Papers by Benjamin Saunders
BMC musculoskeletal disorders, Apr 26, 2017
Sciatica has a substantial impact on patients, and is associated with high healthcare and societa... more Sciatica has a substantial impact on patients, and is associated with high healthcare and societal costs. Although there is variation in the clinical management of sciatica, the current model of care usually involves an initial period of 'wait and see' for most patients, with simple measures of advice and analgesia, followed by conservative and/or more invasive interventions if symptoms fail to resolve. A model of care is needed that does not over-treat those with a good prognosis yet identifies patients who do need more intensive treatment to help with symptoms, and return to everyday function including work. The aim of the SCOPiC trial (SCiatica Outcomes in Primary Care) is to establish whether stratified care based on subgrouping using a combination of prognostic and clinical information, with matched care pathways, is more effective than non-stratified care, for improving time to symptom resolution in patients consulting with sciatica in primary care. We will also assess...
Journal of Pain Research, 2016
Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly manag... more Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly managed in primary care. Evidence suggests that many musculoskeletal conditions share similar prognostic factors. Systematically assessing patient's prognosis and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically effective and cost-effective. This study (Keele Aches and Pains Study) aims to refine and examine the validity of a brief questionnaire (Keele STarT MSK tool) designed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations. We also describe the subgroups of patients, and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice. The study design is mixed methods: a prospective, quantitative observational cohort study with a linked qualitative focus group and interview study. Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice. Participating patients will complete a baseline questionnaire (shortly after consultation), plus questionnaires 2 and 6 months later. A subsample of patients, along with participating GPs and health care practitioners, will be invited to take part in qualitative focus groups and interviews. The Keele STarT MSK tool will be refined based on face, discriminant, construct, and predictive validity at baseline and 2 months, and validated using data from 6-month follow-up. Patient and clinician perspectives about using the tool will be explored. This study will provide a validated prognostic tool (Keele STarT MSK) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low-, medium-, and high-risk subgroups. The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages.
Qualitative Health Research, 2020
Psychological problems are common among people with inflammatory bowel disease (IBD) following st... more Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery. However, the ways in which stoma-related psychological needs are identified and addressed in health care settings remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care professionals about access to psychological support. Semi-structured interviews were conducted with young people with an IBD stoma (18–29 years, n = 13) and health care professionals ( n = 15), including colorectal surgeons, gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection and analysis were informed by constructivist grounded theory. Three analytic categories were developed: “initiating support-seeking,” “affirming psychological needs,” and “mobilizing psychological support,” which capture young peoples’ trajectory to access psychological support. Based on the findings, we highlight the ...
BMC Family Practice, 2020
Background Stratified care involves subgrouping patients based on key characteristics, e.g. progn... more Background Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main trial and of delivering prognostic stratified primary care for patients with musculoskeletal pain. The pilot RCT was conducted in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK development tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. This paper reports on a nested qualitative study exploring the feasibility of delivering stratified care ahead of the main trial. Methods ‘Stimulated-recall’ interviews were conducted with patients and GPs in the stratified care arm (n = 10 patients; 10 GPs), prompted by consulta...
BMC Family Practice, 2020
Background Stratified care involves subgrouping patients based on key characteristics, e.g. progn... more Background Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to appropriate early treatment options. The STarT MSK feasibility and pilot cluster randomised controlled trial (RCT) examined the feasibility of a future main trial and of delivering prognostic stratified primary care for patients with musculoskeletal pain. The pilot RCT was conducted in 8 UK general practices (4 stratified care; 4 usual care) with 524 patients. GPs in stratified care practices were asked to use i) the Keele STarT MSK development tool for risk-stratification and ii) matched treatment options for patients at low-, medium- and high-risk of persistent pain. This paper reports on a nested qualitative study exploring the feasibility of delivering stratified care ahead of the main trial. Methods ‘Stimulated-recall’ interviews were conducted with patients and GPs in the stratified care arm (n = 10 patients; 10 GPs), prompted by consulta...
Sociology of Health & Illness, 2019
Quality & Quantity, 2017
Saturation has attained widespread acceptance as a methodological principle in qualitative resear... more Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturationas essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
International Journal of Social Research Methodology, 2018
In his detailed response to our paper on sample size in qualitative research, Norman Blaikie rais... more In his detailed response to our paper on sample size in qualitative research, Norman Blaikie raises important issues concerning conceptual definitions and taxonomy. In particular, he points out the problems associated with a loose, generic application of adjectives such as 'qualitative' or 'inductive.' We endorse this concern, though we suggest that in some specific contexts a broad categorization may be more appropriate than a more nuanced distinction-provided that it is clear in which sense the terms are employed. However, other concepts, such as saturation, do not lend themselves to generic use, and require a more detailed conceptualization. Blaikie's analysis also makes it clear that meaningful discussion of sample size in qualitative research cannot occur with reference to an undifferentiated conception of the nature of qualitative research; clear distinctions need to be made within this approach in terms of methodology, ontological and epistemological assumptions, and broader research paradigms.
Qualitative research in psychology, Jan 3, 2015
Qualitative researchers attempting to protect the identities of their research participants now f... more Qualitative researchers attempting to protect the identities of their research participants now face a multitude of new challenges due to the wealth of information once considered private but now readily accessible online. We will draw on our research with family members of people with severe brain injury to discuss these challenges in relation to three areas: participant engagement with the mass media, the availability of court transcripts online, and participants' use of social media. We suggest strategies for managing these challenges via disguise, refining informed consent, and discussion with interviewees. In the context of a largely theoretical literature on anonymization, this article offers concrete examples of the dilemmas we faced and will be of illustrative use to other researchers confronting similar challenges.
BMC Musculoskeletal Disorders
Background Sciatica is common and associated with significant impacts for the individual and soci... more Background Sciatica is common and associated with significant impacts for the individual and society. The SCOPiC randomised controlled trial (RCT) (trial registration: ISRCTN75449581) tested stratified primary care for sciatica by subgrouping patients into one of three groups based on prognostic and clinical indicators. Patients in one group were ‘fast-tracked’ for a magnetic resonance imaging (MRI) scan and spinal specialist opinion. This paper reports qualitative research exploring patients’ and clinicians’ perspectives on the acceptability of this ‘fast-track’ pathway. Methods Semi-structured interviews were conducted with 20 patients and 20 clinicians (general practitioners, spinal specialist physiotherapists, spinal surgeons). Data were analysed thematically and findings explored using Normalisation Process Theory (NPT) and ‘boundary objects’ concept. Results Whilst the ‘fast-track’ pathway achieved a degree of ‘coherence’ (i.e. made sense) to both patients and clinicians, part...
Physiotherapy, 2020
Background
Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) wa... more Background
Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored.
Objectives
The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs’, AHAs’ and patients’ attitudes and beliefs towards delegation.
Data sources
MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions.
Study selection
Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs’, AHAs’ and patients’ attitudes and beliefs about delegation.
Data extraction & synthesis
Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted.
Results
Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation.
Conclusion and implications of key findings
Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients’ attitudes and preferences. Further research is needed to facilitate the standardisation of delegation.
Qualitative Health Research, 2020
Psychological problems are common among people with inflammatory bowel disease (IBD) following st... more Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery.
However, the ways in which stoma-related psychological needs are identified and addressed in health care settings
remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care
professionals about access to psychological support. Semi-structured interviews were conducted with young people
with an IBD stoma (18–29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons,
gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection
and analysis were informed by constructivist grounded theory. Three analytic categories were developed: “initiating
support-seeking,” “affirming psychological needs,” and “mobilizing psychological support,” which capture young
peoples’ trajectory to access psychological support. Based on the findings, we highlight the need for both patients and
health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery.
More effective care pathways, which include responsive psychological services, would enhance access to psychological
support for young people with a stoma.
BMC Musculoskeletal Disorders, 2019
Background: Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. Thi... more Background: Musculoskeletal (MSK) pain represents a considerable worldwide healthcare burden. This study aimed to gain consensus from practitioners who work with MSK pain patients, on the most appropriate primary care treatment options for subgroups of patients based on prognostic risk of persistent disabling pain. Agreement was sought on treatment options for the five most common MSK pain presentations: back, neck, knee, shoulder and multisite pain, across three risk subgroups: low, medium and high. Methods: Three consensus group meetings were conducted with multidisciplinary groups of practitioners (n = 20) using Nominal Group Technique, a systematic approach to building consensus using structured in-person meetings of stakeholders which follows a distinct set of stages. Results: For all five pain presentations, "education and advice" and "simple oral and topical pain medications" were agreed to be appropriate for all subgroups. For patients at low risk, across all five pain presentations "review by primary care practitioner if not improving after 6 weeks" also reached consensus. Treatment options for those at medium risk differed slightly across pain-presentations, but all included: "consider referral to physiotherapy" and "consider referral to MSK-interface-clinic". Treatment options for patients at high risk also varied by pain presentation. Some of the same options were included as for patients at medium risk, and additional options included: "opioids"; "consider referral to expert patient programme" (across all pain presentations); and "consider referral for surgical opinion" (back, knee, neck, shoulder). "Consider referral to rheumatology" was agreed for patients at medium and high risk who have multisite pain. Conclusion: In addressing the current lack of robust evidence on the effectiveness of different treatment options for MSK pain, this study generated consensus from practitioners on the most appropriate primary care treatment options for MSK patients stratified according to prognostic risk. These findings can help inform future clinical decision-making and also influenced the matched treatment options in a trial of stratified primary care for MSK pain patients.
Sociology of Health & Illness, 2019
Stoma surgery can be a life-changing procedure due to bodily changes and related psychological re... more Stoma surgery can be a life-changing procedure due to bodily changes and related psychological responses. Despite previous literature identifying unique challenges for young adults living with a long-term condition, no studies have explored the biographical implications of stoma formation. Drawing on interviews with 13 young adults, aged 18-29 years, with a stoma resulting from inflammatory bowel disease, this article aims to generate new theoretical insights in understanding the process of biographical (re)construction and the wider implications of stoma formation among this group. Data analysis combined constructivist grounded theory and narrative analysis. Whilst two narratives display 'biographical suspension' characterised by a distancing of self from their stoma, the majority of narratives highlight positive transformations in the young adults' conceptions of self; which we explain through the concept of 'biographical renewal'. The liberating effects of stoma surgery allowed young adults to reclaim aspects of their pre-illness selves, yet also reconfigure a new, altered sense of self, culminating in a 'new normal'. However, psychological distress also co-existed alongside these positive representations, revealing a tension that young adults attempt to reconcile through narrativising their experiences. Our findings have implications for the identification and management of the psychological needs of young people with a stoma.
A B S T R A C T Sciatica is a common form of low back pain (LBP) that has been identified as dist... more A B S T R A C T Sciatica is a common form of low back pain (LBP) that has been identified as distinct both in terms of the persistence and severity of symptoms. Little research has explored individual experiences of sciatica, and none focuses on individuals with the most severe, long-lasting symptoms who may experience the most profound impact. This paper addresses this gap through proposing a theoretical framework for understanding such experiences , that of biographical suspension as a form of liminality of Self. Twenty semi-structured interviews were conducted with individuals with severe sciatic symptoms between January 2016‒March 2017, as part of the UK-based SCOPiC (SCiatica Outcomes in Primary Care) randomised controlled trial. Data were analysed thematically using the constant comparison method. The concept of 'biographical suspension', originally developed in LBP, emerged as one whereby individuals put life on-hold in the expectation of an eventual return to their former, pain-free selves. Deeper analysis extended this concept to a form of liminality, whereby individuals are caught between pre-and post-sickness selves, unable to fully identify with either. This liminality is underpinned by ongoing beliefs about sciatica as a temporary and fixable 'injury' rather than long-term 'illness', even among those with long-lasting symptoms. This led to a disjuncture between individuals' ongoing pain beliefs and experiences , resulting in longer-term psychological impacts. Biographical suspension is further conceptualised as an experiential stage giving rise to four distinct short-term trajectories: i) symptom resolution leading individuals to occupy a clearly post-liminal state; ii) remaining in suspended liminality; iii) ongoing symptoms leading to a post-liminal state of resignation; ix) a state of being both between sickness and wellness, and straddling hope and fear; thus exemplifying differing states of liminality experienced over time. Findings have implications for the support provided in clinical settings to individuals who may struggle to self-manage due to sustained liminality of Self.
In his detailed response to our paper on sample size in qualitative research, Norman Blaikie rais... more In his detailed response to our paper on sample size in qualitative research, Norman Blaikie raises important issues concerning conceptual definitions and taxonomy. In particular, he points out the problems associated with a loose, generic application of adjectives such as 'qualitative' or 'inductive' . We endorse this concern, though we suggest that in some specific contexts a broad categorization may be more appropriate than a more nuanced distinction -provided that it is clear in which sense the terms are employed. However, other concepts, such as saturation, do not lend themselves to generic use, and require a more detailed conceptualization. Blaikie's analysis also makes it clear that meaningful discussion of sample size in qualitative research cannot occur with reference to an undifferentiated conception of the nature of qualitative research; clear distinctions need to be made within this approach in terms of methodology, ontological and epistemological assumptions and broader research paradigms.
