Effective teamwork is a critical feature of surgical practice and is based on shared expectations... more Effective teamwork is a critical feature of surgical practice and is based on shared expectations and understandings between team members. These shared understandings are intimately tied to a hierarchy of expertise pertaining to role, responsibility and participation status, and it has been suggested that this can sometimes negatively impact trainees’ experience of intraoperative surgical training. This paper examines this issue, exploring how surgeons and their trainees collaboratively manage decision making amidst the hierarchy of expertise. Our data set consists of audio and video recordings of surgical procedures, which are examined using conversation analysis. Our findings indicate that implicit in the interactions between consultant surgeons and trainees is the expectation that the lead surgeon is the authoritative expert and will therefore direct decision making. Trainees actively acquiesce to that order. Notwithstanding this, the analysis underscores some of the interactiona...
IntroductionIn cancer care, multidisciplinary team (MDT) meetings are the gold standard. While th... more IntroductionIn cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying to maximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: “Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70?”. This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings.Materials and methodsThis was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some prin...
Guided by the principles of conversation analysis, we examined the communication practices used t... more Guided by the principles of conversation analysis, we examined the communication practices used to negotiate levels of participation in cancer multidisciplinary team meetings and their implications for patient safety. Three cancer teams participated. Thirty-six weekly meetings were video recorded, encompassing 822 case reviews. A cross-section was transcribed using Jefferson notation. We found a low frequency of gaps between speakers (3%), high frequency of overlaps (24%), and no-gaps-no-overlaps (73%), suggesting fast turn transitions. Securing a turn to speak is challenging due to a systematic reduction in turn-taking opportunities. We contribute to group research with the development of a microlevel methodology for studying multidisciplinary teams.
Background Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patie... more Background Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patients. While they are standard cancer care policy in many countries and recommended worldwide, the way these teams make decisions remains rather little studied and poorly understood. The study we report here aims to address this gap. We apply the ‘orientation-discussion-decision-implementation’ (ODDI) model of team decision-making to cancer MDTs and we argue that to achieve high-quality team-based decision-making, these teams need to engage in a consistent and structured manner in (1) problem identification, (2) discussion, (3) decision reaching and (4) implementation. We investigate the degree to which cancer MDTs consistently engage in these stages of group decision-making, and the underlying interaction formats that they employ in real-time case reviews in their weekly care planning meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer teams in the Greater London and Derbyshire (UK) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were analysed according to the ODDI model using descriptive statistics and frequency counts.Findings and ConclusionsEight formats of team interaction during decision-making were identified during decision-making with the least common (8% of case reviews) being multidisciplinary (i.e. including all core disciplines formally required to attend MDMs). Overall, most patients (54%) were reviewed between two or three disciplines only of those present. While all patients put forward for MDM in the study received a discussion, a small percentage (4%) either bypassed orientation phase of the ODDI model (i.e., case presentation) and went straight into discussing the patient, or they did not explicitly state the decision to the entire team (8%). Disciplines most consistently engaged in all phases of the ODDI model were surgeons (83%) and oncologists (8%), hence case reviews were led either by surgeons (75%), or by oncologists (4%) or jointly by surgeons-oncologists (21%). We conclude that despite MDTs being a set policy in the UK, actual case reviews are not truly MDT-driven. We discuss quality of care implications for cases where the orientation and decision stages of the ODDI model were compromised; and propose a method to select complex patients for MDT review such that the most complex cases only are reviewed by the MDT to allow true team-based decisions).
This study explored the impact of peer tutoring in Clinical Communication teaching as it was expr... more This study explored the impact of peer tutoring in Clinical Communication teaching as it was expressed in the views of Year 1 students and their Peer Tutors at Imperial College London. Methods: a mixed methods approach was used combining questionnaires and focus groups. Quantitative findings were analysed using SPSS v23 and qualitative findings were analysed using Framework Methodology. Results: the findings suggest a very positive experience for both Year 1 students and their Peer Tutors with the former reporting feeling supported to practice and improve on their Clinical Communication Skills in a collaborative environment, being taught and learning from peers who would share their past educational experiences. No significant differences were found between students taught by Peer Tutors and those taught by Course Tutors. Peer Tutors on the other hand, reported an equally positive experience, which gave them an insight into teaching, improved their leadership and feedback skills, enhanced their confidence and helped them reflect on their own Clinical Communication skills. Conclusion: peer tutoring has many advantages as an educational method in medical education and Clinical Communication teaching and should be promoted in medical curricula.
