, and underscore the consistent, wide-ranging interplay between medical, psychological, and social concerns. Patterns in themes across socioeconomic status and insurance coverage suggest that access to information and quality care may vary significantly and could contribute to health disparities. Urologists should employ an individualized approach to counseling and care delivery. Future studies will seek to characterize care priorities in pubertal and post-pubertal age groups to design developmentally adjusted support tools for youth and adults with hypospadias and their families.

Minding the margins: Evaluating the impact of COVID-19 among Latinx and Black communities with optimal qualitative serological assessment tools.

COVID-19 disproportionately affected minorities, while research barriers to engage underserved communities persist. Serological studies reveal infection and vaccination histories within these communities, however lack of consensus on downstream evaluation methods impede meta-analyses and dampen the broader public health impact. To reveal the impact of COVID-19 and vaccine uptake among diverse communities and to develop rigorous serological downstream evaluation methods, we engaged racial and ethnic minorities in Massachusetts in a cross-sectional study (April-July 2022), screened blood and saliva for SARS-CoV-2 and human endemic coronavirus (hCoV) antibodies by bead-based multiplex assay and point-of-care (POC) test and developed across-plate normalization and classification boundary methods for optimal qualitative serological assessments. Among 290 participants, 91.4% reported receiving at least one dose of a COVID-19 vaccine, while 41.7% reported past SARS-CoV-2 infections, which was confirmed by POC- and multiplex-based saliva and blood IgG seroprevalences. We found significant differences in antigen-specific IgA and IgG antibody outcomes and indication of cross-reactivity with hCoV OC43. Finally, 26.5% of participants reported lingering COVID-19 symptoms, mostly middle-aged Latinas. Hence, prolonged COVID-19 symptoms were common among our underserved population and require public health attention, despite high COVID-19 vaccine uptake. Saliva served as a less-invasive sample-type for IgG-based serosurveys and hCoV cross-reactivity needed to be evaluated for reliable SARS-CoV-2 serosurvey results. The use of the developed rigorous downstream qualitative serological assessment methods will help standardize serosurvey outcomes and meta-analyses for future serosurveys beyond SARS-CoV-2.

Consumer Value Preferences: A Case of Dates in Pakistan

This research endeavors to enhance our comprehension of the contemporary value chain associated with dates in the domestic market, while concurrently adapting to the fluctuating dynamics of the marketplace. A paramount emphasis is placed on orchestrating an optimal performance of the dates value chain by integrating all actors involved, focusing on aligning strategies with consumer value preferences. Five distinct focus discussions were conducted across varying socio-economic strata in Karachi to achieve this. Thematic content analysis, a rigorous qualitative research method, was employed to extract meaningful insights from the discussions. Findings showed that dates were a multi-value popular fruit consumed in a variety of forms but the fresh form is mostly utilized form. Consumers ascribed value to its strong religious affiliation, socio-cultural significance, taste, energy, health benefits, functional food, packaging and availability. The main attributes consumers considered in buying dates were clean dates, flavor/taste, packaging, origin, freshness, price, size, brand, and freedom from damage. Consumers expressed concerns about high dates fluctuating prices, trust for safe dates retailer practices, inefficient government regulations, poor marketing systems, and lack of awareness. These findings highlighted that businesses in date value chains did not pay adequate attention to consumer requirements nor had their concerns been responded to. To face competitive value chain potential, consumers highlighted lack of value addition, ineffective labelling, strong local brand sustainable presence to gain consumer confidence. To face market competition there is strong scope of branding, packaging and value addition which consumers are adapting at fast pace have also been reported. Consequently, it will affect the profitability of value chain participants as consumers are evolving with experience and higher living standards. The study also suggested that the government should ensure that consumer concerns such as those relating to food safety are adequately addressed by relevant institutions and organizations. This research not only sheds light on the intricacies of the current market dynamics but also provides strategic insights for stakeholders to optimize the value chain in a manner that resonates with the preferences of consumers across different socio-economic strata in Karachi.

