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1.  Health professionals’ experiences and perceptions of challenges of interprofessional collaboration: Socio-cultural influences of IPC 
Literature shows that interprofessional collaboration (IPC) is a challenging phenomenon both in theory and practice, and it is affected by socio-cultural contexts in which the health professionals (HPs) play their roles. Considering some evidences on the similarities and differences between eastern and western socio-cultural contexts, this study aims to explore and describe the socio-cultural factors influencing IPC in these two contexts.
Materials and Methods:
This was a pilot qualitative descriptive study that was conducted in 2012–2013. Data were collected through conducting one-to-one and group interviews as face-to-face and written in terviews (narratives) with purposeful samples of HPs from various disciplines including nurses, medical doctors (MDs) from variety of specialities, social workers, and psychologists from health system in Iran and Germany. Other methods of data collection were taking field notes and reviewing related literature. The qualitative content analyses method was employed to derive the common categories and themes.
Totally 22 participants took part in the study. Moreover, researchers had a 10-day period of field observation in Germany (health systems affiliated with Albert Ludwigs University of Freiburg). Qualitative data analysis revealed three themes and related subthemes. The themes were: (1) Interaction beyond boundaries, (2) motivation to engage in IPC, and (3) readiness to approaching toward IPC.
The results of the study emphasized that in both eastern and western contexts, organizational, professional, and community socio-cultural textures, mainly in terms of attitudes toward other people, other professions, and IPC, play their role as important factors. We suggest future researches about each of the emerged themes.
PMCID: PMC4325422  PMID: 25709698
Germany; interprofessional collaboration; Iran; nursing profession; socio-cultural
2.  Interprofessional collaboration regarding patients’ care plans in primary care: a focus group study into influential factors 
BMC Family Practice  2016;17:58.
The number of people with multiple chronic conditions demanding primary care services is increasing. To deal with the complex health care demands of these people, professionals from different disciplines collaborate. This study aims to explore influential factors regarding interprofessional collaboration related to care plan development in primary care.
A qualitative study, including four semi-structured focus group interviews (n = 4). In total, a heterogeneous group of experts (n = 16) and health care professionals (n = 15) participated. Participants discussed viewpoints, barriers, and facilitators regarding interprofessional collaboration related to care plan development. The data were analysed by means of inductive content analysis.
The findings show a variety of factors influencing the interprofessional collaboration in developing a care plan. Factors can be divided into 5 key categories: (1) patient-related factors: active role, self-management, goals and wishes, membership of the team; (2) professional-related factors: individual competences, domain thinking, motivation; (3) interpersonal factors: language differences, knowing each other, trust and respect, and motivation; (4) organisational factors: structure, composition, time, shared vision, leadership and administrative support; and (5) external factors: education, culture, hierarchy, domain thinking, law and regulations, finance, technology and ICT.
Improving interprofessional collaboration regarding care plan development calls for an integral approach including patient- and professional related factors, interpersonal, organisational, and external factors. Further, the leader of the team seems to play a key role in watching the patient perspective, organising and coordinating interprofessional collaborations, and guiding the team through developments. The results of this study can be used as input for developing tools and interventions targeted at executing and improving interprofessional collaboration related to care plan development.
Electronic supplementary material
The online version of this article (doi:10.1186/s12875-016-0456-5) contains supplementary material, which is available to authorized users.
PMCID: PMC4884411  PMID: 27233362
Interprofessional collaboration; Multidisciplinary teamwork; Interprofessional Relations; Cooperative behaviour; Health care team; Primary health care; Qualitative research; Focus groups
3.  Service learning in Guatemala: using qualitative content analysis to explore an interdisciplinary learning experience among students in health care professional programs 
Interprofessional collaboration among health care professionals yields improved patient outcomes, yet many students in health care programs have limited exposure to interprofessional collaboration in the classroom and in clinical and service-learning experiences. This practice gap implies that students enter their professions without valuing interprofessional collaboration and the impact it has on promoting positive patient outcomes.
The aim of this study was to describe the interprofessional experiences of students in health care professional programs as they collaborated to provide health care to Guatemalan citizens over a 7-day period.
In light of the identified practice gap and a commitment by college administration to fund interprofessional initiatives, faculty educators from nursing, occupational therapy, and physical therapy conducted a qualitative study to explore a service-learning initiative focused on promoting interprofessional collaboration. Students collaborated in triads (one student from each of the three disciplines) to provide supervised health care to underserved Guatemalan men, women, children, and infants across a variety of community and health care settings. Eighteen students participated in a qualitative research project by describing their experience of interprofessional collaboration in a service-learning environment. Twice before arriving in Guatemala, and on three occasions during the trip, participants reflected on their experiences and provided narrative responses to open-ended questions. Qualitative content analysis methodology was used to describe their experiences of interprofessional collaboration.
