Barriers and facilitators to the implementation of audio-recordings and question prompt lists in cancer care consultations: A qualitative study

Objective: Question prompt lists (QPLs) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. Methods: Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. Results: CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL’s are able to access them, and limited use when there are other existing communication strategies. Conclusions: While CARs and QPLs are beneficial for patients, there are important individual, system and medico-legal considerations regarding usual care. Practice implications: Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential

Sustaining One’s Own Health and Wellness While Supporting a Stroke Survivor: Spouses’ and Partners’ Perspectives

Utilising an interpretive descriptive approach, this qualitative study explores and identifies how spouses and partners of stroke survivors sustain their own health and wellness. Recent literature has mainly focused on identifying psychological coping strategies thought to assist in adapting to the caring role. As a consequence, there is limited knowledge regarding the experiences of how spouses and partners attend to their own health and well-being. This study aimed to explore how spouses and partners sustain their own health and wellness while supporting a stroke survivor. Purposive and theoretical sampling strategies were used to guide recruitment. Semi-structured interviews were carried out with seven spouses and partners who were living with, and supporting a stroke survivor. A central theme with three sub-themes became apparent when examining spouses and partners’ experiences. The theme of Meeting Needs connects the three sub-themes, in that spouses’ and partners’ health and wellness appeared to be influenced by and intertwined with attending to the stroke survivors’ needs. The context of Being in a Relationship provided a rationale for prioritising the stroke survivors’ needs and was the first sub-theme. Secondly, Living Both Lives explains how spouses/partners were busy thinking and attending primarily to the stroke survivor’s daily requirements whilst also trying to attend their own needs. The third sub-theme, Uncertain Health encompasses how a spouse’s and partner’s well-being is connected to the stroke survivors’ health and their future concerns about being able to provide care if they themselves become sick. Therefore, these circumstances shaped their ability to attend to their own health and well-being. Whilst attending to the stroke survivor was at the forefront of their minds there were some strategies which spouses/partners utilised to support their own health and well-being. These were: creating time and space for themselves; talking with others; and comparing own lives against others who were seen to be worse or better off, in order to support their own emotional well-being. This study found that the participants struggled to prioritise and attend to their own health and well-being, as most of them was busy primarily attending to the stroke survivor’s needs. Overall, results suggest that exploring what spouses/partners think and do within the relationship could be valuable for health practitioners. Given that it is the intimate nature of being in a relationship that is the foundation for spouses/partners supporting the stroke survivor, it could also be important for services and health professionals to consider the well-being and needs of the couple, not just the stroke survivor

Abstract T P194: Clinical Use of Telemedicine for Acute Stroke Care in a Regional Area: Findings From the Victorian Stroke Telemedicine (VST) Project

Background: Telemedicine systems can facilitate evidence-based care for patients with stroke, but are rarely used in rural Australia. Objective: We assessed the hypothesis that a stroke telemedicine program could increase stroke thrombolysis and improve the timeliness of diagnosis and investigation of stroke. Methods: The finalised Victorian Stroke Telemedicine (VST) protocol was implemented at one site in regional Australia from October 2011 to October 2012. All patients who present to the Emergency Department (ED) within 4.5 hours of stroke onset, who were aged 18 years or older, and had suspected stroke symptoms, were eligible for a telemedicine consultation. Clinical data was collected for stroke patients who presented within 4.5 hours of symptom onset one year prior to implementation (baseline) and during the one year VST implementation phase. Results: For all admitted strokes during VST (October 2011 - October 2012), stroke thrombolysis increased from 8% to 13% compared to pre-VST data. For those patients who arrive to the ED within 4.5 hours, analysis was based on small groups (baseline n=58; VST n=62), which limited ability to detect statistically significant results. However, there was evidence of clinically important trends, such as a 29 minute reduction in door-to-CT scan from baseline [median 63, IQR 29-103] to VST [34, IQR 20-58, p=.006]. Stroke onset-to-needle time was quicker by 45 minutes after VST implementation [173, IQR 148-234, p=.108]. There was a 21% reduction in hospital transfers (p&lt;0.005). Overall, it was estimated that there was a reduction in three years of disability adjusted life years (DALY’s) for thrombolysed patients. Conclusion: The VST program has enhanced thrombolysis delivery and timeliness of associated clinical investigations and decisions in a regional emergency department. </jats:p

Nurses’ Role in Implementing and Sustaining Acute Telemedicine:A Mixed-Methods, Pre-Post Design Using an Extended Technology Acceptance Model

PURPOSE: Technology-based systems like telemedicine are frequently being implemented into healthcare settings, impacting clinician practices. Little is known about factors influencing acute telemedicine uptake, if factors differ across time, or between nurses and non-nurses. DESIGN: A mixed-methods, pre-post design with implementation of a new acute stroke telemedicine service. METHODS: A survey based on an extended Technology Acceptance Model (TAM) was administered to clinicians involved in acute stroke care at 16 regional hospitals (2014-2017). Open-ended questions postimplementation (at 6 months) included strengths of the program and areas to improve. Subsequently, a secondary analysis of nurses' semistructured interviews at the first telemedicine site (2010-2011) was completed to provide greater explanatory detail. FINDINGS: Surveys were completed by nurses (preimplementation n = 77, postimplementation n = 92) and non-nurses (pre n = 90, post n = 44). Preimplementation, perceived usefulness was the only significant predictor of intending to use telemedicine for nurses, while perceived ease of use and social influence were significant for non-nurses. Postimplementation, perceived usefulness was significant for both groups, as was facilitating conditions for nurses. Specific examples aligned to TAM categories from our detailed interviews (n = 11 nurses) included perceived usefulness (improved clinical support and patient care), perceived ease of use (technical, clinical aspects), facilitating conditions (setting, education, confidence), and social influence (working relationships). CONCLUSIONS: Important factors for acute stroke telemedicine varied between nurses and non-nurses, and changed after implementation. The benefits of telemedicine should be emphasized to nurses. Preimplementation, more non-nurses wanted systems to be easy. Support in clinical, technical, and relationship aspects of telemedicine consultations is required. CLINICAL RELEVANCE: Nurses are influential in implementing acute telemedicine, which is complex, with clinical and technical aspects entwined. Evidence-based implementation strategies must be tailored over time, and between nurses and non-nurses, to ensure initial uptake and ongoing use

Barriers and facilitators to the implementation of audio-recordings and question prompt lists in cancer care consultations: A qualitative study

Objective: Question prompt lists (QPL. s) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. Methods: Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. Results: CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL's are able to access them, and limited use when there are other existing communication strategies. Conclusions: While CARs and QPLs are beneficial for patients, there are important individual, system and medico-legal considerations regarding usual care. Practice implications: Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential