Qualitative analysis of 6961 free-text comments from the first National Cancer Patient Experience Survey in Scotland

Objectives To analyse free-text responses from the first Scottish Cancer Patient Experience Survey (SCPES) to understand patients’ experiences of care, identify valued aspects and areas for improvement.  Design Inductive thematic analysis of seven free-text comment boxes covering all stages of the cancer experience, from a national cohort survey.  Setting and participants Adult cancer patients diagnosed across all Health Boards in Scotland between July 2013 and March 2014, and who had an inpatient stay or hospital visit between January and September 2014. 2663 respondents (of n=4835 survey respondents) provided 6961 free-text comments.  Main outcome measures Positive and negative themes of patients’ experiences. Differences in the proportion of positive to negative comments by demographics.  Methods Data were analysed as follows: (1) comments were initially categorised at a high level (eg, positive, negative, miscellaneous, etc); (2) inductive codes were derived and applied to all relevant comments; (3) codes sharing similar meaning were amalgamated into subthemes, and code frequencies were measured; (4) subthemes were mapped into overarching themes; (5) difference in the proportion of positive to negative comments by demographics were analysed using χ2 tests.  Results Participants made more positive than negative comments (1:0.78). Analysis highlighted the importance to patients of Feeling that Individual Needs Are Met and Feeling Confident Within the System. Comments also provided insight into how Processes and Structures within the system of care can negatively impact on patients’ experience. Particular issues were identified with care experiences in the lead-up to diagnosis.  Conclusions This analysis provides a detailed understanding of patients’ cancer care experiences, therefore indicating what aspects matter in those experiences. Although the majority of comments were positive, there were a significant number of negative comments, especially about the lead-up to diagnosis. Comments suggest patients would value greater integration of care from services involved in their treatment for cancer

Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: a scoping review

Background: Workload and workforce issues in primary care are key drivers for the growing international trend to expand nursing roles. Advanced nurse practitioners are increasingly being appointed to take on activities and roles traditionally carried out by doctors. Successful implementation of any new role within multidisciplinary teams is complex and time-consuming, therefore it is important to understand the factors that may hinder or support implementation of the advanced nurse practitioner role in primary care settings. Objectives: To identify, appraise and synthesise the barriers and facilitators that impact implementation of advanced practitioner roles in primary care settings. Methods: A scoping review conducted using the Arksey and O’Malley (2005) framework and reported in accordance with PRISMA-ScR. Eight databases (Cochrane Library, Health Business Elite, Kings Fund Library, HMIC, Medline, CINAHL, SCOPUS and Web of Science) were searched to identify studies published in English between 2002 and 2017. Study selection and methodological assessment were conducted by two independent reviewers. A pre-piloted extraction form was used to extract the following data: study characteristics, context, participants and information describing the advanced nurse practitioner role. Deductive coding for barriers and facilitators was undertaken using a modified Yorkshire Contributory Framework. We used inductive coding for barriers or facilitators that could not be classified using pre-defined codes. Disagreements were addressed through discussion. Descriptive data was tabulated within evidence tables, and key findings for barriers and facilitators were brought together within a narrative synthesis based on the volume of evidence. Findings: Systematic searching identified 5976 potential records, 2852 abstracts were screened, and 122 full texts were retrieved. Fifty-four studies (reported across 76 publications) met the selection criteria. Half of the studies (n=27) were conducted in North America (n=27), and 25/54 employed a qualitative design. The advanced nurse practitioner role was diverse, working across the lifespan and with different patient groups. However, there was little agreement about the level of autonomy, or what constituted everyday activities. Team factors were the most frequently reported barrier and facilitator. Individual factors, lines of responsibility and ‘other’ factors (i.e. funding), were also frequently reported barriers. Facilitators included individual factors, supervision and leadership and ‘other’ factors (i.e. funding, planning for role integration). Conclusion: Building collaborative relationships with other healthcare professionals and negotiating the role are critical to the success of the implementation of the advanced nurse practitioner role. Team consensus about the role and how it integrates into the wider team is also essential