An interprofessional service-learning experience positively affected students’ learning, their growth in interprofessional collaboration, and their understanding and appreciation of health care professions besides their own. The experience also generated feelings of gratitude for the opportunity to be a member of an interprofessional team and to serve those in need by giving of themselves.
The findings support service learning as a platform to encourage interprofessional collaboration among students in health care professional programs. The research will inform future service-learning experiences in which interdisciplinary collaboration is an outcome of interest.
PMCID: PMC3573825  PMID: 23430865
content analysis; interdisciplinary collaboration; service-learning; qualitative research
4.  Implementing successful interprofessional communication opportunities in health care education: a qualitative analysis 
To explore the experience of an interprofessional communication educational intervention among nursing and medical students.
Forty-five medical students and 50 nursing students participated in two-hour-long interprofessional communication skills education sessions with interprofessional groups of 6-8 students each. The sessions were based on the Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPSTM) curriculum. Problematic communication scenarios were presented and then reenacted by the students with role plays that depicted improvements in interprofessional communication. Afterward, narratives describing their experience were collected from a focus group interview. Using the conventional content analysis approach, key phrases and statements were coded into themes.
The study found that students felt increased competence and confidence when responding to conflict after practicing communication in a safe environment. Based on the opportunity to come to know their colleagues, students recognized that patient safety was a shared goal. Six themes were extracted from the narratives describing their experiences: support for process, patient safety, coming to know colleague, support for tools, respectful collaboration, and barriers to communication.
TeamSTEPPSTM provided a framework for effective and respectful collaboration. A significant barrier identified by students was that these communication techniques were not consistently demonstrated during their clinical experiences. An emphasis on interprofessional communication skills and teamwork should begin in the academic setting and be reinforced in both the formal and hidden curricula.
PMCID: PMC4205528
Interprofessional communication; TeamSTEPPSTM
5.  Joy and Challenges in Improving Chronic Illness Care: Capturing Daily Experiences of Academic Primary Care Teams 
Journal of General Internal Medicine  2010;25(Suppl 4):581-585.
Two chronic care collaboratives (The National Collaborative and the California Collaborative) were convened to facilitate implementing the chronic care model (CCM) in academic medical centers and into post-graduate medical education.
We developed and implemented an electronic team survey (ETS) to elicit, in real-time, team member’s experiences in caring for people with chronic illness and the effect of the Collaborative on teams and teamwork.
The ETS is a qualitative survey based on Electronic Event Sampling Methodology. It is designed to collect meaningful information about daily experience and any event that might influence team members’ daily work and subsequent outcomes.
Forty-one residency programs from 37 teaching hospitals participated in the collaboratives and comprised faculty and resident physicians, nurses, and administrative staff.
Each team member participating in the collaboratives received an e-mail with directions to complete the ETS for four weeks during 2006 (the National Collaborative) and 2007 (the California Collaborative).
At the team level, the response rate to the ETS was 87% with team members submitting 1,145 narrative entries. Six key themes emerged from the analysis, which were consistent across all sites. Among teams that achieved better clinical outcomes on Collaborative clinical indicators, an additional key theme emerged: professional work satisfaction, or “Joy in Work”. In contrast, among teams that performed lower in collaborative measures, two key themes emerged that reflected the effect of providing care in difficult institutional environments—“lack of professional satisfaction” and awareness of “system failures”.
The ETS provided a unique perspective into team performance and the day-to-day challenges and opportunities in chronic illness care. Further research is needed to explore systematic approaches to integrating the results from this study into the design of improvement efforts for clinical teams.
PMCID: PMC2940446  PMID: 20737233
chronic illness; team; joy in work; graduate medical education; ambulatory training; interprofessional training
6.  A Qualitative Investigation into Why the Motivation of Massage Therapy Students Changes over the Course of Their Professional Education 
In previous research, the motivation of massage therapy students was observed to change between commencement of their professional studies and entry into practice. The change involved a decrease in intrinsic motivation (associated with altruism) and an increase in extrinsic motivation (associated with the prospect of external rewards). This paper reports on the influences underlying those changes.
The research used a qualitative design in which data were collected during a series of individual in-depth semi-structured interviews with massage therapy graduates, just after completion of a 2-year (2200-hour) full-time program. After informed consent was obtained, interviews were taped, transcribed, and analyzed, resulting in identification of a number of themes and subthemes.
