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Purpose: The numbers of adolescent and young adult (AYA) survivors of childhood cancer are exponentially growing. To ensure suitable services are available to meet the needs of this growing populat...

At the heart of the teaching practice is the art of questioning. Costa and Kallick noted that questions are the means by which insights unlock thinking. Effective questioning is essential to effective teaching. Despite this, a cohesive theory on the method of questioning has yet to be developed. A discussion of questioning is vital to moving the teaching profession forward. In this article, we propose a model of effective questioning that we see as the first step toward identifying a unifying theory of questioning. Our model contains the following three components: (1) a well-structured item (a good question), (2) clear expectations for the response (which we call ‘the five considerations’), and (3) a constructivist conversation. This work succeeds in bridging the gap between practice and theory that may otherwise limit good teachers from utilizing their questions in the most effective manner. Because of this, our model should be of use to teachers, teacher educators, professional developers, educational researchers, and theoreticians. We hope that a continued discussion of questioning ensues in all of these circles, so that our field can move closer toward the development of a theory of questioning.

AIM AND OBJECTIVE: To examine the factors associated with time to first analgesic medication in the emergency department. BACKGROUND: Pain is the most common symptom presenting to the emergency department, and the time taken to deliver analgesic medication is a common outcome measure. Factors associated with time to first analgesic medication are likely to be multifaceted, but currently poorly described. DESIGN: Retrospective cohort study. METHODS: Cox proportional hazards regression modelling was undertaken to evaluate the associations between person, environment, health and illness variables within Symptom Management Theory and time to first analgesic medication in a sample of adult patients presenting with moderate-to-severe pain to an emergency department over twelve months. This study was completed in line with the STROBE statement. RESULTS: 383 patients were included in the study, 290 (75.92%) of these patients received an analgesic medication in a median time of 45 minutes (interquartile range, 70 minutes). A model containing nine explanatory variables associated with time to first analgesic medication was identified. These nine variables (employment status, discharge location, triage score, Charlson score, arrival pain score, socio-economic status, first location, daily total treatment time and patient time to be seen) represent all of the domains of the Symptom Management Theory. CONCLUSIONS: Person, environment, health and illness factors are associated with the time taken to deliver analgesic medication to those in pain in the emergency department. This study demonstrates the complexity of factors associated with pain care and the applicability of Symptom Management Theory to pain care in the emergency department. RELEVANCE TO CLINICAL PRACTICE: Identifying a model of factors that are associated with the time in which the most common symptom presenting to the emergency department is treated allows for targeted interventions to groups likely to receive poor care and a framework for its evaluation.

Background: The availability and implementation of high-quality decision-making support are integral to ensuring the delivery of quality cancer care and subsequently achieving positive patient outcomes and experiences. Decision Support Systems (DSS) are increasingly used to support decision-making in clinical practice. However, it is not known beyond supporting the decision-making process whether DSS are indeed effective in improving outcomes for people affected by cancer. The purpose of this review was to identify and synthesize the available literature regarding the effects of DSS on patient-reported outcomes in cancer, both during and after cancer treatment.Methods: We conducted a systematic search of four databases for empirical literature published between 2000 and July 2021, in the English language, that reported an evaluation of patient-reported outcomes. Key information was extracted from each article including study design, type of cancer, intervention elements, type of DSS intervention, measures, and key outcomes. We appraised study quality using the Mixed Methods Appraisal Tool (MMAT).Results: We included 14 studies, which we categorized as symptom assessment interventions or interactive educational interventions. Studies described a range of health-related and process-related patient-reported outcomes, as well as decisional complexities. Findings were mixed regarding the effectiveness of clinical DSS interventions in improving total symptom distress and severity, whereas the majority were effective in reducing mean scores for worst and usual pain. Interventions were not effective in improving other health-related patient-reported outcomes including quality of life, global distress, depression, or self-efficacy and there were mixed effects for reducing decisional conflict. Regarding process-related patient-reported outcomes, there was moderate to high patient adherence to the intervention as well as generally high satisfaction and acceptability. However, there was minimal evidence for the effect of clinical DSS interventions in clinician adherence to intervention recommendations. Conclusions: Inconsistencies in reporting of interventions may be a contributing factor to heterogeneous effects of clinical DSS regarding a broad range of patient-reported outcomes. There is a need to develop and implement evidence-based reporting guidelines to improve the reliability and validity of reporting clinical DSS interventions and enhance their timely translation into practice.Systematic review registration: PROSPERO (CRD42020190977)

Objectives: Ensuring implementation fidelity of patient-reported outcome measures (PROMs) in the complex clinical setting remains exigent. We aimed to integrate the routine use of PROM reports in day-to-day patient care and assess the implementation outcomes using statistical process control (SPC) methods. Study Design and Setting: This prospective pilot study used an implementation science framework to integrate PROMs. SPC analysis was applied to track patient completion rates and staff acknowledgment rates over time. Daily observational data across clinical areas were collected to assess potential variations. Results: Data were available from 324 patient encounters over 14 weeks. On average, 78% (52% to 100%) of eligible patients entering the clinic completed the PROMs; staff acknowledged 78% (50–100%) of these patient reports. Most patterns of fluctuation were inside the control frame. Dips in compliance relating to changes in clinic daily routine, including the introduction of the second randomized clinic, were quickly resolved with a structured response. Conclusion: Implementation of PROMs was feasible with reasonable patient completion and staff acknowledgment rates. Fidelity was vulnerable to barriers impacting the daily routine or unusual events in the clinics, suggesting that greater standardization and integration into clinic processes may yet further improve compliance and consistency of reporting.

PurposeWe evaluated the utility of the implementation science framework “Integrated Promoting Action on Research Implementation in Health Services” (i-PARIHS) for introducing patient-reported outcome measures (PROMs) into a medical oncology outpatient department. The i-PARIHS framework identifies four core constructs for implementation, including Facilitation, Innovation, Context and Recipients.MethodsA pilot study used the i-PARIHS framework to identify PROM implementation barriers and enablers to inform facilitation support strategies, such as training clinicians and staff, workflow support, technical support and audit and feedback. Pre- and post-implementation surveys were completed by 83 and 72 staff, respectively, (nurses, doctors and allied health), to assess perceived knowledge, enablers, barriers and utility of PROMs; and acceptability of the PROM intervention was also assessed post-implementation.ResultsImportant barriers included time constraints and previous experiences with technology. Enablers included good leadership support and a culture of learning. Facilitation strategies were used to overcome barriers identified in the i-PARIHS core domains. Compared to before the intervention, staff surveys showed improvement in perceived usefulness, perceived understanding and interpretation skills for PROMs. Staff perceptions about lack of time to use PROMs during visits remained a major perceived barrier post-implementation.ConclusionThe i-PARIHS framework was useful for guiding the implementation of PROMs in routine oncology care. The four core i-PARIHS constructs (Facilitation, Innovation, Context and Recipients) identified factors that directly impacted implementation, with Facilitation having a particularly important role to overcome these barriers. Oncology clinics and health systems considering implementing PROMs should consider having a dedicated Facilitator available during PROM implementation.

Background: People with end-stage kidney disease (ESKD) suffer from multiple symptoms, which have a negative impact on their health-related quality of life (HRQoL). Educational and behavioural interventions are being developed for this population; however, the effect of these interventions is unclear. Aim: To evaluate the effectiveness of educational or behavioural interventions compared with standard care or alternative strategies on reducing symptoms and improving HRQoL in adults with ESKD receiving haemodialysis (HD). Methods: An effectiveness systematic review using Joanna Briggs Institute (JBI) procedures was conducted on experimental studies [randomised controlled trials (RCTs), pseudo-RCTs and quasi-experimental designs] published in English between January 2009 and July 2019. Studies were retrieved from CINAHL, PubMed, MEDLINE, Embase, PsycINFO, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trial) and JBI databases. Effect size at 95% confidence interval was calculated where possible. Results: Eighteen studies involving 791 participants were included in this review. All studies involved behavioural interventions with the majority of studies (n = 11) targeting psychological symptoms. Interventions were categorised as either active or passive. Active interventions seemed to improve some physical symptoms, although there was very little evidence of improvements to HRQoL. Passive interventions tended to have a large effect on psychological symptoms and the mental health components of HRQoL. Conclusion: Due to great heterogeneity between studies, meta-analyses could not be conducted further limiting the evidence to inform practice. In addition, further research on educational interventions to teach self-management strategies for symptom management and to improve HRQoL in people with ESKD receiving HD are needed.