A closer look into the ‘black box’ of coaching – linguistic research into the local effectiveness of coaching with the help of conversation analysis

ABSTRACT This paper, located in the paradigm of Linguistic Coaching Process Research, theoretically introduces Conversation Analysis (CA) as a means to explore the ‘black box’ of coaching, i.e., the concrete conversation, and to address pressing research gaps in this field. CA, developed to describe, analyse, and understand practices and patterns of talk-in-interaction, presents a rigorous, systematic, and transparent qualitative method to document and research the sequentially organised conversational structure of coaching as well as the discursive practices of coach and client. The analytical power of CA lies in identifying change-inducing practices and in detailing how these contribute to the local effectiveness of coaching. A case in point are questioning practices, whose transformative power as local agents of change emerges in their sequential set-up as ‘coaches’ question – clients’ response – coaches’ reaction in third position’. In an exemplary analysis using CA, we illustrate the (un-)successful processing of questions in coaching. The two data extracts stem from the ongoing project Questioning Sequences in Coaching. While the paper aims to shed predominantly theoretical light on how to linguistically unpack the ‘black box’ of coaching, it also aims to sensitise practitioners to consider interventions, e.g., questions, as embedded in the locally transpiring, turn-by-turn interaction with their clients.

Patient experience of spontaneous intracranial hypotension (SIH): qualitative interviews for concept elicitation

Background & objectivesSpontaneous intracranial hypotension (SIH) is an underdiagnosed and debilitating condition caused by a spinal cerebrospinal fluid (CSF) leak. Although SIH can lead to substantial morbidity and disability, little data exists about patients’ perspectives. Without hearing directly from patients, our understanding of the full experience of having SIH is limited, as is our ability to identify and use appropriate patient-reported outcome measures (PROMs) within clinical care and research. The purpose of this study was to conduct qualitative interviews with confirmed SIH patients to fully describe their experiences and identify relevant concepts to measure.MethodsPatients were recruited from an SIH specialty clinic at a large, U.S.-based healthcare center. Patients undergoing an initial consultation who were ≥ 18 years old, English-speaking, met the International Classification of Headache Disorders-3 criteria for SIH, and had a brain MRI with contrast that was positive for SIH were eligible to participate. During semi-structured qualitative interviews with a trained facilitator, participants were asked to describe their current SIH symptoms, how their experiences with SIH had changed over time, and the aspects of SIH that they found most bothersome. Analysts reviewed the data, created text summaries, and wrote analytic reports.ResultsFifteen participants completed interviews. Common symptoms reported by patients included headache, tinnitus, ear fullness/pressure/pain, and neck or interscapular pain. Patients reported that their symptoms worsened over the course of their day and with activity. The most bothersome aspect of SIH was disruption to daily activities and limits to physical activities/exercise, which were severe. With regard to symptoms, the most bothersome and impactful included physical pain and discomfort (including headache), as well as fatigue.ConclusionsPatients reported a diverse set of symptoms that were attributed to SIH, with devastating impacts on functioning and high levels of disability. Researchers considering use of PROMs for SIH should consider inclusion of both symptom scales and aspects of functioning, and future work should focus on evaluating the validity of existing measures for this patient population using rigorous qualitative and quantitative methods in diverse samples. Additionally, these data can be used to assist clinicians in understanding the impacts of SIH on patients.

Hybridizing qualitative coding with natural language processing and deep learning to assess public comments: A case study of the clean power plan

Public comments are a rich source of data on attitudes toward public policy, but the scale poses major challenges for qualitative analyses. Supervised deep learning and natural language processing potentially enable classification of these data but require high quality labeled inputs. This study investigates whether hybridizing rigorous qualitative coding methods with machine learning approaches can classify large amounts of policy-oriented text data (public comments) while keeping manual effort tractable. Using a convolutional neural network, we evaluate spatiotemporal variation in themes and expressed public attitudes toward a specific US climate policy, the Clean Power Plan (CPP), which was proposed in 2014 and repealed in 2019 without ever taking effect. Public comments were solicited for both the proposal and proposed repeal across eight cities, representing a large and highly targeted dataset on dynamic public attitudes toward the CPP. Rigorous manual coding and data augmentation techniques enabled good model performance (F1 scores of 0.71 and 0.81, respectively, for sentiment and topic classification), even with a very small training set. We find that most speakers supported the CPP despite its eventual repeal and uncover notable rhetorical trends like competing narratives of justice for those affected by climate change versus fossil fuel host communities.