Previously noted changes in student motivation involved an increase in the influence of extrinsic rewards and a decrease in motivation related to helping and working with people. The findings of the present study suggest that these changes are explained by two main themes, each with a number of subthemes. The first theme, The Reality of Life in Practice, is associated with two subthemes: Debt Load, and Effectiveness in Achieving Positive Health Outcomes. The second theme, An Evolving Self-Image As a Health Care Professional, is associated with three sub-themes: Rigor/Intensity of the Educational Program, Developing Perspective of Massage Therapy As a Career, and Interaction with Faculty.
The data suggest that the change in motivation noted in previous work (increased extrinsic motivation and decreased intrinsic motivation) is influenced in different ways by each identified theme. Although schools must be vigilant in ensuring that their programs support the humanistic mission of health care, the present study indicates that the change in motivation noted in earlier work is not sinister. Rather, it appears to be related to the development of a realistic perspective of life as a health care practitioner, which departs from the more naïve expectations of students when they commence their professional studies.
PMCID: PMC3091456  PMID: 21589720
Massage therapy; motivation; education; professional socialization
7.  The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus 
Ongoing care for chronic conditions such as diabetes is best provided by a range of health professionals working together. There are challenges in achieving this where collaboration crosses organisational and sector boundaries. The aim of this article is to explore the influence of power dynamics and trust on collaboration between health professionals involved in the management of diabetes and their impact on patient experiences.
A qualitative case study conducted in a rural city in Australia. Forty five health service providers from nineteen organisations (including fee-for-service practices and block funded public sector services) and eight patients from two services were purposively recruited. Data was collected through semi-structured interviews that were audio-taped and transcribed. A thematic analysis approach was used using a two-level coding scheme and cross-case comparisons.
Three themes emerged in relation to power dynamics between health professionals: their use of power to protect their autonomy, power dynamics between private and public sector providers, and reducing their dependency on other health professionals to maintain their power. Despite the intention of government policies to support more shared decision-making, there is little evidence that this is happening. The major trust themes related to role perceptions, demonstrated competence, and the importance of good communication for the development of trust over time. The interaction between trust and role perceptions went beyond understanding each other's roles and professional identity. The level of trust related to the acceptance of each other's roles. The delivery of primary and community-based health services that crosses organisational boundaries adds a layer of complexity to interprofessional relationships. The roles of and role boundaries between and within professional groups and services are changing. The uncertainty and vulnerability associated with these changes has affected the level of trust and mistrust.
Collaboration across organisational boundaries remains challenging. Power dynamics and trust affect the strategic choices made by each health professional about whether to collaborate, with whom, and to what level. These decisions directly influenced patient experiences. Unlike the difficulties in shifting the balance of power in interprofessional relationships, trust and respect can be fostered through a mix of interventions aimed at building personal relationships and establishing agreed rules that govern collaborative care and that are perceived as fair.
PMCID: PMC3376040  PMID: 22413897
8.  Exploring interprofessional collaboration during the integration of diabetes teams into primary care 
BMC Family Practice  2016;17:12.
Specialised diabetes teams, specifically certified nurse and dietitian diabetes educator teams, are being integrated part-time into primary care to provide better care and support for Canadians living with diabetes.
This practice model is being implemented throughout Canada in an effort to increase patient access to diabetes education, self-management training, and support. Interprofessional collaboration can have positive effects on both health processes and patient health outcomes, but few studies have explored how health professionals are introduced to and transition into this kind of interprofessional work.
Data from 18 interviews with diabetes educators, 16 primary care physicians, 23 educators’ reflective journals, and 10 quarterly debriefing sessions were coded and analysed using a directed content analysis approach, facilitated by NVIVO software.
Four major themes emerged related to challenges faced, strategies adopted, and benefits observed during this transition into interprofessional collaboration between diabetes educators and primary care physicians: (a) negotiating space, place, and role; (b) fostering working relationships; (c) performing collectively; and (d) enhancing knowledge exchange.
Our findings provide insight into how healthcare professionals who have not traditionally worked together in primary care are collaborating to integrate health services essential for diabetes management. Based on the experiences and personal reflections of participants, establishing new ways of working requires negotiating space and place to practice, role clarification, and frequent and effective modes of formal and informal communication to nurture the development of trust and mutual respect, which are vital to success.
PMCID: PMC4736701  PMID: 26831500
Canada; Collaboration; Diabetes education; Diabetes management; Integrated care, interprofessional; Collaboration; New work; Primary care; Specialist care
9.  A conceptual framework for interprofessional shared decision making in home care: Protocol for a feasibility study 
Shared decision making (SDM) is fundamental to informed consent and client-centered care. So far, SDM frameworks have been limited to the client-physician dyad, even though care is increasingly delivered by interprofessional (IP) teams. IP collaboration is especially essential in home care, one of health care's most rapidly growing areas. This study will assess whether it is possible to practice SDM in IP home care.
