Efficacy of a training intervention on the quality of practitioners' decision support for patients deciding about place of care at the end of life: A randomized control trial: Study protocol

<p>Abstract</p> <p>Background</p> <p>Most people prefer home palliation but die in an institution. Some experience decisional conflict when weighing options regarding place of care. Clinicians can identify patients' decisional needs and provide decision support, yet generally lack skills and confidence in doing so. This study aims to determine whether the quality of clinicians' decision support can be improved with a brief, theory-based, skills-building intervention.</p> <p>Theory</p> <p>The Ottawa Decision Support Framework (ODSF) guides an evidence based, practical approach to assist clinicians in providing high-quality decision support. The ODSF proposes that decisional needs [personal uncertainty, knowledge, values clarity, support, personal characteristics] strongly influence the quality of decisions patients make. Clinicians can improve decision quality by providing decision support to address decisional needs [clarify decisional needs, provide facts and probabilities, clarify values, support/guide deliberation, monitor/facilitate progress].</p> <p>Methods/Design</p> <p>The efficacy of a brief education intervention will be assessed in a two-phase study. In phase one a focused needs assessment will be conducted with key informants. Phase two is a randomized control trial where clinicians will be randomly allocated to an intervention or control group. The intervention, informed by the needs assessment, knowledge transfer best practices and the ODSF, comprises an online tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach. Participants will be assessed: a) at baseline (quality of decision support); b) after the tutorial (knowledge); and c) four weeks after the other interventions (quality of decision support, intention to incorporate decision support into practice and perceived usefulness of intervention components). Between group differences in the primary outcome (quality of decision support scores) will be analyzed using ANOVA.</p> <p>Discussion</p> <p>Few studies have investigated the efficacy of an evidence-based, theory guided intervention aimed at assisting clinicians to strengthen their patient decision support skills. Expanding our understanding of how clinicians can best support palliative patients' decision-making will help to inform best practices in patient-centered palliative care. There is potential transferability of lessons learned to other care situations such as chronic condition management, advance directives and anticipatory care planning. Should the efficacy evaluation reveal clear improvements in the quality of decision support provided by clinicians who received the intervention, a larger scale implementation and effectiveness trial will be considered.</p> <p>Trial registration</p> <p>This study is registered as NCT00614003</p

Interação universidade-empresa no Brasil: evidências do Diretório dos Grupos de Pesquisa do CNPq

O presente trabalho investiga a interação universidade-empresa no Brasil por meio de informações disponíveis no Diretório dos Grupos de Pesquisa do CNPq coletadas no Censo 2002. Apesar dos problemas inerentes à base de dados, estas informações fornecem um panorama recente da interação entre universidades e empresas no País. Os resultados encontrados apontam que as relações de colaboração são concentradas em termos de áreas do conhecimento dos grupos de pesquisa, instituições às quais os grupos estão vinculados e setor de atividade das empresas. As interações mais freqüentes entre os agentes foram as atividades de Engenharia não-rotineira, de Consultoria Técnica e Treinamento de pessoal. À medida que estes resultados forem ao encontro das especificidades do Sistema Nacional de Inovação presente no País, incentivos podem ser dados com vistas a aumentar a transferência do conhecimento acadêmico para as empresas.<br>The present work investigates university-industry interactions in Brazil through available data from CNPq's Research Groups Directory collected in Census 2002. Although limitations intrinsic to information collected, the database supplies some evidence from recent university-industry interactions in Brazil. Collaborative relations are restricting to some members, and the agents involved are concentrated in both sides. The more frequent relationships were no routine engineering, consultancy and trainament. This result were in accordance with Brazilian's NSI, but also suggests that's much more can be done fostering academic knowledge transference to firms in the country