Economic geographies of Asian international financial centers: A sympathetic critique

Through a comprehensive review of economic geography studies on Asian international financial centers (IFCs) published from 2009, this paper aims to provide a sympathetic critique of the key research trajectories of financial geographies and to outline research gaps where economic geographers could contribute to the relevant literature. Economic geographers have identified a prominent change in the geographies of the international finance industry, with the rapid development and the emergence of inter-city networks among Asian IFCs, and suggested how the emerging FinTech industries could reshape the competitive dynamics and thus the financial landscape of IFCs. The literature has unpacked the general mechanisms of how Asian IFCs grow and evolve as well as their spatial patterns but has neglected the macro political-economic contexts that drive the development dynamics of Asian IFCs. To maintain the long-term prospects of financial geography, we call for efforts to theorize (Asian-based) financial geographies and develop the corresponding analytical frameworks with rigorous quantitative and qualitative methods to examine the development trajectories of Asian IFCs and their socio-political and geo-economical mechanisms. Moreover, economic geographers could develop a set of composite parameters to capture the attributes and structures that could (re)shape the development trajectories of inter-city and intra-city financial networks and their level of resilience to external shocks.

Volunteer Experiences of Pediatric Palliative Care among University Students: A Phenomenological Approach.

This phenomenological analysis was conducted to explore the experiences of college student volunteers in the field of pediatric palliative care. In-depth interviews were conducted with nine study participants who had experience volunteering with children receiving pediatric palliative care. The study analysis was conducted using the Colaizzi method, a rigorous qualitative research method, to develop "intra-group" comparisons among the study participants. Through an analysis of the data, 51 themes, 18 theme clusters, and five main categories were derived. The results confirmed that the experience of university student volunteers in pediatric palliative care can be summarized as "awareness of the role of a volunteer," "difficulties encountered while volunteering," "efforts to overcome the difficulties of volunteer work," "personal reflection," and "awareness of life and death." The results of this study can be used as a practical guide for the effective management of volunteers in the pediatric palliative care setting.

In Their Own Words, "Waiting Sucks:" A Qualitative Study of Medical Testing-Related Anxiety in Patients with Cancer.

This qualitative study sought to learn from patients with cancer -- in their own words -- about anxiety associated with medical testing. Patients with cancer or a history of cancer were recruited from an oncology clinic. After oral consent, each was interviewed in person. A semi-structured interview guide was used to help focus the interviews. Interviews were then recorded, transcribed, and analyzed with rigorous qualitative methods. Twenty patients are the focus of this report, which highlights 2 main themes from the data. The first is that anxiety related to medical testing is a real entity. Although not all patients experienced it, those who did described it as such ("I was a little apprehensive." "It's the anticipation." "I don't think it bothers me until I get near the time for testing."). The second theme focused on coping. Patients offered insight on how to cope ("So I just deal with it and work." "And don't let myself sink into a pity pot …." "See your scan as a tool instead of … instead of um … a death sentence, I suppose."). In patients with cancer, the anxiety from medical testing is real, could perhaps be mitigated by sharing coping methods from patient to patient, and merits further study.

PD50-11 THE PATIENT VOICE: EXPERIENCES WITH URETERAL STENT REMOVAL – A URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STUDY

