Nursing - Theses
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ItemDevelopment of a guideline to inform the content of a summarized patient information form regarding cancer clinical trials( 2014)Ethical review processes support the need to present comprehensive information to enable patients with cancer make informed decisions about whether or not to participate in a clinical trial. However, evidence indicates that patients do not always understand information given to them about the requirements and purpose of clinical trials, raising concerns about the status of consent given. Researchers have attempted to enhance patients’ understanding through implementation of diverse interventions, but these have had mixed outcomes. The thesis started with a systematic review to explore the efficacy of interventions developed to improve patient understanding of clinical trials. The findings of the systematic review suggested limited impact of the interventions on patient understanding. Likely reasons for the limited success were: 1) only a small element of the communication process was addressed by the studies; 2) studies lacked a theoretical framework; 3) studies lacked a detailed description of the intervention development process; 4) studies did not draw on evidence to inform the inclusion of essential information as part of interventions being tested to enable informed consent; and 5) studies lacked reliable and valid outcome measures to measure the impact of interventions on patients’ knowledge of trial purposes and requirements. This PhD set out to develop a guideline for health professionals to inform the creation of the Summarized Patient Information Forms (SPIFs); a document designed to complement the lengthy and often complex Participant Information and Consent Forms (PICFs) given to patients eligible for cancer clinical trials. The purpose of the PhD was to develop a resource to help address documented limitations in patients’ understanding of cancer clinical trial consent forms. Habermas’ Theory of Communicative Action (TCA) was chosen as the theoretical framework to inform the study design. In Stage I, a Delphi process was adopted to generate an exhaustive list of information regarded as important to support informed clinical trial participation and then to reduce this information, through a consensus process, to essential items for inclusion in a SPIF. The Delphi consensus process produced 14 statements regarded as essential information to be included in a SPIF. Stage II involved the development of a guideline for health professionals to inform the production of a SPIF to support patients’ understanding of cancer trial participation requirements during the informed consent process. The SPIF also has the potential to support patients to ask questions or voice concerns during the informed consent process as a result of providing information in an accessible and familiar language. This PhD has produced a robust guideline for health professionals with which to inform the development of a SPIF; a short and concise document as an adjunct to the full PICF to enhance the informed consent process. Once developed, a SPIF can be used to enhance communication of essential information between health professionals and patients. The SPIF has the potential to help professionals share information in an understandable way, to ensure patients understand what clinical trial participation involves and thus, address international concerns about the status of consent currently being achieved with patients recruited to cancer clinical trials.
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ItemExamining healthcare professionals’ communication across the perioperative pathway to improve patient safety( 2012)Background: Communication practices of healthcare professionals have been strongly implicated in the cascade of events that unfold into poor outcomes for surgical patients. Many local and international reports consistently implicate the perioperative environment and communication failure, as critical constituents in the generation of serious adverse events. However, research is lacking into how communication failure occurs and how healthcare professionals achieve communication successes, across all domains of the perioperative pathway, which includes preoperative, intraoperative and postoperative domains. Aims: The aims of this thesis are to explore healthcare professionals’ communication patterns and failures, and describe the impact of communication failures on clinical practice and patient care across the perioperative pathway. Additionally, this thesis aims to provide understandings of how healthcare professionals overcome communication failures and bridge communication gaps across the perioperative pathway. Methods: An institutional ethnographic design was used, involving structured and unstructured observations, focus groups, patient interviews and the International Communications Association’s survey, as research methods. Healthcare professionals of different disciplines were purposively selected from diverse perioperative areas in three, public, metropolitan hospitals. A three-dimensional communication model was used to explore sociocultural and environmental influences on communication, attributes of the communication encounter and outcomes of communication encounters. Data were analysed using an institutional ethnographic approach to uncover the social relations interconnecting healthcare professionals’ work and communication practices. The social relations were traced to identify the institutional relations ruling healthcare professionals’ communication. Findings: Over 350 observation hours, 2 focus groups, 20 interviews and 281 survey responses were collated. Healthcare professionals’ communication patterns revealed communication was frequently face-to-face, short in duration and interrupted. Constant information relay was evident as healthcare professionals engaged in patterns of conveying and exchanging information within disciplines, across disciplines, and across domains of the perioperative pathway. Communication failure occurred due to a lack of open communication among healthcare professionals, as a result of difficultly in distributing information and of healthcare professionals adapting work processes to streamline their work. Furthermore, the odds of communication failure happening were higher when overlapping communication occurred and when post anaesthetic care nurses engaged in multitasking while communicating. Frequent consequences of communication failure were associated with: increased communication interactions, missing information conveyed in communication encounters and increased workload. Compromised patient safety and a reduction in the quality of patients’ care were also outcomes of communication failure. Healthcare professionals exhibited many communication successes as they applied a range of compensatory strategies to forestall communication failure. These strategies overcame discontinuities in communication to prevent patient harm. Healthcare professionals were observed to anticipate, detect and compensate for information loss in communication. Implications: To foster open and accurate communication a reduction in time pressures could ease asynchronous workflows, increase time for documentation, lessen the need for multitasking while communicating, and diminish overlapping communication. Additionally, to encourage information sharing, interdisciplinary education could provide understandings into healthcare professionals’ roles and information needs, and balance unequal power relationships. Furthermore, direct and timely communication could be promoted by technology systems that facilitate information distribution, and support direct communication among healthcare professionals.