We will use a qualitative case study and a quantitative survey to capture the macro, meso and micro levels of stakeholders in home care. The case study will follow the knowledge-to-action process framework to evaluate the work of an IP home care team at a Quebec City health center. Sources of data will include one-on-one interviews with patients, family caregivers or surrogates and significant others, and administrators; a focus group of home care health professionals; organizational documents; and government policies and standards. The interview guide for the interviews and the focus group will explore current practices and clinical problems addressed in home care; factors that could influence the implementation of the proposed IP approach to SDM; the face and content validity of the approach; and interventions to facilitate the implementation and evaluation of the approach. The survey will ask 300 health professionals working in home care at the health center to complete a questionnaire based on the Theory of Planned Behaviour that measures their intentions to engage in an IP approach to SDM. We will use our analysis of the individual interviews, the focus group and the survey to elaborate a toolkit for implementing an IP approach to SDM in home care. Finally, we will conduct a pilot study in Alberta to assess the transferability of our findings.
We believe that developing tools to implement IP SDM in home care is essential to strengthening Canada's healthcare system and furthering patient-centered care. This study will contribute to the evaluation of IP SDM delivery models in home care. It will also generate practical, policy-oriented knowledge regarding the barriers and facilitators likely to influence the practice of IP SDM in home care.
PMCID: PMC3045286  PMID: 21281487
10.  Structuring communication relationships for interprofessional teamwork (SCRIPT): a cluster randomized controlled trial 
Trials  2007;8:23.
Despite a burgeoning interest in using interprofessional approaches to promote effective collaboration in health care, systematic reviews find scant evidence of benefit. This protocol describes the first cluster randomized controlled trial (RCT) to design and evaluate an intervention intended to improve interprofessional collaborative communication and patient-centred care.
The objective is to evaluate the effects of a four-component, hospital-based staff communication protocol designed to promote collaborative communication between healthcare professionals and enhance patient-centred care.
The study is a multi-centre mixed-methods cluster randomized controlled trial involving twenty clinical teaching teams (CTTs) in general internal medicine (GIM) divisions of five Toronto tertiary-care hospitals. CTTs will be randomly assigned either to receive an intervention designed to improve interprofessional collaborative communication, or to continue usual communication practices.
Non-participant naturalistic observation, shadowing, and semi-structured, qualitative interviews were conducted to explore existing patterns of interprofessional collaboration in the CTTs, and to support intervention development. Interviews and shadowing will continue during intervention delivery in order to document interactions between the intervention settings and adopters, and changes in interprofessional communication.
The primary outcome is the rate of unplanned hospital readmission. Secondary outcomes are length of stay (LOS); adherence to evidence-based prescription drug therapy; patients' satisfaction with care; self-report surveys of CTT staff perceptions of interprofessional collaboration; and frequency of calls to paging devices. Outcomes will be compared on an intention-to-treat basis using adjustment methods appropriate for data from a cluster randomized design.
Pre-intervention qualitative analysis revealed that a substantial amount of interprofessional interaction lacks key core elements of collaborative communication such as self-introduction, description of professional role, and solicitation of other professional perspectives. Incorporating these findings, a four-component intervention was designed with a goal of creating a culture of communication in which the fundamentals of collaboration become a routine part of interprofessional interactions during unstructured work periods on GIM wards.
Trial registration
Registered with National Institutes of Health as NCT00466297.
PMCID: PMC2045094  PMID: 17877830
11.  Nine States’ Use of Collaboratives to Improve Children’s Health Care Quality in Medicaid and CHIP 
Academic pediatrics  2013;13(6 Suppl):S95-102.
We examine quality improvement (QI) collaboratives underway in 9 states participating in the Children’s Health Insurance Program Reauthorization Act (CHIPRA) Quality Demonstration Grant Program. A total of 147 diverse, child-serving practices were participating in the collaboratives. We conducted 256 semistructured interviews with key stakeholders from March to August 2012—2 years into the 5-year demonstration projects—and analyzed states’ grant applications, operating plans, and progress reports. The collaboratives have multiple complex aims. In addition to developing patient-centered medical home (PCMH) capability, some states use collaboratives to familiarize practices with CMS’s Initial Core Set of Children’s Health Care Quality Measures, practice-level quality measurement, and improving QI knowledge and skills. The duration of the collaboratives is longer than other well-known collaborative models. Collaboratives also vary in their methods for targeting areas for improvement and strategies for motivating practice recruitment and engagement. States also vary with respect to the other strategies they use to support QI and PCMH development. All states supplement the collaboratives with practice facilitation; the majority utilized practice-level parent engagement, but only 4 used work-force augmentation (ie, providing care coordinators and QI specialists). Practice staff highly valued aspects of the collaboratives and supplemental strategies, including the opportunity to work with experts and other child-serving practices; states’ efforts to provide stipends and align demonstration efforts with other professional requirements or programs; receipt of relevant, customized QI materials; opportunities to learn how care coordinators or QI specialists might work in their practice without the risk of hiring them; and satisfaction from learning more about quality measures, QI concepts and techniques, critical medical home components, and how to identify PCMH capacity and performance gaps. However, practice staff also reported a variety of challenges, including difficulty learning from other practices that have very different preexisting QI and PCMH capacity and patient populations, or that are working on different topic areas and measures; a sometimes overwhelming amount of materials and ideas covered during in-person meetings; difficulty keeping up with Webinars, calls, and Web sites/blogs; and trouble motivating and sharing information with other practice staff not attending collaborative activities. As the demonstration projects continue, states and the national evaluation team will learn more about how best to use collaboratives and complementary strategies to support child-serving practices in QI and PCMH development. States will also search for ways to sustain and spread these activities after the demonstration ends, if they prove effective.
PMCID: PMC5091932  PMID: 24268093
collaborative; Medicaid/CHIP; patient-centered medical home; primary care; quality improvement
12.  Role construction and boundaries in interprofessional primary health care teams: a qualitative study 
The move towards enhancing teamwork and interprofessional collaboration in health care raises issues regarding the management of professional boundaries and the relationship among health care providers. This qualitative study explores how roles are constructed within interprofessional health care teams. It focuses on elucidating the different types of role boundaries, the influences on role construction and the implications for professionals and patients.
A comparative case study was conducted to examine the dynamics of role construction on two interprofessional primary health care teams. The data collection included interviews and non-participant observation of team meetings. Thematic content analysis was used to code and analyze the data and a conceptual model was developed to represent the emergent findings.
The findings indicate that role boundaries can be organized around interprofessional interactions (giving rise to autonomous or collaborative roles) as well as the distribution of tasks (giving rise to interchangeable or differentiated roles). Different influences on role construction were identified. They are categorized as structural (characteristics of the workplace), interpersonal (dynamics between team members such as trust and leadership) and individual dynamics (personal attributes). The implications of role construction were found to include professional satisfaction and more favourable wait times for patients. A model that integrates these different elements was developed.
Based on the results of this study, we argue that autonomy may be an important element of interprofessional team functioning. Counter-intuitive as this may sound, we found that empowering team members to develop autonomy can enhance collaborative interactions. We also argue that while more interchangeable roles could help to lessen the workloads of team members, they could also increase the potential for power struggles because the roles of various professions would become less differentiated. We consider the conceptual and practical implications of our findings and we address the transferability of our model to other interprofessional teams.
PMCID: PMC4222600  PMID: 24267663
Role boundaries; Interprofessional collaboration; Influences on role construction; Comparative case study
13.  Eurocan plus report: feasibility study for coordination of national cancer research activities 
The EUROCAN+PLUS Project, called for by the European Parliament, was launched in October 2005 as a feasibility study for coordination of national cancer research activities in Europe. Over the course of the next two years, the Project process organized over 60 large meetings and countless smaller meetings that gathered in total over a thousand people, the largest Europe–wide consultation ever conducted in the field of cancer research.
Despite a strong tradition in biomedical science in Europe, fragmentation and lack of sustainability remain formidable challenges for implementing innovative cancer research and cancer care improvement. There is an enormous duplication of research effort in the Member States, which wastes time, wastes money and severely limits the total intellectual concentration on the wide cancer problem. There is a striking lack of communication between some of the biggest actors on the European scene, and there are palpable tensions between funders and those researchers seeking funds.
It is essential to include the patients’ voice in the establishment of priority areas in cancer research at the present time. The necessity to have dialogue between funders and scientists to establish the best mechanisms to meet the needs of the entire community is evident. A top priority should be the development of translational research (in its widest form), leading to the development of effective and innovative cancer treatments and preventive strategies. Translational research ranges from bench–to–bedside innovative cancer therapies and extends to include bringing about changes in population behaviours when a risk factor is established.
The EUROCAN+PLUS Project recommends the creation of a small, permanent and independent European Cancer Initiative (ECI). This should be a model structure and was widely supported at both General Assemblies of the project. The ECI should assume responsibility for stimulating innovative cancer research and facilitating processes, becoming the common voice of the cancer research community and serving as an interface between the cancer research community and European citizens, patients’ organizations, European institutions, Member States, industry and small and medium enterprises (SMEs), putting into practice solutions aimed at alleviating barriers to collaboration and coordination of cancer research activities in the European Union, and dealing with legal and regulatory issues. The development of an effective ECI will require time, but this entity should be established immediately. As an initial step, coordination efforts should be directed towards the creation of a platform on translational research that could encompass (1) coordination between basic, clinical and epidemiological research; (2) formal agreements of co–operation between comprehensive cancer centres and basic research laboratories throughout Europe and (3) networking between funding bodies at the European level.
The European Parliament and its instruments have had a major influence in cancer control in Europe, notably in tobacco control and in the implementation of effective population–based screening. To make further progress there is a need for novelty and innovation in cancer research and prevention in Europe, and having a platform such as the ECI, where those involved in all aspects of cancer research can meet, discuss and interact, is a decisive development for Europe.
Executive Summary
Cancer is one of the biggest public health crises facing Europe in the 21st century—one for which Europe is currently not prepared nor preparing itself. Cancer is a major cause of death in Europe with two million casualties and three million new cases diagnosed annually, and the situation is set to worsen as the population ages.
These facts led the European Parliament, through the Research Directorate-General of the European Commission, to call for initiatives for better coordination of cancer research efforts in the European Union. The EUROCAN+PLUS Project was launched in October 2005 as a feasibility study for coordination of national cancer research activities. Over the course of the next two years, the Project process organized over 60 large meetings and countless smaller meetings that gathered in total over a thousand people. In this respect, the Project became the largest Europe-wide consultation ever conducted in the field of cancer research, implicating researchers, cancer centres and hospitals, administrators, healthcare professionals, funding agencies, industry, patients’ organizations and patients.
The Project first identified barriers impeding research and collaboration in research in Europe. Despite a strong tradition in biomedical science in Europe, fragmentation and lack of sustainability remain the formidable challenges for implementing innovative cancer research and cancer care improvement. There is an enormous duplication of research effort in the Member States, which wastes time, wastes money and severely limits the total intellectual concentration on the wide cancer problem. There is a striking lack of communication between some of the biggest actors on the European scene, and there are palpable tensions between funders and those researchers seeking funds.
In addition, there is a shortage of leadership, a multiplicity of institutions each focusing on its own agenda, sub–optimal contact with industry, inadequate training, non–existent career paths, low personnel mobility in research especially among clinicians and inefficient funding—all conspiring against efficient collaboration in cancer care and research. European cancer research today does not have a functional translational research continuum, that is the process that exploits biomedical research innovations and converts them into prevention methods, diagnostic tools and therapies. Moreover, epidemiological research is not integrated with other types of cancer research, and the implementation of the European Directives on Clinical Trials 1 and on Personal Data Protection 2 has further slowed the innovation process in Europe. Furthermore, large inequalities in health and research exist between the EU–15 and the New Member States.
The picture is not entirely bleak, however, as the European cancer research scene presents several strengths, such as excellent basic research and clinical research and innovative etiological research that should be better exploited.
When considering recommendations, several priority dimensions had to be retained. It is essential that proposals include actions and recommendations that can benefit all Member States of the European Union and not just States with the elite centres. It is also essential to have a broader patient orientation to help provide the knowledge to establish cancer control possibilities when we exhaust what can be achieved by the implementation of current knowledge. It is vital that the actions proposed can contribute to the Lisbon Strategy to make Europe more innovative and competitive in (cancer) research.
The Project participants identified six areas for which consensus solutions should be implemented in order to obtain better coordination of cancer research activities. The required solutions are as follows. The proactive management of innovation, detection, facilitation of collaborations and maintenance of healthy competition within the European cancer research community.The establishment of an exchange portal of information for health professionals, patients and policy makers.The provision of guidance for translational and clinical research including the establishment of a translational research platform involving comprehensive cancer centres and cancer research centres.The coordination of calls and financial management of cancer research projects.The construction of a ‘one–stop shop’ as a contact interface between the industry, small and medium enterprises, scientists and other stakeholders.The support of greater involvement of healthcare professionals in translational research and multidisciplinary training.
In the course of the EUROCAN+PLUS consultative process, several key collaborative projects emerged between the various groups and institutes engaged in the consultation. There was a collaboration network established with Europe’s leading Comprehensive Cancer Centres; funding was awarded for a closer collaboration of Owners of Cancer Registries in Europe (EUROCOURSE); there was funding received from FP7 for an extensive network of leading Biological Resource Centres in Europe (BBMRI); a Working Group identified the special needs of Central, Eastern and South–eastern Europe and proposed a remedy (‘Warsaw Declaration’), and the concept of developing a one–stop shop for dealing with academia and industry including the Innovative Medicines Initiative (IMI) was discussed in detail.