There has been considerable recent interest in methods of determining sample size for qualitative... more There has been considerable recent interest in methods of determining sample size for qualitative research a priori, rather than through an adaptive approach such as saturation. Extending previous literature in this area, we identify four distinct approaches to determining sample size in this way: rules of thumb, conceptual models, numerical guidelines derived from empirical studies, and statistical formulae. Through critical discussion of these approaches, we argue that each embodies one or more questionable philosophical or methodological assumptions, namely: a naïve realist ontology; a focus on themes as enumerable 'instances' , rather than in more conceptual terms; an incompatibility with an inductive approach to analysis; inappropriate statistical assumptions in the use of formulae; and an unwarranted assumption of generality across qualitative methods. We conclude that, whilst meeting certain practical demands, determining qualitative sample size a priori is an inherently problematic approach, especially in more interpretive models of qualitative research.
Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly manag... more Musculoskeletal conditions represent a considerable burden worldwide, and are predominantly managed in primary care. Evidence suggests that many musculoskeletal conditions share similar prognostic factors. Systematically assessing patient's prognosis and matching treatments based on prognostic subgroups (stratified care) has been shown to be both clinically effective and cost-effective. This study (Keele Aches and Pains Study) aims to refine and examine the validity of a brief questionnaire (Keele STarT MSK tool) designed to enable risk stratification of primary care patients with the five most common musculoskeletal pain presentations. We also describe the subgroups of patients, and explore the acceptability and feasibility of using the tool and how the tool is best implemented in clinical practice. The study design is mixed methods: a prospective, quantitative observational cohort study with a linked qualitative focus group and interview study. Patients who have consulted their GP or health care practitioner about a relevant musculoskeletal condition will be recruited from general practice. Participating patients will complete a baseline questionnaire (shortly after consultation), plus questionnaires 2 and 6 months later. A subsample of patients, along with participating GPs and health care practitioners, will be invited to take part in qualitative focus groups and interviews. The Keele STarT MSK tool will be refined based on face, discriminant, construct, and predictive validity at baseline and 2 months, and validated using data from 6-month follow-up. Patient and clinician perspectives about using the tool will be explored. This study will provide a validated prognostic tool (Keele STarT MSK) with established cutoff points to stratify patients with the five most common musculoskeletal presentations into low-, medium-, and high-risk subgroups. The qualitative analysis of patient and health care perspectives will inform practitioners on how to embed the tool into clinical practice using established general practice IT systems and clinician-support packages.
Background: Sciatica has a substantial impact on patients, and is associated with high healthcare... more Background: Sciatica has a substantial impact on patients, and is associated with high healthcare and societal costs. Although there is variation in the clinical management of sciatica, the current model of care usually involves an initial period of 'wait and see' for most patients, with simple measures of advice and analgesia, followed by conservative and/or more invasive interventions if symptoms fail to resolve. A model of care is needed that does not over-treat those with a good prognosis yet identifies patients who do need more intensive treatment to help with symptoms, and return to everyday function including work. The aim of the SCOPiC trial (SCiatica Outcomes in Primary Care) is to establish whether stratified care based on subgrouping using a combination of prognostic and clinical information, with matched care pathways, is more effective than non-stratified care, for improving time to symptom resolution in patients consulting with sciatica in primary care. We will also assess the impact of stratified care on service delivery and evaluate its cost-effectiveness compared to non-stratified care. Methods/Design: Multicentre, pragmatic, parallel arm randomised trial, with internal pilot, cost-effectiveness analysis and embedded qualitative study. We will recruit 470 adult patients with sciatica from general practices in England and Wales, over 24 months. Patients will be randomised to stratified care or non-stratified care, and treated in physiotherapy and spinal specialist services, in participating NHS services. The primary outcome is time to first resolution of sciatica symptoms, measured on a 6-point ordered categorical scale, collected using text messaging. Secondary outcomes include physical function, pain intensity, quality of life, work loss, healthcare use and satisfaction with treatment, and will be collected using postal questionnaires at 4 and 12-month follow-up. Semi-structured qualitative interviews with a subsample of participants and clinicians will explore the acceptability of stratified care. Discussion: This paper presents the details of the rationale, design and processes of the SCOPiC trial. Results from this trial will contribute to the evidence base for management of patients with sciatica consulting in primary care. Trial registration: ISRCTN75449581, date: 20.11.2014.