You have accessJournal of UrologyCME1 May 2022PD50-11 THE PATIENT VOICE: EXPERIENCES WITH URETERAL STENT REMOVAL – A URINARY STONE DISEASE RESEARCH NETWORK (USDRN) STUDY Carrie Dombeck, Charles Scales, Kevin McKenna, Teresa Swezey, Jodi Antonelli, Alana Desai, Jonathan Harper, Michele Curatolo, Naim Maalouf, Peter Reese, Rebecca McCune, Hussein Al-Khalidi, Ziya Kirkali, and Amy Corneli Carrie DombeckCarrie Dombeck More articles by this author , Charles ScalesCharles Scales More articles by this author , Kevin McKennaKevin McKenna More articles by this author , Teresa SwezeyTeresa Swezey More articles by this author , Jodi AntonelliJodi Antonelli More articles by this author , Alana DesaiAlana Desai More articles by this author , Jonathan HarperJonathan Harper More articles by this author , Michele CuratoloMichele Curatolo More articles by this author , Naim MaaloufNaim Maalouf More articles by this author , Peter ReesePeter Reese More articles by this author , Rebecca McCuneRebecca McCune More articles by this author , Hussein Al-KhalidiHussein Al-Khalidi More articles by this author , Ziya KirkaliZiya Kirkali More articles by this author , and Amy CorneliAmy Corneli More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002621.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are often employed after ureteroscopy, and subsequently require removal. Despite this requirement, to date, no studies have qualitatively described patients’ experiences with removing indwelling ureteral stents following ureteroscopy for stone disease. The objective of this study was to describe the qualitative experiences of patients undergoing ureteral stent removal. METHODS: The USDRN Study to Enhance Understanding of Stent-Associated Symptoms (STENTS) is a prospective observational cohort study that included a nested cohort of participants who completed qualitative in-depth interviews (n=38) within 30 days after stent removal. Participants were asked to reflect on (1) painful or bothersome aspects of stent removal (2) symptoms immediately after removal, and (3) symptoms in the days after removal. All interviews were audio-recorded, transcribed, and analyzed using a rigorous qualitative method (applied thematic analysis). RESULTS: Of the 38 participants, 21 (55%) were female, with ages ranging from 13 to 77 years. Interviews were conducted 7–30 days (median = 16 days) after stent removal. Almost all participants (n=31) reported experiencing either pain or discomfort at some point during stent removal, but this was of short duration for most. Many (n=21) also described anticipatory anxiety related to the procedure, and several (n=11) discussed discomfort arising from lack of privacy, embarrassment, or feeling exposed (Table). Interactions with medical providers had the potential to ease patient concerns, or conversely, to increase discomfort. Following stent removal, several participants (n=18) described persistence of pain and/or urinary symptoms, but for most, these largely resolved within 24 hours. Only a few reported lingering symptoms more than a day after stent removal. CONCLUSIONS: Our findings expand the understanding of patient experiences during and shortly after ureteral stent removal, and importantly, identify opportunities for improvement. Patients experience psychological distress related to stent removal, which has not been described previously. Optimal communication before and during the removal procedure, and about the possibility of delayed pain, may improve patient experience. Source of Funding: NIH/NIDDK © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e840 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Dombeck More articles by this author Charles Scales More articles by this author Kevin McKenna More articles by this author Teresa Swezey More articles by this author Jodi Antonelli More articles by this author Alana Desai More articles by this author Jonathan Harper More articles by this author Michele Curatolo More articles by this author Naim Maalouf More articles by this author Peter Reese More articles by this author Rebecca McCune More articles by this author Hussein Al-Khalidi More articles by this author Ziya Kirkali More articles by this author Amy Corneli More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Stress and Resilience Town Hall: A systems response to support the health workforce during COVID-19 and beyond

ObjectiveThe COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic. MethodWe conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85). ResultsWe identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time. ConclusionsThe virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.

Identifying Core Functions of an Evidence-Based Intervention to Improve Cancer Care Quality in Rural Hospitals.

Background:Rural patients experience worse cancer survival outcomes than urban patients despite similar incidence rates, due in part to significant barriers to accessing quality cancer care. Community hospitals in non-metropolitan/rural areas play a crucial role in providing care to patients who desire and are able to receive care locally. However, rural community hospitals typically face challenges to providing comprehensive care due to lack of resources. The University of Kentucky’s Markey Cancer Center Affiliate Network (MCCAN) is an effective complex, multi-level intervention, improving cancer care in rural/under-resourced hospitals by supporting them in achieving American College of Surgeons Commission on Cancer (CoC) standards. With the long-term goal of adapting MCCAN for other rural contexts, we aimed to identify MCCAN’s core functions (i.e., the components key to the intervention’s effectiveness/implementation) using theory-driven qualitative data research methods.Methods:We conducted eight semi-structured virtual interviews with administrators, coordinators, clinicians, and certified tumor registrars from five MCCAN affiliate hospitals that were not CoC-accredited prior to joining MCCAN. Study team members coded interview transcripts and identified themes related to how MCCAN engaged affiliate sites in improving care quality (intervention functions) and implementing CoC standards (implementation functions) and analyzed themes to identify core functions. We then mapped core functions onto existing theories of change and presented the functions to MCCAN leadership to confirm validity and completeness of the functions.Results:Intervention core functions included: providing expertise and templates for achieving accreditation, establishing a culture of quality-improvement among affiliates, and fostering a shared goal of quality care. Implementation core functions included: fostering a sense of community and partnership, building trust between affiliates and Markey, providing information and resources to increase feasibility and acceptability of meeting CoC standards, and mentoring and empowering administrators and clinicians to champion implementation.Conclusion:The MCCAN intervention presents a more equitable strategy of extending the resources and expertise of large cancer centers to assist smaller community hospitals in achieving evidence-based standards for cancer care. Using rigorous qualitative methods, we distilled this intervention into its core functions, positioning us (and others) to adapt the MCCAN intervention to address cancer disparities in other rural contexts.

