[show abstract][hide abstract] ABSTRACT: PURPOSE: Individuals with cancer frequently report significant gaps in information, support, and health care service navigation at diagnosis and in the survivorship phase. A comprehensive web-based tool called the Oncology Interactive Navigator™ (OIN) appears promising in addressing these gaps. The present qualitative inquiry explores the perceptions of individuals concerning the OIN™, as a complementary resource to support psychosocial adjustment to cancer and guide access to cancer care services. METHOD: As part of a pilot multi-method multi-site study, 151 individuals newly diagnosed with colorectal cancer or melanoma were offered unrestricted access to the OIN™ for 8 weeks. Qualitative interviews were undertaken with a subset of participants (n = 20) to explore their experience with the tool. Interviews were digitally audio-recorded and transcribed verbatim. RESULTS: The OIN™ was reported to be instrumental in fulfilling participants' cancer information and supportive care needs, particularly early in the cancer trajectory. More specifically, the tool was seen as a "go to" resource to obtain more detailed information, validate information provided elsewhere, and pace exposure to cancer information. Content also was perceived to be of high quality, practical, and comprehensive. All participants underscored how the tool improved their cancer knowledge, facilitated communication, and prepared them for subsequent medical consultations. CONCLUSION: Given the rapid proliferation of web-based tools of varying scope, quality, and relevance, the exploration of users' perspectives is key to informing the development, refinement, implementation, and sustainability of promising web-based tools such as the OIN™.
Supportive Care in Cancer 03/2013; · 2.09 Impact Factor
[show abstract][hide abstract] ABSTRACT: The Internet has become an important source of health information for patients and health care providers (HCPs) alike. Whereas studies have begun to document the effects of the internet on health behaviors and outcomes, surprisingly few studies have explored HCPs' perceptions of the internet as a key resource accessed by patients. However, as HCPs are seen as pivotal in guiding patients toward these resources, it is timely to study their perceptions. Therefore, the present inquiry explores HCPs' views of a recently developed high quality virtual navigation tool called the Oncology Interactive Navigator™ (OIN).
Using a qualitative approach, in-depth interviews were conducted with 16 members of a multidisciplinary colorectal oncology team and volunteers at a large Cancer Centre in Montreal, Quebec, Canada.
Content analysis revealed emerging themes centering on key benefits including: perceptions of a highly accessible, comprehensive high quality repository of cancer information; a means to further enhance HCP-patient communication and trust; and a significant catalyst to patient-family communication and support. Perceived drawbacks included patient (e.g., socio-demographic profile) and system's (e.g., professional roles and time constraints) characteristics that may limit OIN™ full implementation and uptake.
The findings underscore the relevance of virtual navigation tools to ensure optimal person-centred care in cancer. Findings also suggest how virtual tools such as the OIN™ can best be used in practice as well as they guide strategies to adopt to optimize implementation of similar innovations in health care.
International Journal of Medical Informatics 01/2012; 81(6):395-403. · 2.06 Impact Factor
[show abstract][hide abstract] ABSTRACT: ICU nurses often report that timely informational and supportive resources would ease distress for clients and providers alike.
This pilot study was aimed to explore the role of a comprehensive information and support programme in enhancing the work environment, task performance and reducing emotional distress amongst ICU nurses. RESEARCH METHODOLOGY/DESIGN: Through a mixed quantitative and qualitative design, nurses were invited to complete self-report questionnaires (n=25) and to participate in focus groups (n=7) prior to (T1) and 6 weeks after the implementation of the supportive programme (T2).
Measures of physical and mental effort were found to be significantly lower (t=2.45, p=0.02) at post test (T2). Statistical trends towards significance were observed for higher performance satisfaction (t=1.70, p=0.10) and lower emotional distress (t=2.00, p=0.06) at T2. Focus group data revealed that nurses felt more supported in their work, had more satisfaction with work tasks accomplished and felt more emotionally supported with the programme being in place.
Preliminary data from this pilot study suggest that a comprehensive information and support programme designed to support nurses in the ICU can enhance well being and workplace related factors. Work is currently underway to document the program's impact on family members in the ICU. Future studies should document further how and when similar programme contribute to enhance the workplace for other ICU staff.
Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 12/2011; 28(1):32-40.