Saturation has attained widespread acceptance as a methodological principle in qualitative resear... more Saturation has attained widespread acceptance as a methodological principle in qualitative research. It is commonly taken to indicate that, on the basis of the data that have been collected or analysed hitherto, further data collection and/or analysis are unnecessary. However, there appears to be uncertainty as to how saturation should be conceptualized, and inconsistencies in its use. In this paper, we look to clarify the nature, purposes and uses of saturation, and in doing so add to theoretical debate on the role of saturation across different methodologies. We identify four distinct approaches to saturation, which differ in terms of the extent to which an inductive or a deductive logic is adopted, and the relative emphasis on data collection, data analysis, and theorizing. We explore the purposes saturation might serve in relation to these different approaches, and the implications for how and when saturation will be sought. In examining these issues, we highlight the uncertain logic underlying saturation— as essentially a predictive statement about the unobserved based on the observed, a judgement that, we argue, results in equivocation, and may in part explain the confusion surrounding its use. We conclude that saturation should be operationalized in a way that is consistent with the research question(s), and the theoretical position and analytic framework adopted, but also that there should be some limit to its scope, so as not to risk saturation losing its coherence and potency if its conceptualization and uses are stretched too widely.
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Papers by Benjamin Saunders
Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored.
Objectives
The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs’, AHAs’ and patients’ attitudes and beliefs towards delegation.
Data sources
MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions.
Study selection
Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs’, AHAs’ and patients’ attitudes and beliefs about delegation.
Data extraction & synthesis
Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted.
Results
Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation.
Conclusion and implications of key findings
Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients’ attitudes and preferences. Further research is needed to facilitate the standardisation of delegation.
However, the ways in which stoma-related psychological needs are identified and addressed in health care settings
remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care
professionals about access to psychological support. Semi-structured interviews were conducted with young people
with an IBD stoma (18–29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons,
gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection
and analysis were informed by constructivist grounded theory. Three analytic categories were developed: “initiating
support-seeking,” “affirming psychological needs,” and “mobilizing psychological support,” which capture young
peoples’ trajectory to access psychological support. Based on the findings, we highlight the need for both patients and
health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery.
More effective care pathways, which include responsive psychological services, would enhance access to psychological
support for young people with a stoma.
Delegation by Allied Health Professionals (AHPs) to Allied Health Assistants (AHAs) was introduced in response to various challenges affecting modern health care delivery. However, the clinical and cost-effectiveness of using AHAs is relatively unexplored.
Objectives
The aim of this review was to synthesise the available evidence on; firstly, the clinical and cost-effectiveness of interventions delegated by AHPs to AHAs and secondly, AHPs’, AHAs’ and patients’ attitudes and beliefs towards delegation.
Data sources
MEDLINE, AMED, CINAHL, Cochrane Library, PsycINFO, PEDro, OTseeker and Web of Science databases were searched from inception until January 2019 without restrictions.
Study selection
Primary studies investigating the clinical and cost-effectiveness of any intervention delegated by an AHP, across the spectrum of clinical areas in relation to adult patients, as well as AHPs’, AHAs’ and patients’ attitudes and beliefs about delegation.
Data extraction & synthesis
Data were extracted by pairs of reviewers. Thematic analysis and synthesis of descriptive and analytical themes was conducted.
Results
Thirteen publications of variable methodological quality were included. Three studies reported quantitative research and ten qualitative research. No study explored the cost-effectiveness. Only one study investigated clinical effectiveness. Training for both AHPs and AHAs and having clear processes in place were identified as important facilitators of delegation.
Conclusion and implications of key findings
Delegation is not standardised across AHPs or within each profession. There are clear knowledge gaps regarding the clinical and cost-effectiveness of delegation by AHPs and patients’ attitudes and preferences. Further research is needed to facilitate the standardisation of delegation.
However, the ways in which stoma-related psychological needs are identified and addressed in health care settings
remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care
professionals about access to psychological support. Semi-structured interviews were conducted with young people
with an IBD stoma (18–29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons,
gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection
and analysis were informed by constructivist grounded theory. Three analytic categories were developed: “initiating
support-seeking,” “affirming psychological needs,” and “mobilizing psychological support,” which capture young
peoples’ trajectory to access psychological support. Based on the findings, we highlight the need for both patients and
health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery.
More effective care pathways, which include responsive psychological services, would enhance access to psychological
support for young people with a stoma.
such as catastrophic brain injury and end-of-life decision-making. Using examples from in-depth
interviews with family members of people in vegetative and minimally conscious states, this article
discusses the issues we faced in trying to maximise participant anonymity alongside maintaining
the integrity of our data. We discuss how we developed elaborate, context-sensitive strategies
to try to preserve the richness of the interview material wherever possible while also protecting
participants. This discussion of the practical and ethical details of anonymising is designed to add
to the largely theoretical literature on this topic and to be of illustrative use to other researchers
confronting similar dilemmas.
for managing these challenges via disguise, refining informed consent, and discussion with interviewees. In the context of a largely theoretical literature on anonymization, this article offers concrete examples of the dilemmas we faced and will be of illustrative use to other researchers confronting similar challenges.