Purpose A small number of studies report that patients with peripheral neuropathy (PN) who engage in activities that promote a sense of personal well-being and provide physical, emotional, or spiritual comfort have a better quality of life and higher levels of adjustment to the changes generated by their illness and accompanying symptoms. This systematic review sought to evaluate the effectiveness of self-management activities that patients with PN initiate themselves to relieve PN symptoms and improve quality of life. Methods Search terms were limited to include self-management activities initiated by patients (i.e., activities with no or minimal involvement from clinicians) that aim to provide relief of PN symptoms. Outcomes included in searches were pain, numbness, and tingling, associated with PN and quality of life. Results The database searches identified 2979 records, of which 1620 were duplicates. A total of 1322 papers were excluded on the basis of screening the abstract. An additional 21 full text articles were excluded because they did not meet the eligibility criteria. A total of 16 papers were included in the review. Conclusion This review identified that a number of self-management strategies that were initiated by patients, including heat, exercise, meditation, and transcutaneous electrical nerve stimulation (TENS) therapy, may reduce self-reported PN symptoms. As the available studies were of low quality, these strategies warrant further investigation with more homogeneous samples, using more rigorously designed trials and larger samples. Implications for Cancer Survivors Patients experiencing PN may find a range of self-initiated strategies beneficial in reducing PN symptoms and improving quality of life. However, because of the low quality of the available studies, clinicians need to monitor patients’ responses to determine the effectiveness of these interventions as adjuncts to clinician-initiated interventions.

ObjectivesStudies indicate women aged 25–49 years previously treated for cancer report cognitive alterations. Good evidence indicates physical activity can be beneficial after cancer and might additionally benefit cognitive function. This short report presents data from a substudy of the Younger Women’s Wellness after Cancer Program (YWWACP), which explored cognitive alterations and investigated potential associations between physical activity and cognitive function in participants in the YWWACP. The primary aim of this substudy was to determine in younger women previously treated for breast cancer (1) whether subjectively reported cognitive function changed over time and (2) if physical activity is associated with subjectively reported cognitive function, and if time had an impact on this.MethodsAll participants had completed breast cancer treatment. Data were collected at baseline (n=41) and at 12 weeks. Measures assessed demographics, self-reported physical activity, cognitive function, sleep quality, stress, anxiety and depression using validated and reliable, subjectively reported instruments.ResultsCognitive function and physical activity scores increased across the time points, with cognitive function revealing a statistically significant increase over time (p=0.004). Statistical testing revealed that physical activity was not correlated with cognitive function and that change in physical activity was not correlated with change in cognitive function.ConclusionThese data provide early evidence that cognitive function and physical activity improved over time in this sample. However, interpretations of a correlation between physical activity and cognitive function should be made with caution, and future research would benefit from larger samples.