Several other dimensions currently lacking were identified. There is an absolute necessity to include the patients’ voice in the establishment of priority areas in cancer research at the present time. It was a salutary lesson when it was recognized that all that is known about the quality of life of the cancer patient comes from the experience of a tiny proportion of cancer patients included in a few clinical trials. The necessity to have dialogue between funders and scientists to establish the best mechanisms to meet the needs of the entire community was evident. A top priority should be the development of translational research (in its widest form) and the development of effective and innovative cancer treatments and preventative strategies in the European Union. Translational research ranges from bench-to-bedside innovative cancer therapies and extends to include bringing about changes in population behaviours when a risk factor is established.
Having taken note of the barriers and the solutions and having examined relevant examples of existing European organizations in the field, it was agreed during the General Assembly of 19 November 2007 that the EUROCAN+PLUS Project had to recommend the creation of a small, permanent and neutral ECI. This should be a model structure and was widely supported at both General Assemblies of the project. The proposal is based on the successful model of the European Molecular Biology Organisation (EMBO), and its principal aims include providing a forum where researchers from all backgrounds and from all countries can meet with members of other specialities including patients, nurses, clinicians, funders and scientific administrators to develop priority programmes to make Europe more competitive in research and more focused on the cancer patient.
The ECI should assume responsibility for: stimulating innovative cancer research and facilitating processes;becoming the common voice of the cancer research community and serving as an interface between the cancer research community and European citizens, patients’ and organizations;European institutions, Member States, industry and small and medium enterprises;putting into practice the aforementioned solutions aimed at alleviating barriers and coordinating cancer research activities in the EU;dealing with legal and regulatory issues.
Solutions implemented through the ECI will lead to better coordination and collaboration throughout Europe, more efficient use of resources, an increase in Europe’s attractiveness to the biomedical industry and better quality of cancer research and education of health professionals.
The Project considered that European legal instruments currently available were inadequate for addressing many aspects of the barriers identified and for the implementation of effective, lasting solutions. Therefore, the legal environment that could shelter an idea like the ECI remains to be defined but should be done so as a priority. In this context, the initiative of the European Commission for a new legal entity for research infrastructure might be a step in this direction. The development of an effective ECI will require time, but this should be established immediately. As an initial step, coordination efforts should be directed towards the creation of a platform on translational research that could encompass: (1) coordination between basic, clinical and epidemiological research; (2) formal agreements of co-operation between comprehensive cancer centres and basic research laboratories throughout Europe; (3) networking between funding bodies at the European level. Another topic deserving immediate attention is the creation of a European database on cancer research projects and cancer research facilities.
Despite enormous progress in cancer control in Europe during the past two decades, there was an increase of 300,000 in the number of new cases of cancer diagnosed between 2004 and 2006. The European Parliament and its instruments have had a major influence in cancer control, notably in tobacco control and in the implementation of effective population–based screening. To make further progress there is a need for novelty and innovation in cancer research and prevention in Europe, and having a platform such as the ECI, where those involved in all aspects of cancer research can meet, discuss and interact, is a decisive development for Europe.
PMCID: PMC3234055  PMID: 22274749
14.  Challenges of interprofessional collaboration in Iranian mental health services: A qualitative investigation 
Nurses and other members of health care team provide mental patients with health services through interprofessional collaboration which is a main strategy to improve health services. Nevertheless, many difficulties are evidently influencing interprofessional collaboration in Iranian context. This paper presented the results of a study aimed to explore the context.
Materials and Methods:
A qualitative study was conducted using in-depth interviews to collect data from 20 health professionals and 4 clients or their family members who were selected purposefully from the health centers affiliated with Isfahan University of Medical Sciences. Themes were identified using latent qualitative content analysis. Trustworthiness of the study was supported considering auditability, neutrality, consistency and transferability. The study lasted from 2010 to 2011.
Some important challenges were identified as protecting professional territory, medical oriented approach and teamwork deficits. They were all under a main theme emphasizing professionals’ divergent views. It could shed insight into underlying causes of collaboration gaps among nurses and other health professionals.
The three introduced themes implied difficulties mainly related to divergences among health professionals. Moreover, the difficulties revealed the need for training chiefly to improve their convergent shared views and approaches. Therefore, it is worthwhile to suggest interprofessional education for nurses and other professionals with special attention to improving interpersonal skills as well as mental health need-based services.
PMCID: PMC3696970  PMID: 23833601
Mental health services; interprofessional collaboration; challenges; Iran
15.  Factors influencing communication and decision-making about life-sustaining technology during serious illness: a qualitative study 
BMJ Open  2016;6(5):e010451.
We aimed to identify factors influencing communication and decision-making, and to learn how physicians and nurses view their roles in deciding about the use of life-sustaining technology for seriously ill hospitalised patients and their families.