[show abstract][hide abstract] ABSTRACT: In providing palliative and end-of-life care, professional and lay hospice workers alike attend to patient and family needs to encourage a dignified death. However, there are few comparative inquiries documenting how differential workplace preparation affects the processes and outcomes related to being confronted to death and dying. This qualitative study explores and compares these experiences among a diverse sample of health workers (N = 25) in a grassroots cancer care hospice in Bangalore, India. Our findings underscore how personal views, socio-economic status, beliefs and values, occupational experience, and workplace interventions interact to shape 'worldviews' about death and dying. Whereas health workers report conflicting feelings of relief and sadness when confronted with the death of their patients, these mixed emotions are often lessened through open dialogue among newly trained and more experienced health workers. Moreover, experienced hospice workers wished to ensure that less experienced ones are provided with the necessary workplace support to lessen psychological 'hardening' that may occur with repeated exposure to death. In dealing with the diverse needs of hospice workers, both individual and collective needs must be considered to ensure an optimal workplace climate. Future work should study how hospice workers' views on death and dying evolve with time and experience.
Palliative Medicine 04/2011; 26(3):250-6. · 2.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: Patient decision making is an area of increasing inquiry. For older individuals experiencing cancer, variations in health and functional status, physiologic aspects of aging, and tension between quality and quantity of life present unique challenges to treatment-related decision making. We used the pragmatic utility method to analyze the concept of patient decision making in the context of older individuals with cancer. We first evaluated its maturity in existing literature and then posed analytical questions to clarify aspects found to be only partially mature. In this context, we found patient decision making to be an ongoing process, changing with time, reflecting individual and relational components, as well as analytical and emotional ones. Assumptions frequently associated with patient decision making were not consistent with the empirical literature. Careful attention to the multifaceted components of patient decision making among older individuals with cancer provides guidance for research, supportive interventions, and targeted follow-up care.
Qualitative Health Research 02/2011; 21(7):900-26. · 2.19 Impact Factor
[show abstract][hide abstract] ABSTRACT: Informational support to family members of ICU patients has significant potential for reducing their psychological distress, enabling them to better cope and support the patient.
To describe family member perception of informational support, anxiety, satisfaction with care, and their interrelationships, to guide further refinement of a local informational support initiative and its eventual evaluation. METHODOLOGY/DESIGN: This cross-sectional descriptive correlational pilot study collected data from a convenience sample of 29 family members using self-report questionnaires.
22-bed medical-surgical intensive care unit of a 659-bed university affiliated teaching hospital in Montreal, Quebec, Canada.
Mean informational support, assessed with a modified version of the CCFNI (Molter and Leske, 1983), was 55.41(SD=13.28; theoretical range of 20-80). Mean anxiety, assessed with the State Anxiety Scale (Spielberger et al., 1983) was 45.41 (SD=15.27; theoretical range of 20-80). Mean satisfaction with care, assessed using Androfact (Version 4.0, 2001), was 83.09 (SD=15.49; theoretical range of 24-96). A significant positive correlation was found between informational support and satisfaction with care (r=0.741, p<.001). No significant relationships were noted between informational support and anxiety nor between satisfaction with care and anxiety.
Findings are related to the ultimate objectives of refining a local informational support initiative and its eventual evaluation, and in so doing, are of more widespread interest to others striving to make evidence based improvements to the care of similar populations.
Intensive & critical care nursing: the official journal of the British Association of Critical Care Nurses 04/2010; 26(2):114-22.
[show abstract][hide abstract] ABSTRACT: To examine the impact of an 8-week cancer multimedia informational intervention on health-related outcomes among individuals newly diagnosed with cancer.
Using a pre-/post-quasi-experimental design, participants with breast or prostate cancer (n=250) were conveniently recruited from four oncology ambulatory clinics and completed questionnaires at three points (enrolment, 1-2 weeks post-intervention, and 3 months later).
Repeated-measure analyses showed that, when compared to controls, the intervention significantly improved satisfaction with cancer information over time for women (p<.001), prevented deterioration in functional quality of life (p=.030) and marginally improved perceived oncologist informational support (p=.051). There were no significant differences in psychosocial adjustment among men. Unlike previously suggested, the intervention did not have a differential impact according to levels of personal resources (self-esteem, mastery, and optimism). However, for all outcomes and regardless of group, participants high in personal resources reported better adjustment across time.
Even though the hypotheses were only partially supported, the findings provide preliminary evidence that multimedia interventions can be supportive.
With increasing numbers of new cancer diagnoses, cancer survivors and more limited health care resources, further research is needed to evaluate potential benefits of health information technology in providing support to individuals facing cancer.