Health expectations : an international journal of public participation in health care and health policy, Jan 3, 2018
Asymmetries in knowledge and competence in the medical encounter often mean that doctor-patient c... more Asymmetries in knowledge and competence in the medical encounter often mean that doctor-patient communication can be compromised. This study explores this issue and examines whether the likelihood of patient question asking is increased following the delivery of diagnostic test results. It also examines whether that likelihood is related to the way in which the test results are delivered. To examine when and how patients initiate questions following diagnostic news announcements. We audio-recorded oncology consultations (n = 47) consisting of both first consultations and follow-up consultations with patients with different types of cancer, at a leading UK teaching hospital. From the primary sample, we identified 30 consultations based on a basic count of the frequency of patient questions and their positioning in relation to diagnostic announcements. This subset of 30 consultations consisted of a mix of first and follow-up consultations. Our data demonstrate how the design and deliv...
Acta Obstetricia et Gynecologica Scandinavica, 2015
To explore the impact of maternal death on maternity professionals, and their related professiona... more To explore the impact of maternal death on maternity professionals, and their related professional and personal needs. A qualitative study comprising semi-structured interviews in a UK inner-city academic maternity unit with over 5000 deliveries annually. Purposive sampling was utilised and semi-structured face-to-face interviews were performed with14 healthcare professionals: four midwives, five doctors in training grades (trainees) and five consultant obstetricians. Identification of key themes derived by textual analysis. Five main themes were identified: professional culture, organisational culture and external expectation; personal blame and debriefing; professional training; shaping the training; support and counselling. Maternal death has a major impact on professionals' feelings of grief, guilt and shame, which they are reluctant to talk about. Maternity professionals expressed a desire for training to prepare themselves to respond effectively in the event of maternal death.. There was ambiguity about 'debriefing' within a changing institutional culture. Maternal death is a devastating consequence of pregnancy. If these findings are replicated by interviewing a greater number and breadth of maternity professionals then healthcare institutions need to develop appropriate training to prepare and help staff, which should improve the support they can give to the bereaved and each other. This article is protected by copyright. All rights reserved.
This article considers the role of the consumer in the diffusion of mobile telecommunications tec... more This article considers the role of the consumer in the diffusion of mobile telecommunications technologies. There is presently little research on the consumption and use of mobile technologies, and the aim of the present paper is to facilitate discussion about the way consumer behaviour is currently understood in industry and academia. The paper considers key themes in social science research on mobile ICTs, and understandings of the consumer held by those in the mobile industry. Bringing these understandings together, we reiterate the now well attested view that the diffusion and consumption of mobile telephony and computing cannot be understood without investigating the contexts and processes of their use in everyday life.
In Wales, we increasingly face the challenge of delivering highly specialised health-care service... more In Wales, we increasingly face the challenge of delivering highly specialised health-care services from the capital city Cardiff, to remote clinical sites. The problem for the delivery of cancer genetics services in Wales is that Cardiff is off-centre and geographically distant from a major proportion of the population based in North Wales. Furthermore, much of this population is rural and scattered, with poor travel links. It was impractical to increase the already extensive travelling time to North Wales undertaken by Cardiff-based consultants, but a balance needed to be sought between increasing local staff, maintaining centralisation of resources and achieving a critical mass of expertise and personnel.Therefore, the Cancer Genetics Service for Wales (CGSW) began exploring new approaches to service delivery that would allow us to expand our capacity to give information at sites distant to the main specialist centre, while maintaining the quality of service and information provided. A pilot study was c...