Qualitative Research Methods in Chronic Disease: Introduction and Opportunities to Promote Health Equity.

Public health research that addresses chronic disease has historically underutilized and undervalued qualitative methods. This has limited the field's ability to advance (a) a more in-depth understanding of the factors and processes that shape health behaviors, (b) contextualized explanations of interventions' impacts (e.g., why and how something did or did not work for recipients and systems), and (c) opportunities for building and testing theories. We introduce frameworks and methodological approaches common to qualitative research, discuss how and when to apply them in order to advance health equity, and highlight relevant strengths and challenges. We provide an overview of data collection, sampling, and analysis for qualitative research, and we describe research questions that can be addressed by applying qualitative methods across the continuum of chronic disease research. Finally, we offer recommendations to promote the strategic application of rigorous qualitative methods, with an emphasis on priority areas to enhance health equity across the evidence generation continuum.

Cultural considerations and rigorous qualitative methods in public diplomacy research

Cultural considerations and rigorous qualitative methods in public diplomacy research

Care coordination challenges between a high-volume center and rural physicians treating patients with pancreatic cancer.

58 Background: Pancreatic cancer (PC) patients treated at high-volume centers (HVCs) benefit from specialty services that may not be accessible to rural patients: complex treatment planning, advanced surgical and chemo-radiation options, and multidisciplinary team-based care. As a result, rural PC patients often seek treatment at multiple locations for different episodes of care (i.e., chemotherapy and surgery). The facilitators and barriers to coordinating care between rural physicians and HVCs for rural PC patients treated by both types of providers are not well-understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two co-authors independently coded the interview transcripts to develop a thematic account of HVC-rural physician care coordination barriers and facilitators. Results: Initial interactions between PC specialists and rural PC patients often require duplication of diagnostic testing (i.e., imaging) due to inadequate transfer of medical records at the time of consultation. This is partly due to inefficient phone communication between HVCs and rural physicians. Such inefficiencies often discourage two-way communication between HVCs and rural physicians, and this can hinder development of a shared understanding of patients’ treatment plans. Specialists suggested a dual-approach may help to improve care coordination in this context: (a) developing better personal relationships with rural physicians to facilitate information-sharing and “closing-the-loop” on patients’ treatment plans; and (b) implementing data systems that permit physicians to share patients’ records across organizations. Several specialists acknowledged the benefit of having a dedicated care coordinator who could help patients connect with specialists, navigate the different healthcare systems, and relay information between providers. Conclusions: Given the challenges that can complicate the PC treatment process for rural patients, it is important to consider opportunities to address these issues. Taking steps to improve efficiency in communication may help facilitate the development of cohesive treatment plans and promote team-based care. Further studies are needed to examine the effects of care coordination interventions, like the use of care coordinators, on improving care for rural PC patients.

Multidisciplinary care for rural pancreatic cancer patients: Providers’ perspectives about patients’ challenges navigating between rural healthcare settings and high-volume centers.