Patient Education and Counseling 10/2009; 80(1):48-55. · 2.37 Impact Factor
[show abstract][hide abstract] ABSTRACT: Based on a survey of the literature in human and nursing sciences and illustrated with concrete research examples, we will identify promising research directions for mixed-methods studies and present strategies for applying this type of research design to the evaluation of nursing interventions. This article provides three examples of mixed-methods design that utilize schematic representation about evaluation of nursing interventions. Based on examples, the issues discussed are: (1) sufficient significance for research program to invest the required human and material resources, (2) reason for using qualitative and quantitative data simultaneously or sequentially, (3) integration of qualitative and quantitative data when the participants are from different target populations; (4) presentation of the findings.
[show abstract][hide abstract] ABSTRACT: To report on the integration of quantitative and qualitative findings to increase understanding of the role of cancer informational support and use of health care services among individuals newly diagnosed with breast or prostate cancer.
A mixed methods sequential design was used. First, a quantitative secondary analysis considered self-report data from a large number of individuals newly diagnosed with cancer (n = 250); next, a follow-up, in-depth qualitative inquiry with distinct individuals also newly diagnosed was conducted (n = 20); last, using a quantitative-hierarchical strategy, quantitative and qualitative findings were merged and re-analyzed.
Quantitative analyses showed significant relationships between informational support and health care services. For instance, individuals who received more intense cancer informational support [face-to-face and information technology (IT)] spent more time with nurses. Women with breast cancer as opposed to men with prostate cancer also were found to rely primarily on nurses for cancer information and information on health services available, whereas men relied mostly on their oncologists. In-depth interviews revealed that informational support could be construed as positive, unsupportive, or mixed depending on context. The mixed design analysis documented positive experiences for individuals who reported to be better prepared for consultations and treatments with information provided by more than one source. Negative experiences with physicians were reported by both women and men but the former was about quality of cancer information provided and the latter in terms of quantity.
A mixed methods approach allowed a deeper understanding of the role of informational support on subsequent use of health care services by individuals with cancer. Further studies may include other types of cancer and diverse background characteristics to clarify how informational support and subsequent use of health services may be jointly determined by these factors.
Journal of Evaluation in Clinical Practice 05/2009; 15(2):346-59. · 1.51 Impact Factor
[show abstract][hide abstract] ABSTRACT: In many surveys, nurses cite work interruptions as a significant contributor to medication administration errors.
To review the evidence on (1) nurses' interruption rates, (2) characteristics of such work interruptions, and (3) contribution of work interruptions to medication administration errors.
Search strategy: CINHAL (1982-2008), MEDLINE (1980-2008), EMBASE (1980-2008), and PSYCINFO (1980-2008) were searched using a combination of keywords and reference lists. Selection criteria: Original studies published in English using nurses as participants and for which work interruption frequencies are reported. Data collection and analysis: Studies were identified and selected by two reviewers. Once selected, a single reviewer extracted data and assessed quality based on established criteria. Data on nurses' work interruption rates were synthesized to produce a pooled estimate.
Twenty-three studies were considered for analysis. A rate of 6.7 work interruptions per hour was obtained, based on 14 studies that reported both an observation time and work interruption frequency. Work interruptions are mostly initiated by nurses themselves through face-to-face interactions and are of short duration. A lower proportion of interruptions resulted from work system failures such as missing medication. One nonexperimental study documented the contribution of work interruptions to medication administration errors with evidence of a significant association (p = 0.01) when errors related to time of administration are excluded from the analysis. Conceptual shortcomings were noted in a majority of reviewed studies, which included the absence of theoretical underpinnings and a diversity of definitions of work interruptions.
Future studies should demonstrate improved methodological rigor through a precise definition of work interruptions and reliability reporting to document work interruption characteristics and their potential contribution to medication administration errors, considering the limited evidence found. Meanwhile, efforts should be made to reduce the number of work interruptions experienced by nurses.
Worldviews on Evidence-Based Nursing 05/2009; 6(2):70-86. · 1.35 Impact Factor
[show abstract][hide abstract] ABSTRACT: The purpose of this 2-part paper was to describe individuals' health information-seeking behavior (HISB) patterns that emerged from our grounded theory study. Thirty individual interviews and 8 focus groups were conducted with individuals diagnosed with cancer. Analysis was characterized by constant comparison diagram, an evolving coding scheme, and ultimately the generation of a grounded theory of HISB patterns. Five HISB patterns were identified: (1) intense information seeking-a keen interest in detailed cancer information; (2) complementary information seeking-the process of getting "good enough" cancer information; (3) fortuitous information seeking-the search for cancer information mainly from others diagnosed with cancer; (4) minimal information seeking-a limited interest for cancer information; and (5) guarded information seeking-the avoidance of some cancer information. Part 1 focuses on describing the first 3 HISB patterns considered to illustrate variations in active information seeking. Each pattern is explained, including the type, amount, and sources of information sought. This analysis documents variations in active HISB often overlooked in the cancer literature. Findings may assist healthcare professionals in tailoring their informational interventions according to a patient's preferred HISB pattern. Furthermore, findings may inform the refinement of instruments measuring HISB to include variations in active information seeking.