Background Persistent low back and leg pain is a common and highly disabling musculoskeletal cond... more Background Persistent low back and leg pain is a common and highly disabling musculoskeletal condition. Many patients seek the opinion of a neurosurgeon with a view to surgical intervention. Few data are available which document the experiences of patients at these consultations. Aims To investigate the experiences of patients seeking a neurosurgical opinion for back and leg pain. Methods 15 patients (Males 9 Females 6) were consented and recruited into this study and participated in an in-depth semi-structured interview about their experiences of the consultation. Interviews were recorded and transcribed. Transcribed data were read independently by two researchers and analysed using grounded theory. Results Three subgroups of patients were identified from the interviews. Group 1: Patients that were offered surgery and described a positive experience. Group 2: Patients that were not offered surgery and described a positive experience. Group 3: Patients that were not offered surgery and described a negative experience. Analysis revealed a number of different themes pertaining to the experiences of each group. However, two overarching themes of i) meeting patients9 expectations and ii) the factor of hope, emerged as significant contributors to their experience and were evident in all three subgroups. Conclusion Findings identified the need to manage patient expectations in the consultation in order to provide a positive experience. Providing patients with hope who are not undergoing surgery, but who have an expectation for it, is likely to provide a more positive experience and therefore increased satisfaction with care. No conflicts of interest Part funded by North East London Foundation Trust
Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of M... more Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the 'Orientation-Discussion-Decision-Implementation' framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the
Supplemental material, sj-pdf-1-qhr-10.1177_10497323211037651 for Physiotherapists' Approache... more Supplemental material, sj-pdf-1-qhr-10.1177_10497323211037651 for Physiotherapists' Approaches to Patients' Concerns in Back Pain Consultations Following a Psychologically Informed Training Program by Ian Cowell, Alison McGregor, Peter O'Sullivan, Kieran O'Sullivan, Ross Poyton, Veronika Schoeb and Ged Murtagh in Qualitative Health Research
Guidelines advocate a combined physical and psychological approach to musculoskeletal management ... more Guidelines advocate a combined physical and psychological approach to musculoskeletal management of non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). Extending the traditional scope of practice to include psychosocial domains has proved challenging for physiotherapists. Using Cognitive Functional Therapy (CFT) as an exemplar of a PIP approach for NSCLBP, this thesis developed and evaluated a training programme in CFT, to investigate the barriers to embedding PIP into primary care; with the intention of enhancing intervention fidelity for future clinical trials (see Figure 1 for a summary of the research phases). Methods: The perceptions of physiotherapists pre-training on managing NSCLBP from a bio-psychosocial (BPS) perspective (Chapter 2), and their perceptions after the training programme on its impact on managing NSCLBP (Chapter 5), were evaluated using thematic analysis. Communication practice was analysed pre-training (Chapter...
Journal of Bone and Joint Surgery-british Volume, 2017
Background Persistent low back and leg pain is a common and highly disabling musculoskeletal cond... more Background Persistent low back and leg pain is a common and highly disabling musculoskeletal condition. Many patients seek the opinion of a neurosurgeon with a view to surgical intervention. Few data are available which document the experiences of patients at these consultations. Aims To investigate the experiences of patients seeking a neurosurgical opinion for back and leg pain. Methods 15 patients (Males 9 Females 6) were consented and recruited into this study and participated in an in-depth semi-structured interview about their experiences of the consultation. Interviews were recorded and transcribed. Transcribed data were read independently by two researchers and analysed using grounded theory. Results Three subgroups of patients were identified from the interviews. Group 1: Patients that were offered surgery and described a positive experience. Group 2: Patients that were not offered surgery and described a positive experience. Group 3: Patients that were not offered surgery ...
Guidelines advocate a combined physical and psychological approach to managing non-specific chron... more Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient...
Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experien... more Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experiences of women with CLBP and the impact on identity. This is the first study that investigates how women with CLBP construct illness identities in Kuwait. Methods: This study adopted a constructivist grounded theory methodology using dimensional analysis. In line with the grounded theory (GT) approach, data collection and analysis took place concurrently. A longitudinal study design was adopted. Semi-structured interviews were used to investigate women's perspectives on their experiences with CLBP in relation to their socio-political and cultural context. Eleven women were recruited from three musculoskeletal outpatient clinics in Kuwait. Initially, five women were purposively sampled. A follow up interview was conducted with four of those women one year after the initial interview to investigate any changes in their experiences. Subsequently, six women were theoretically sampled with the aim of comparing the influence of age, educational level, marital status, socioeconomic status and time on women's illness experiences. Results: The findings of this study offer the first explanatory theory of the construction of illness identities of women with CLBP in Kuwait. Women's identities can be see as part of a continuum from oppressed at one end to liberated at the other. Salience of oppressed identities was associated with periods of exacerbation of CLBP and passive coping behaviours. Appearance of liberated identities was accompanied with episodes of remission of CLBP and active coping approaches. Conclusion: Changes in women's social circumstances, thoughts and feelings over time were related to changes in the identities they portrayed, and changes in their manifestation of CLBP and illness experiences. Implications: The substantive theory developed through this study has implications for clinical practice, education and research, and may inform musculoskeletal physiotherapy professional development. Funding Acknowledgements: Funded by the Government of Kuwait.