Library Safari and iPads: Technology to Enhance Student Learning

Poster presentation at the Mississippi State Universities Emerging Technologies Summit, August 12, 2011.The Library Safari program, at the University of Maryland, aims at reducing freshmen anxiety about using a large academic library through structured exercises and teamwork. Students enrolled in UNIV 100 – The Students in the University come to a library workshop, are divided into small teams and assigned a set of unique exercises that introduce them to a variety of service sites, print and online resources, all designed to provide a greater understanding of how the main campus library is organized. Printed team exercises and hardwired computers have traditionally been used to conduct this workshop. In fall 2011, librarians plan to experiment by incorporating emerging technologies like the iPad into the way students interface with the physical library and its resources. Using an iPad, each Library Safari team will explore the library using the catalog, other online resources and to virtually complete a set of exercises. By semester’s end, analysis will be conducted to evaluate the users experience and the efficacy of the technology by comparing the results of students using iPads in 2011 to those who used traditional means in fall 2010. Results could determine what changes should be made to improve the Library Safari program

Increasing walking in patients with intermittent claudication: Protocol for a randomised controlled trial

Background: People with intermittent claudication are at increased risk of death from heart attack and stroke compared to matched controls. Surgery for intermittent claudication is for symptom management and does not reduce the risk of cardiovascular morbidity and mortality. Increasing physical activity can reduce claudication symptoms and may improve cardiovascular health. This paper presents the pilot study protocol for a randomised controlled trial to test whether a brief psychological intervention leads to increased physical activity, improvement in quality of life, and a reduction in the demand for surgery, for patients with intermittent claudication. Methods/Design: We aim to recruit 60 patients newly diagnosed with intermittent claudication, who will be randomised into two groups. The control group will receive usual care, and the treatment group will receive usual care and a brief 2-session psychological intervention to modify illness and walking beliefs and develop a walking action plan. The primary outcome will be walking, measured by pedometer. Secondary outcomes will include quality of life and uptake of surgery for symptom management. Participants will be followed up after (a) 4 months, (b) 1 year and (c) 2 years. Discussion: This study will assess the acceptability and efficacy of a brief psychological intervention to increase walking in patients with intermittent claudication, both in terms of the initiation, and maintenance of behaviour change. This is a pilot study, and the results will inform the design of a larger multi-centre trial. Trial Registration: Current Controlled Trials ISRCTN2805187

Developing meta-ethnography reporting guidance for research and practice

Background:Meta-ethnography is a commonly used methodology for qualitative evidence synthesis. Research has identified that the quality of reporting of published meta-ethnographies is often poor and this has limited the utility of meta-ethnography findings to influence policy and practice.Objective(s):To develop guidance to improve the completeness and clarity of meta-ethnography reporting.Methods / DesignThe eMERGe study followed the recommended approach for developing health research reporting guidelines and used a systematic mixed methods approach. It comprised of: (1) a methodological systematic review of guidance in the conduct and reporting of meta-ethnography; (2) a review and audit of published meta-thnographies, along with interviews with meta-ethnography end-users, to identify good practice principles; (3) A consensus workshop and two eDelphi studies to agree guidance content; (4) development of the guidance table and explanatory notes.ResultsResults from the methodological systematic review and the audit of published meta-ethnographies revealed that more guidance was required around the reporting of all phases of meta-ethnography conduct, and in particular, the synthesis phases 4-6 (relating studies, translating studies into one another and synthesising translations). Following the guidance development process, the eMERGe Reporting Guidance was produced, consisting of 19 items grouped into the 7 phases of meta-ethnography.LimitationsThe finalised Guidance has not yet been evaluated in practice, therefore it is not possible at this stage to comment on their utility. However, we look forward to evaluating their uptake and usability in the future. ConclusionsThe eMERGe Reporting Guidance has been developed following a rigorous process in line with guideline development recommendations. The guidance is intended to improve the clarity and completeness of reporting of meta-ethnographies, to facilitate use of their findings to inform the design and delivery of services and interventions in health, social care and other iv fields. The eMERGe project developed a range of training material to support use of the guidance, which is freely available at www.emergeproject.org.Future workMeta-ethnography is an evolving qualitative evidence synthesis methodology, and future research will refine the guidance to accommodate future methodological developments. We will also investigate the impact of the eMERGe reporting guidance with a view to updating the guidance