Cancer nursing 01/2009; 32(1):11-23. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: To document characteristics of nurses' work interruptions (WIs) during medication administration.
A descriptive observational study design was used along with a sample of 102 medication administration rounds. Data were collected on a single medical unit using a unit dose distribution system during fall 2007.
Data collection on WIs relied on direct structured observation. The following WI characteristics were recorded: source, secondary task, location, management strategies, and duration.
374 WIs were observed over 59 hours 2 minutes of medication administration time (6.3 WI/hr). During the preparation phase, nurse colleagues (n= 36; 29.3%) followed by system failures such as missing medication or equipment (n= 28; 22.8%) were the most frequent source of WIs. Nurses were interrupted during the preparation phase mostly to solve system failures (n= 33; 26.8%) or for care coordination (n= 30; 24.4%). During the administration phase, the most frequent sources of WIs were self-initiation (n= 41; 16.9%) and patients (n= 39; 16.0%). The most frequent secondary task undertaken during the administration phase was direct patient care (n= 105; 43.9%). WIs lasted 1 min 32 s on average, and were mostly handled immediately (n= 357; 98.3%).
The process of medication administration is not protected against WIs, which poses significant risks.
Interventions to reduce WIs during the medication administration process should target nurses and system failures to maximize medication administration safety.
Journal of Nursing Scholarship 01/2009; 41(4):330-6. · 1.61 Impact Factor
[show abstract][hide abstract] ABSTRACT: This quasi-experimental longitudinal study documented the impact of a comprehensive cancer informational intervention using information technology on healthcare service use among individuals newly diagnosed with cancer. Women with breast cancer (n = 205) and men with prostate cancer (n = 45) were recruited within 8 weeks of diagnosis at 4 university teaching hospitals in Montreal, Quebec, Canada. The intervention group (n = 148) received a 1-hour training on information technology use, a CD-ROM on cancer, and a list of reputable cancer-related Web sites. The intervention material was available for a period of 8 weeks. The control group (n = 102) received usual care. Self-reported questionnaires were completed at T1 (baseline), T2 (1 week after intervention), and T3 (3 months after intervention). Using multivariate statistics, the experimental group reported significantly more satisfaction with cancer information received compared to the control group. No significant differences were found between experimental and control groups in their reliance on healthcare services. However, women as opposed to men spent more time with nurses, were more satisfied with cancer information received, and relied more heavily on health services. Future research would explore whether the latter observations reflect genuine sex differences or are more contingent on the specific cancer diagnosis.
Cancer nursing 01/2009; 32(1):37-44. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: This is the second of a 2-part article describing differential health information-seeking behavior (HISB) patterns within the context of a cancer diagnosis that emerged in our grounded theory study. Data from 30 semistructured interviews and 8 focus groups with individuals diagnosed with breast, prostate, or colorectal cancer were analyzed using constant comparison analysis, diagramming, and open, axial, and selective coding. In part 1, 3 HISB patterns illustrating variation in active information-seeking behavior were described: (1) intense information seeking a keen interest in detailed cancer information, (2) complementary information seeking the process of getting "good enough" cancer information, and (3) fortuitous information seeking the search for cancer information mainly from others diagnosed with cancer. Part 2 describes 2 additional patterns coined in this study as minimal information-seeking behavior limited interest for cancer information and guarded information-seeking behavior avoidance of certain types of cancer information. Part 2 challenges traditional views that consider disinterest and avoidance as similar concepts subsumed under "blunting." Findings may be used to refine informational interventions and measurement strategies to best differentiate between cancer information avoidance and disinterest.
Cancer nursing 01/2009; 32(1):26-36. · 1.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: Measurement is essential to nursing practice and research, and adequate tool selection is crucial for both. The present paper seeks to provide an overview of key issues to consider in tool development, selection, and psychometric testing using the concept of pain. Both the classic and the contemporary approaches to validity are described and compared. Although sharing similar features, the contemporary approach seems more encompassing, because it considers measurement purposes, participants' characteristics, and conditions under which instruments are used. Strategies pertaining to reliability and validity testing are discussed and illustrated with specific pain assessment measures, including pain intensity scales, multidimensional questionnaires, and other behavioral tools. Depending on measurement purposes, the more appropriate strategies are highlighted. Cultural issues in pain measurement as well as pragmatic criteria for measure selection also are discussed.