< 0.0001). Only a few studies analysed the impact of factors on local recurrence. Conclusions: A ... more < 0.0001). Only a few studies analysed the impact of factors on local recurrence. Conclusions: A higher age (>60 years), size (> 5 cms), grade (>2), depth (deep to deep fascia) and positive margins of excision are associated with poor overall survival. Similarly, size (> 5cms) and deeper location are associated with higher metastasis.
Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered wi... more Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient's perspective as part of the treatment process. 'Agenda setting' has been introduced as the key to understanding patients' concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients' with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analysed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients' concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. A physiotherapist-focused style tended to predominate. On occasions patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A demonstrating that a more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
Effective teamwork is a critical feature of surgical practice and is based on shared expectations... more Effective teamwork is a critical feature of surgical practice and is based on shared expectations and understandings between team members. These shared understandings are intimately tied to a hierarchy of expertise pertaining to role, responsibility and participation status, and it has been suggested that this can sometimes negatively impact trainees’ experience of intraoperative surgical training. This paper examines this issue, exploring how surgeons and their trainees collaboratively manage decision making amidst the hierarchy of expertise. Our data set consists of audio and video recordings of surgical procedures, which are examined using conversation analysis. Our findings indicate that implicit in the interactions between consultant surgeons and trainees is the expectation that the lead surgeon is the authoritative expert and will therefore direct decision making. Trainees actively acquiesce to that order. Notwithstanding this, the analysis underscores some of the interactiona...
IntroductionIn cancer care, multidisciplinary team (MDT) meetings are the gold standard. While th... more IntroductionIn cancer care, multidisciplinary team (MDT) meetings are the gold standard. While they are trying to maximize productivity on the back of the steadily increasing workload, growing cancer incidence, financial constraints, and staff shortages, concerns have been raised with regards to the quality of team output, as reported by Cancer Research UK in 2017: “Sometimes we discuss up to 70 patients. This is after a whole day of clinics, and we do not finish until after 19.00. Would you want to be number 70?”. This study aimed to explore systematically some of the dynamics of group interaction and teamwork in MDT meetings.Materials and methodsThis was a prospective observational study conducted across three MDTs/university hospitals in the United Kingdom. We video-recorded 30 weekly meetings where 822 patient cases were reviewed. A cross-section of the recordings was transcribed using the Jefferson notation system and analyzed using frequency counts (quantitative) and some prin...
Guided by the principles of conversation analysis, we examined the communication practices used t... more Guided by the principles of conversation analysis, we examined the communication practices used to negotiate levels of participation in cancer multidisciplinary team meetings and their implications for patient safety. Three cancer teams participated. Thirty-six weekly meetings were video recorded, encompassing 822 case reviews. A cross-section was transcribed using Jefferson notation. We found a low frequency of gaps between speakers (3%), high frequency of overlaps (24%), and no-gaps-no-overlaps (73%), suggesting fast turn transitions. Securing a turn to speak is challenging due to a systematic reduction in turn-taking opportunities. We contribute to group research with the development of a microlevel methodology for studying multidisciplinary teams.
Background Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patie... more Background Multidisciplinary oncology teams (MDTs) are integral to care planning for cancer patients. While they are standard cancer care policy in many countries and recommended worldwide, the way these teams make decisions remains rather little studied and poorly understood. The study we report here aims to address this gap. We apply the ‘orientation-discussion-decision-implementation’ (ODDI) model of team decision-making to cancer MDTs and we argue that to achieve high-quality team-based decision-making, these teams need to engage in a consistent and structured manner in (1) problem identification, (2) discussion, (3) decision reaching and (4) implementation. We investigate the degree to which cancer MDTs consistently engage in these stages of group decision-making, and the underlying interaction formats that they employ in real-time case reviews in their weekly care planning meetings. MethodsThis is a prospective observational study. Breast, colorectal and gynaecological cancer teams in the Greater London and Derbyshire (UK) areas were video recorded over 12-weekly meetings encompassing 822 case reviews. Data were analysed according to the ODDI model using descriptive statistics and frequency counts.Findings and ConclusionsEight formats of team interaction during decision-making were identified during decision-making with the least common (8% of case reviews) being multidisciplinary (i.e. including all core disciplines formally required to attend MDMs). Overall, most patients (54%) were reviewed between two or three disciplines only of those present. While all patients put forward for MDM in the study received a discussion, a small percentage (4%) either bypassed orientation phase of the ODDI model (i.e., case presentation) and went straight into discussing the patient, or they did not explicitly state the decision to the entire team (8%). Disciplines most consistently engaged in all phases of the ODDI model were surgeons (83%) and oncologists (8%), hence case reviews were led either by surgeons (75%), or by oncologists (4%) or jointly by surgeons-oncologists (21%). We conclude that despite MDTs being a set policy in the UK, actual case reviews are not truly MDT-driven. We discuss quality of care implications for cases where the orientation and decision stages of the ODDI model were compromised; and propose a method to select complex patients for MDT review such that the most complex cases only are reviewed by the MDT to allow true team-based decisions).