116 Background: Multidisciplinary care from high-volume centers (HVCs) improves outcomes for patients with pancreatic cancer (PC). However, rural PC patients lack access to high-volume PC specialists, resulting in the need for them to travel to distant HVCs for specialized treatment. The barriers and challenges rural PC patients face when seeking care at distant HVCs is poorly understood. Methods: We conducted semi-structured interviews with PC specialists (medical, surgical, and radiation oncologists, n = 9) at a HVC (The Ohio State University) actively treating and co-managing rural PC patients with rural physicians. Using rigorous qualitative methods, two coders independently coded the interview transcripts to develop a thematic account of challenges rural PC patients encounter when receiving care at distant HVCs. Results: PC specialists commonly identified transportation as a major barrier they believed their rural PC patients experienced, and noted both the distance these patients needed to travel and difficulties patients reported in navigating major cities to receive care at HVCs. Similarly, providers commented that rural PC patients and their families reported having difficulty finding affordable lodging near HVCs sometimes resulting in the need for frequent and inconvenient back-and-forth travel between the HVC and the patient’s home. One interviewee stressed the importance of health literacy and the need for providers to improve physician-patient communication as well as provide resources to help rural PC patients better understand their condition and recommended treatment plan. PC specialists also indicated that some rural PC patients had expressed discomfort about contacting physicians outside their in-person clinic visits. They also reported that the possible duplication of services such as diagnostic imaging that could occur may result in increased financial stress for their patients. Conclusions: PC specialists noted several challenges they perceived their rural PC patients may face when navigating care between rural healthcare settings and HVCs. Notably, these challenges may both impact the delivery of high-quality multidisciplinary care and cause additional stress for rural PC patients. Future studies should examine how interventions (e.g., patient navigators, support groups, educational resources) aimed specifically at addressing barriers to multidisciplinary PC care for rural PC patients can be designed and implemented.

Management practices for leaders to promote infection prevention: Lessons from a qualitative study

Prevention of healthcare-associated infections (HAIs) is critical to reduce preventable deaths and healthcare costs. Variable success with HAI prevention efforts has suggested that management practices are critical to support clinical infection prevention practices. This study examined hospital leaders' management practices around the prevention of catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs) to identify actions that leaders can take to promote HAI prevention efforts. We conducted interviews with 420 key informants, including managers and frontline staff, in 18 hospitals across the United States. Interviewees were asked about management practices supporting HAI prevention. We analyzed interview transcripts using rigorous qualitative methods to understand how management practices were operationalized in infection prevention efforts. Across hospitals and interviewees, three management practices were characterized as important facilitators of HAI prevention: (1) engagement of executive leadership; (2) information sharing; and (3) manager coaching. We found that visible executive leadership, efficient communication, and frequent opportunities to provide and promote learning from feedback were perceived to promote and sustain HAI prevention efforts. Our findings provide insight into management practices for leaders that support successful HAI prevention. In practice, these tactics may need to be adjusted to accommodate the current restrictions caused by the COVID-19 pandemic, in order to maintain HAI prevention efforts as a priority.

1889P Information access and use: A Grounded theory of how patients and their friends and family use information to navigate the cancer journey

Information needs are among the most common unmet supportive care need for cancer patients and their informal caregivers. Previous work has identified that, in addition to information that supports coping and shared decision making, there is a need for practical information that helps individuals plan their lives around key aspects of the cancer journey such as the receipt of healthcare and altered life expectancy. The objective of this study was to develop a theory to inform the development of novel informational interventions capable of addressing this need. Classical Grounded Theory, a rigorous and systematic qualitative method for theory generation, was used to analyze data collected through digitally recorded one-on-one interviews with cancer patients and their friends/family. Interviews focused on the challenges that the participants had following the cancer diagnosis and how information was obtained and used. Data analysis began as soon as interview data from the first interview was available and continued until theoritical saturation was achieved. Coding, constant comparison, memoing and theoritical sampling were integral to the data analysis process. Data collection and analysis concluded when theoritical saturation was achieved. A total of 60 participants were interviewed (31 cancer patients and 29 friends/family). The core category that emerged was Cancer Related Data (CRD) quality as a modifier of the disruption to personal projects resulting from cancer. The theory that emerged consisted of four variables: 1) personal projects; 2) cancer as a source of disruption to personal projects; 3) information as the process of accessing and using CRD; 4) accessibility, credibility, applicability, and framing as key components of CRD quality. Informational resources containing high quality CRD are key to limiting the disruptive effects of cancer on the lives of patients and their friends and family. The internet is a highly accessible platform for CRD delivery. Future work should involve developing internet based resources integrated into clinical care that contain high quality CRD designed to help individuals plan their lives around the consequences of cancer.