A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

OBJECTIVE: Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. METHODS: This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. RESULTS: Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. CONCLUSIONS: Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

Preferences for cancer support group topics and group satisfaction among patients and caregivers.

This study investigated patients living with cancer and caregivers of patients living with cancer with regard to cancer support group content and satisfaction with this model of support (N = 3,723). Using a cross-sectional survey design participants were recruited through registered users of the NexCura Cancer Profiler website. Demographic and clinical variables, including perceived social support, were compared between patients and caregivers. Topic importance questions, and the proportion of patients and caregivers who selected those topics identified as very important and important, was calculated and compared. Group satisfaction was elicited and compared between patients and caregivers. This research can be used to inform, guide, and support group work helping address patient and caregiver need improving their quality of life.

Identification of latent classes in patients who are receiving biotherapy based on symptom experience and its effect on functional status and quality of life.

PURPOSE/OBJECTIVES: to identify subgroups of patients receiving biotherapy with pain, fatigue, sleep disturbance, and depression and to determine functional status and quality of life differences between subgroups. DESIGN: a descriptive, prospective, cohort study design. SETTING: internet-based survey. SAMPLE: 187 patients with cancer receiving biotherapy. METHODS: pain intensity, Piper Fatigue Scale, General Sleep Disturbance Scale, Center for Epidemiological Studies-Depression, Karnofsky Performance Scale, and the Multidimensional Quality of Life Scale-Cancer were used at two time points one month apart (T1 and T2). Latent profile analysis identified subgroups. MAIN RESEARCH VARIABLES: biotherapy, symptoms, functional status, and quality of life. FINDINGS: At T1 (N = 187), five patient subgroups were identified, ranging from subgroup 1 (mild fatigue and sleep disturbance) to subgroup 5 (severe on all four symptoms). At T2 (N = 114), three patient subgroups were identified, ranging from subgroup 1 (mild pain, fatigue, and sleep disturbance without depression) to subgroup 3 (mild pain, moderate fatigue, and sleep disturbance with severe depression). At each time point, the patient subgroup with the most severe symptoms showed significantly lower functional status and quality of life. CONCLUSIONS: as with other cancer treatments, biotherapy can be divided into similar patient subgroups with four prevalent symptoms. Subgroups of patients differ in functional status and quality of life as a result of symptom severity. IMPLICATIONS FOR NURSING: clinicians should assess and identify patients with severe levels of the four prevalent symptoms and offer appropriate interventions. Future study is needed to investigate the factors that contribute to symptom severity and to examine the occurrence of symptom clusters that may place patients at increased risk for poorer outcomes.

An examination of the influence of patient race and ethnicity on expressed interest in learning about cancer clinical trials.

PURPOSE: A number of factors have been identified as being associated with the documented low accrual rate of minorities into cancer-related clinical trials in the USA. An important issue is the fundamental interest, or lack thereof, of these specific patient populations in actually considering study participation. METHODS: To examine this issue, aggregate data were analyzed from a proprietary Internet-based decision support program (NexProfiler Treatment Option Tools for Cancer, NexCura, Seattle, WA, USA) embedded into approximately 100 cancer-associated Web sites where responding patients (or their families) were asked, but not required, to identify their race/ethnicity (African-American, Asian-American, Caucasian and Hispanic) and to also respond to the question, "Are you interested in learning about clinical trials?". RESULTS: Of the > 60,000 patients who both self-identified their race/ethnicity and responded to the question regarding their desire to learn about clinical trials, approximately 10% were from the minority (non-Caucasian) groups. Of note, in all four malignancies analyzed (breast, colorectal, lung, and prostate) and in both patients < or = 60 and > 60 years of age, each of the three non-Caucasian populations expressed an interest in learning about such studies that was equal to, if not greater than, that observed in the Caucasian respondents. CONCLUSION: Assuming these provocative results regarding self-declared desire to learn about clinical trials can be confirmed by others with similar Internet-associated databases, this analysis suggests Web-based recruitment strategies may be an effective method to communicate with minority populations in the US (and, perhaps, elsewhere) with a specific interest in considering participation in cancer clinical trials.

A nursing standards-based system that works!

A 200-bed community hospital has been using a standards-based system since 1985 to guide nursing practice and establish the framework for documentation. Managers and staff nurses appreciate this system for its comprehensive yet simple approach, and its value has stood the test of time. The comprehensive standards model and its use are described.