This study explored the impact of peer tutoring in Clinical Communication teaching as it was expr... more This study explored the impact of peer tutoring in Clinical Communication teaching as it was expressed in the views of Year 1 students and their Peer Tutors at Imperial College London. Methods: a mixed methods approach was used combining questionnaires and focus groups. Quantitative findings were analysed using SPSS v23 and qualitative findings were analysed using Framework Methodology. Results: the findings suggest a very positive experience for both Year 1 students and their Peer Tutors with the former reporting feeling supported to practice and improve on their Clinical Communication Skills in a collaborative environment, being taught and learning from peers who would share their past educational experiences. No significant differences were found between students taught by Peer Tutors and those taught by Course Tutors. Peer Tutors on the other hand, reported an equally positive experience, which gave them an insight into teaching, improved their leadership and feedback skills, enhanced their confidence and helped them reflect on their own Clinical Communication skills. Conclusion: peer tutoring has many advantages as an educational method in medical education and Clinical Communication teaching and should be promoted in medical curricula.
Health expectations : an international journal of public participation in health care and health policy, Jan 3, 2018
Asymmetries in knowledge and competence in the medical encounter often mean that doctor-patient c... more Asymmetries in knowledge and competence in the medical encounter often mean that doctor-patient communication can be compromised. This study explores this issue and examines whether the likelihood of patient question asking is increased following the delivery of diagnostic test results. It also examines whether that likelihood is related to the way in which the test results are delivered. To examine when and how patients initiate questions following diagnostic news announcements. We audio-recorded oncology consultations (n = 47) consisting of both first consultations and follow-up consultations with patients with different types of cancer, at a leading UK teaching hospital. From the primary sample, we identified 30 consultations based on a basic count of the frequency of patient questions and their positioning in relation to diagnostic announcements. This subset of 30 consultations consisted of a mix of first and follow-up consultations. Our data demonstrate how the design and deliv...
Acta Obstetricia et Gynecologica Scandinavica, 2015
To explore the impact of maternal death on maternity professionals, and their related professiona... more To explore the impact of maternal death on maternity professionals, and their related professional and personal needs. A qualitative study comprising semi-structured interviews in a UK inner-city academic maternity unit with over 5000 deliveries annually. Purposive sampling was utilised and semi-structured face-to-face interviews were performed with14 healthcare professionals: four midwives, five doctors in training grades (trainees) and five consultant obstetricians. Identification of key themes derived by textual analysis. Five main themes were identified: professional culture, organisational culture and external expectation; personal blame and debriefing; professional training; shaping the training; support and counselling. Maternal death has a major impact on professionals&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; feelings of grief, guilt and shame, which they are reluctant to talk about. Maternity professionals expressed a desire for training to prepare themselves to respond effectively in the event of maternal death.. There was ambiguity about &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;debriefing&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; within a changing institutional culture. Maternal death is a devastating consequence of pregnancy. If these findings are replicated by interviewing a greater number and breadth of maternity professionals then healthcare institutions need to develop appropriate training to prepare and help staff, which should improve the support they can give to the bereaved and each other. This article is protected by copyright. All rights reserved.
This article considers the role of the consumer in the diffusion of mobile telecommunications tec... more This article considers the role of the consumer in the diffusion of mobile telecommunications technologies. There is presently little research on the consumption and use of mobile technologies, and the aim of the present paper is to facilitate discussion about the way consumer behaviour is currently understood in industry and academia. The paper considers key themes in social science research on mobile ICTs, and understandings of the consumer held by those in the mobile industry. Bringing these understandings together, we reiterate the now well attested view that the diffusion and consumption of mobile telephony and computing cannot be understood without investigating the contexts and processes of their use in everyday life.
In Wales, we increasingly face the challenge of delivering highly specialised health-care service... more In Wales, we increasingly face the challenge of delivering highly specialised health-care services from the capital city Cardiff, to remote clinical sites. The problem for the delivery of cancer genetics services in Wales is that Cardiff is off-centre and geographically distant from a major proportion of the population based in North Wales. Furthermore, much of this population is rural and scattered, with poor travel links. It was impractical to increase the already extensive travelling time to North Wales undertaken by Cardiff-based consultants, but a balance needed to be sought between increasing local staff, maintaining centralisation of resources and achieving a critical mass of expertise and personnel.Therefore, the Cancer Genetics Service for Wales (CGSW) began exploring new approaches to service delivery that would allow us to expand our capacity to give information at sites distant to the main specialist centre, while maintaining the quality of service and information provided. A pilot study was c...
Background Persistent low back and leg pain is a common and highly disabling musculoskeletal cond... more Background Persistent low back and leg pain is a common and highly disabling musculoskeletal condition. Many patients seek the opinion of a neurosurgeon with a view to surgical intervention. Few data are available which document the experiences of patients at these consultations. Aims To investigate the experiences of patients seeking a neurosurgical opinion for back and leg pain. Methods 15 patients (Males 9 Females 6) were consented and recruited into this study and participated in an in-depth semi-structured interview about their experiences of the consultation. Interviews were recorded and transcribed. Transcribed data were read independently by two researchers and analysed using grounded theory. Results Three subgroups of patients were identified from the interviews. Group 1: Patients that were offered surgery and described a positive experience. Group 2: Patients that were not offered surgery and described a positive experience. Group 3: Patients that were not offered surgery and described a negative experience. Analysis revealed a number of different themes pertaining to the experiences of each group. However, two overarching themes of i) meeting patients9 expectations and ii) the factor of hope, emerged as significant contributors to their experience and were evident in all three subgroups. Conclusion Findings identified the need to manage patient expectations in the consultation in order to provide a positive experience. Providing patients with hope who are not undergoing surgery, but who have an expectation for it, is likely to provide a more positive experience and therefore increased satisfaction with care. No conflicts of interest Part funded by North East London Foundation Trust
Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of M... more Despite an increase in research on multidisciplinary team (MDT) meetings, the implementation of MDT-driven decision-making, ie, its fidelity, remains unstudied. We report fidelity using an observational protocol measuring degree to which MDTs in their weekly meetings in the UK adhere to 1) the stages of group decision-making as per the 'Orientation-Discussion-Decision-Implementation' framework, and 2) cancer guidelines on the composition and characteristics of their weekly meetings produced by the
Supplemental material, sj-pdf-1-qhr-10.1177_10497323211037651 for Physiotherapists' Approache... more Supplemental material, sj-pdf-1-qhr-10.1177_10497323211037651 for Physiotherapists' Approaches to Patients' Concerns in Back Pain Consultations Following a Psychologically Informed Training Program by Ian Cowell, Alison McGregor, Peter O'Sullivan, Kieran O'Sullivan, Ross Poyton, Veronika Schoeb and Ged Murtagh in Qualitative Health Research
Guidelines advocate a combined physical and psychological approach to musculoskeletal management ... more Guidelines advocate a combined physical and psychological approach to musculoskeletal management of non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). Extending the traditional scope of practice to include psychosocial domains has proved challenging for physiotherapists. Using Cognitive Functional Therapy (CFT) as an exemplar of a PIP approach for NSCLBP, this thesis developed and evaluated a training programme in CFT, to investigate the barriers to embedding PIP into primary care; with the intention of enhancing intervention fidelity for future clinical trials (see Figure 1 for a summary of the research phases). Methods: The perceptions of physiotherapists pre-training on managing NSCLBP from a bio-psychosocial (BPS) perspective (Chapter 2), and their perceptions after the training programme on its impact on managing NSCLBP (Chapter 5), were evaluated using thematic analysis. Communication practice was analysed pre-training (Chapter...