Pain management nursing: official journal of the American Society of Pain Management Nurses 10/2008; 9(3):120-30. · 1.31 Impact Factor
[show abstract][hide abstract] ABSTRACT: This paper is a presentation of the critical reflection on the types of findings obtained from the combination of individual interviews and focus groups, and how such triangulation contributes to knowledge production and synthesis.
Increasingly, qualitative method triangulation is advocated as a strategy to achieve more comprehensive understandings of phenomena. Although ontological and epistemological issues pertaining to triangulation are a topic of debate, more practical discussions are needed on its potential contributions, such as enhanced data richness and depth of inquiry.
Data gathered through individual interviews and focus groups from a study on patterns of cancer information-seeking behaviour are used to exemplify the added-value but also the challenges of relying on methods combination.
The integration of focus group and individual interview data made three main contributions: a productive iterative process whereby an initial model of the phenomenon guided the exploration of individual accounts and successive individual data further enriched the conceptualisation of the phenomenon; identification of the individual and contextual circumstances surrounding the phenomenon, which added to the interpretation of the structure of the phenomenon; and convergence of the central characteristics of the phenomenon across focus groups and individual interviews, which enhanced trustworthiness of findings.
Although the use of triangulation is promising, more work is needed to identify the added-value or various outcomes pertaining to method combination and data integration.
Journal of Advanced Nursing 05/2008; 62(2):228-37. · 1.53 Impact Factor
[show abstract][hide abstract] ABSTRACT: Few women currently meet revised WHO recommendations to breastfeed exclusively for 6 months postpartum. In this prospective study we aimed to determine the influence of socio-demographic, psychosocial, and perinatal factors on the length of exclusive breastfeeding among 189 Canadian primiparous mothers. A majority of the participants did not meet their exclusive breastfeeding goals, and only 5% breastfed exclusively for a full 6 months. Breastfeeding self-efficacy, in-hospital formula supplementation, prenatal class attendance, and type of delivery independently predicted exclusive breastfeeding duration. Findings underscore the complex interplay of factors influencing breastfeeding, highlight the early postpartum weeks as a critical period for the establishment of exclusive breastfeeding, and suggest the need for a continuum of pre- and postnatal strategies for prolonging the exclusive breastfeeding period.
Research in Nursing & Health 04/2008; 31(5):428-41. · 2.18 Impact Factor
[show abstract][hide abstract] ABSTRACT: A qualitative study was undertaken to explore the role of informational support in relation to health care service use among individuals with cancer. In-depth interviews were conducted with participants (N = 20) newly diagnosed with either breast or prostate cancer receiving radiotherapy from an oncology clinic in Montreal, Quebec. Content analysis revealed that participants' perceptions about their experience with cancer informational support in relation to health care services varied along the following dimensions: (1) Cancer informational support was tangible, which enabled, confirmed, normalized, and directed their decisions about reliance on health services; (2) Cancer informational support was somewhat paralyzing, which led to distress, conflict, reduced confidence in the health care system and, at times, misuse of health care services; and (3) Cancer informational support was limiting, with perceptions of having received both helpful and unhelpful cancer information which, in turn, although tolerated, offered little guidance in terms of reliance on the most appropriate services. Knowledge about how and when informational support may be most timely may optimize individuals' well being and further guide their use of cancer-related services.
Canadian oncology nursing journal = Revue canadienne de nursing oncologique 02/2008; 18(4):193-205.
[show abstract][hide abstract] ABSTRACT: Seeking information about one's health is increasingly documented as a key coping strategy in health-promotive activities and psychosocial adjustment to illness. In this article, the authors critically examine the scientific literature from 1982 to 2006 on the concept of health information-seeking behavior (HISB) to determine its level of maturity and clarify the concept's essential characteristics. A principle-based method of concept analysis provides the framework for exploring the nature of HISB. The authors reviewed approximately 100 published articles and five books reporting on HISB. Although HISB is a popular concept used in various contexts, most HISB definitions provide little insight into the concept's specific meanings. The authors describe the concept's characteristics, contributing to a clearer understanding of HISB, and discuss operationalizations, antecedents, and outcomes of HISB. Such an analysis of HISB might guide further theorizing on this highly relevant concept and assist health care providers in designing optimal informational interventions.
Qualitative Health Research 11/2007; 17(8):1006-19. · 2.19 Impact Factor