Background Intense and aggressive treatment regimens for most children’s cancer have achieved vast improvements in survival but are also responsible for both a high number and burden of symptoms. The use of Patient Reported Outcome Measures (PROMs) demonstrates a range of benefits for improved symptom management in adults with cancer. There are, however, multiple barriers to integrating PROMs into routine care in children and adolescents with cancer. This study aims to evaluate: (1) the effectiveness of electronic PROMs to generate stratified alerts, symptom management recommendations and graphical summaries (the RESPONSE system) to improve health outcomes and (2) the implementation of the RESPONSE system by assessing feasibility, acceptability, satisfaction, and sustainability. Methods A pragmatic hybrid II effectiveness-implementation controlled trial, using mixed methods, will be undertaken, advancing both knowledge of the effectiveness of the intervention and implementation factors. One-hundred and sixty children with cancer receiving active treatment will be recruited 1:1 to a non-randomised study involving two groups with an equal number of participants in each group. The intervention group (n = 80) will be prospectively recruited to receive the RESPONSE system intervention over eight weeks, versus the historical matched control group (n = 80) who will complete the ePROMs without access to the RESPONSE system. The primary outcome of the effectiveness trial is change between groups in total symptom burden. Secondary outcomes include child health-related quality-of-life and implementation outcomes. Trial data will be analysed using linear mixed-effects models. Formative implementation evaluation is informed by CFIR and ERIC frameworks and implementation outcomes will be mapped to the RE-AIM framework and include interviews, field notes, as well as administrative data to evaluate feasibility, acceptability, satisfaction and sustainability. Trial registration number ACTRN12621001084875. Retrospectively Registered 16 August 2021.

Purpose Investigate the reported use and perceived effectiveness of self-care activities for chemotherapy-induced peripheral neuropathy (CIPN) symptoms in the feet. Methods Cancer survivors with CIPN (n = 405) completed a questionnaire that assessed the use and perceived effectiveness of 25 self-care activities. Effectiveness was rated on a 0 (not at all) to 10 (completely effective) numeric rating scale . Descriptive statistics and regression analyses were conducted to identify demographic, clinical, and pain characteristics associated with the use and effectiveness of selected self-care activities. Results The five most commonly used activities were: went for a walk (73.8%); watched television (67.8%); read a book, newspaper or magazine (64.4%); listened to radio, music (60.0%); and did exercises (jogging, swimming) (58.6%). The five most effective self-care activities were: had a trigger point injection (8.3 ( ± 1.3)); took tranquilizers (4.8 ( ± 2.6)); went for ultrasonic stimulation treatment (4.3 ( ± 3.1)); used a heating pad or hot water bottle (4.3 ( ± 2.5)); and used a transcutaneous electric nerve stimulator (4.2 ( ± 2.6)). Demographic, clinical, and pain characteristics influenced use and perceived effectiveness of selected self-care activities to varying degrees. Conclusions Two-thirds of the survivors used at least seven self-care activities to manage CIPN symptoms. The most commonly used activities did not receive the highest effectiveness ratings. Some activities that were rated as highly effective warrant more rigorous evaluation. Survivors can try a range of activities to decrease CIPN symptoms in the feet following discussion of their potential risks and benefits with their clinicians.

Background Active warming reduces risk of surgical complications. Implementation of a perioperative thermal care bundle increased use of active warming for surgical patients. Objective This study aimed to determine if implementing a thermal care bundle to prevent inadvertent perioperative hypothermia is cost-effective. Design A model-based cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects. Setting Hospitals undertaking between 5,000 and 40,000 surgeries per year, which either implemented or did not implement the thermal care bundle, were modelled. Participants The decision tree guiding the structure of the model was populated with clinical outcomes (surgical site infection, blood transfusion requirement and morbid cardiac events) of a hypothetical cohort of surgical patients. Interventions Implementation or non-implementation of the thermal care bundle. Main outcome measures Net monetary benefit was calculated by multiplying the health benefits (quality-adjusted life years) by the willingness-to-pay threshold minus the cost. We tested a range of values for willingness to pay per quality-adjusted life year thresholds and plotted results for expected incremental benefits and probability of cost-effectiveness. The incremental cost-effectiveness ratio was also calculated. Results Thermal care bundle implementation simultaneously reduced costs and increased quality-adjusted life years in the majority of simulations (88.1%). The average cost reduction was $689,659 (95% credible intervals spanned from a $2,718,364 decrease in costs to $379,826 increase in costs) and average difference in quality-adjusted life years was 54 (95% CI = 0.4 less to 176 more). This equated to an incremental cost-effectiveness ratio of $12747 saved per quality-adjusted life year gained. Conclusions It is likely that increasing use of active warming by implementing the thermal care bundle would generate cost-savings and improve the quality of life for surgical patients. It would be good value for hospitals with similar characteristics to those included in our model to allocate the extra resources required for implementation.

Background: Technology is increasingly transforming the way we interact with others and undertake activities in our daily lives. The healthcare setting has, however, been relatively slow to adopt technology solutions to facilitate communication between patients and healthcare providers. While the procedural and policy requirements of healthcare systems will ultimately drive such solutions, understanding the preferences and attitudes of patients is essential to ensure that technology implemented in the healthcare setting facilitates communication in safe, acceptable, and appropriate ways. Therefore, the purpose of this study was to examine patient preferences for using technology to communicate with health services about symptoms experienced following discharge from the hospital. Methods: Primary data were collected from patients admitted to a large metropolitan hospital in Australia during three consecutive months in 2018. Participants were asked about their daily use of technology including use of computers, email, phone, text messaging, mobile applications, social media, online discussion forums, and videoconference. They were then asked about their use of technologies in managing their health, and preferences for use when communicating about symptoms with health services following discharge from hospital. Results: Five hundred and twenty-five patients with a wide range of differing clinical conditions and demographics participated. Patients indicated they used a range of technologies in their everyday lives and to manage their health. Almost 60% of patients would prefer to return to hospital if they were experiencing symptoms of concern. However, if patients experienced symptoms that were not of concern, over 60% would prefer to communicate with the hospital via telephone or using technology. Admitting condition, income, and age were significantly associated with preferences for communication about symptoms following hospital discharge.Conclusions: Patients have varied preferences for communicating with the health service post-hospital discharge. Findings suggest that some, but not all patients, would prefer to use technology to traditional methods of communicating with the healthcare team. Health services should offer patients multiple options for communicating about their recovery to ensure individual needs are appropriately met.

Introduction The aim of this study was to identify strategies to implement patient‐reported outcome measures (PROMs) into routine oncology outpatients' clinical care. Methods Qualitative focus groups were conducted with staff from multiple disciplines using a semistructured interview guide, with supporting data collected in field notes. Data were analysed using a Directed Content Analysis guided by an implementation science framework. The synthesis of the extracted data aimed to identify key requirements which correspond to intrinsic enablers and barriers for implementation. Results 52 staff members from the multi‐disciplinary team participated. Data extracted showed five key themes and three key requirements regarding implementation of PROMs. Staff would consider using PROMs if there was strong research evidence that demonstrates benefits for patient outcomes, if PROM data was relevant to current clinical practice, and if applied appropriately in the specific setting. These findings add pragmatic detail and new knowledge to the current evidence on pathways to PROM implementation. This data can be used to inform implementation of PROMs into health services. Conclusion Staff have valuable tacit knowledge of what works in practice that offers a unique opportunity to increase successful implementation of a PROM intervention for patient symptom reporting.

Objectives To assess the feasibility of conducting a trial of a psycho-educational intervention involving the provision of tailored information and coaching to improve management of a cancer-related symptom cluster (fatigue, pain and sleep disturbance) and reduce symptom cluster impacts on patient health outcomes in the Vietnamese context, and to undertake a preliminary evaluation of the intervention. Methods A parallel-group single blind pilot quasi-experimental trial was conducted with 102 cancer patients in one Vietnamese hospital. The intervention group received one face-to-face session and two phone sessions delivered by a nurse one week apart and the comparison group received usual care. Patient outcomes were measured at baseline prior to the chemotherapy cycle and immediately preceding the next chemotherapy cycle. Separate linear mixed models were used to evaluate the impact of the intervention on total symptom cluster severity, symptom scores, functional status, depressive symptoms and health-related quality of life. Results The study design was feasible with a recruitment rate of 22.6% and attrition rate of 9.8%. Compared to the control group, the intervention group showed a significant reduction in symptom cluster severity, fatigue severity, fatigue interference, sleep disturbance, depression and anxiety. Significant differences were not observed for pain severity, pain interference, functional status and health-related quality of life. The intervention was acceptable to the study population, with a high attendance rate of 78% and adherence rate of 95.7%. Conclusion On the basis of the present study findings, future randomized controlled trials are needed to test the effectiveness of a symptom cluster psycho-educational intervention in Vietnam.