Journal of Bone and Joint Surgery-british Volume, 2017
Background Persistent low back and leg pain is a common and highly disabling musculoskeletal cond... more Background Persistent low back and leg pain is a common and highly disabling musculoskeletal condition. Many patients seek the opinion of a neurosurgeon with a view to surgical intervention. Few data are available which document the experiences of patients at these consultations. Aims To investigate the experiences of patients seeking a neurosurgical opinion for back and leg pain. Methods 15 patients (Males 9 Females 6) were consented and recruited into this study and participated in an in-depth semi-structured interview about their experiences of the consultation. Interviews were recorded and transcribed. Transcribed data were read independently by two researchers and analysed using grounded theory. Results Three subgroups of patients were identified from the interviews. Group 1: Patients that were offered surgery and described a positive experience. Group 2: Patients that were not offered surgery and described a positive experience. Group 3: Patients that were not offered surgery ...
Guidelines advocate a combined physical and psychological approach to managing non-specific chron... more Guidelines advocate a combined physical and psychological approach to managing non-specific chronic low back pain (NSCLBP), referred to as psychologically informed practice (PIP). PIP is underpinned by patient-centered principles and skilled communication. Evidence suggests that a physiotherapist-focused style of communication prevails in physiotherapy. There is a recognized need for observational research to identify specific communication practices in physiotherapy interactions. This observational study explored the interactional negotiation of agenda setting following a PIP training intervention, by identifying and describing how physiotherapists solicit and respond to the agenda of concerns that patients with NSCLBP bring to primary care initial encounters. The research setting was primary care. Nineteen initial physiotherapy consultations were video-recorded, transcribed, and analyzed using conversation analysis, a qualitative observational method. These data revealed a patient...
Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experien... more Kuwait. Finally, there is a deficiency of studies that focus on the particularity of the experiences of women with CLBP and the impact on identity. This is the first study that investigates how women with CLBP construct illness identities in Kuwait. Methods: This study adopted a constructivist grounded theory methodology using dimensional analysis. In line with the grounded theory (GT) approach, data collection and analysis took place concurrently. A longitudinal study design was adopted. Semi-structured interviews were used to investigate women's perspectives on their experiences with CLBP in relation to their socio-political and cultural context. Eleven women were recruited from three musculoskeletal outpatient clinics in Kuwait. Initially, five women were purposively sampled. A follow up interview was conducted with four of those women one year after the initial interview to investigate any changes in their experiences. Subsequently, six women were theoretically sampled with the aim of comparing the influence of age, educational level, marital status, socioeconomic status and time on women's illness experiences. Results: The findings of this study offer the first explanatory theory of the construction of illness identities of women with CLBP in Kuwait. Women's identities can be see as part of a continuum from oppressed at one end to liberated at the other. Salience of oppressed identities was associated with periods of exacerbation of CLBP and passive coping behaviours. Appearance of liberated identities was accompanied with episodes of remission of CLBP and active coping approaches. Conclusion: Changes in women's social circumstances, thoughts and feelings over time were related to changes in the identities they portrayed, and changes in their manifestation of CLBP and illness experiences. Implications: The substantive theory developed through this study has implications for clinical practice, education and research, and may inform musculoskeletal physiotherapy professional development. Funding Acknowledgements: Funded by the Government of Kuwait.
< 0.0001). Only a few studies analysed the impact of factors on local recurrence. Conclusions: A ... more < 0.0001). Only a few studies analysed the impact of factors on local recurrence. Conclusions: A higher age (>60 years), size (> 5 cms), grade (>2), depth (deep to deep fascia) and positive margins of excision are associated with poor overall survival. Similarly, size (> 5cms) and deeper location are associated with higher metastasis.
Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered wi... more Background: Guidelines advocate that non-specific chronic low back pain (NSCLBP) be considered within a multi-dimensional bio-psychosocial (BPS) framework. This BPS approach advocates incorporating the patient's perspective as part of the treatment process. 'Agenda setting' has been introduced as the key to understanding patients' concerns in medical encounters; however, this has received little attention in physiotherapy. This study explored how physiotherapists solicit and respond to the agenda of concerns that patients' with NSCLBP bring to initial encounters. Method: The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded, transcribed and analysed using conversation analysis, a qualitative observational method. Both verbal and non-verbal features of the interaction were considered. Results: This data highlights a spectrum of communication styles ranging from more physiotherapist-focused, where the physiotherapists did not attend to patients' concerns, to a more patient-focused style, which provided greater opportunities for patients to voice their concerns. A physiotherapist-focused style tended to predominate. On occasions patients were willing to pursue their own agenda when their concern was initially overlooked. Conclusion: This study provides empirical evidence on communication patterns in physiotherapy practice. A demonstrating that a more collaborative style of communication with a shared conversational agenda provided patients with the conversational space to describe their concerns more fully.
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