The qualitative study used Flanagan's critical incident technique to guide interpretive description of open-ended in-depth individual interviews.
Participants were recruited from the medical wards at 3 Canadian hospitals.
Interviews were completed with 30 healthcare professionals (9 staff physicians, 9 residents and 12 nurses; aged 25–63 years; 73% female) involved in decisions about the care of seriously ill hospitalised patients and their families.
Participants described encounters with patients and families in which communication and decision-making about life-sustaining technology went particularly well and unwell (ie, critical incidents). We further explored their roles, context and challenges. Analysis proceeded using constant comparative methods to form themes independently and with the interprofessional research team.
We identified several key factors that influenced communication and decision-making about life-sustaining technology. The overarching factor was how those involved in such communication and decision-making (healthcare providers, patients and families) conceptualised the goals of medical practice. Additional key factors related to how preferences and decision-making were shaped through relationships, particularly how people worked toward ‘making sense of the situation’, how physicians and nurses approached the inherent and systemic tensions in achieving consensus with families, and how physicians and nurses conducted professional work within teams. Participants described incidents in which these key factors interacted in dynamic and unpredictable ways to influence decision-making for any particular patient and family.
A focus on more meaningful and productive dialogue with patients and families by (and between) each member of the healthcare team may improve decisions about life-sustaining technology. Work is needed to acknowledge and support the non-curative role of healthcare and build capacity for the interprofessional team to engage in effective decision-making discussions.
PMCID: PMC4885276  PMID: 27217281
Decision-making; End-of-life; Hospital; Advanced Illness; Aging; Patient Involvement
16.  What influences patient decision-making in amyotrophic lateral sclerosis multidisciplinary care? A study of patient perspectives 
Patients with amyotrophic lateral sclerosis (ALS) are required to make decisions concerning quality of life and symptom management over the course of their disease. Clinicians perceive that patients’ ability to engage in timely decision-making is extremely challenging. However, we lack patient perspectives on this issue. This study aimed to explore patient experiences of ALS, and to identify factors influencing their decision-making in the specialized multidisciplinary care of ALS.
An exploratory study was conducted. Fourteen patients from two specialized ALS multidisciplinary clinics participated in semistructured interviews that were audio recorded and transcribed. Data were analyzed for emergent themes.
Decision-making was influenced by three levels of factors, ie, structural, interactional, and personal. The structural factor was the decision-making environment of specialized multidisciplinary ALS clinics, which supported decision-making by providing patients with disease-specific information and specialized care planning. Interactional factors were the patient experiences of ALS, including patients’ reaction to the diagnosis, response to deterioration, and engagement with the multidisciplinary ALS team. Personal factors were patients’ personal philosophies, including their outlook on life, perceptions of control, and planning for the future. Patient approaches to decision-making reflected a focus on the present, rather than anticipating future progression of the disease and potential care needs.
Decision-making for symptom management and quality of life in ALS care is enhanced when the patient’s personal philosophy is supported by collaborative relationships between the patient and the multidisciplinary ALS team. Patients valued the support provided by the multidisciplinary team; however, their focus on living in the present diverged from the efforts of health professionals to prepare patients and their carers for the future. The challenge facing health professionals is how best to engage each patient in decision-making for their future needs, to bridge this gap.
PMCID: PMC3514070  PMID: 23226006
consumer perspectives; patient decision-making; multidisciplinary care; amyotrophic lateral sclerosis
17.  Combining administrative data feedback, reflection and action planning to engage primary care professionals in quality improvement: qualitative assessment of short term program outcomes 
Improving primary care for chronic disease management requires a coherent, integrated approach to quality improvement. Evidence in the continuing professional development (CPD) field suggests the importance of using strategies such as feedback delivery, reflective practice and action planning to facilitate recognition of gaps and service improvement needs. Our study explored the outcomes of a CPD intervention, named the COMPAS Project, which consists of a three-hour workshop composed of three main activities: feedback, critical reflection and action planning. The feedback intervention is delivered face-to-face and presents performance indicators extracted from clinical-administrative databases. This aim of this study was to assess the short term outcomes of this intervention to engage primary care professional in continuous quality improvement (QI).
In order to develop an understanding of our intervention and of its short term outcomes, a program evaluation approach was used. Ten COMPAS workshops on diabetes management were directly observed and qualitative data was collected to assess the intervention short term outcomes. Data from both sources were combined to describe the characteristics of action plans developed by professionals. Two independent coders analysed the content of these plans to assess if they promoted engagement in QI and interprofessional collaboration.
During the ten workshops held, 26 interprofessional work teams were formed. Twenty-two of them developed a QI project they could implement themselves and that targeted aspects of their own practice they perceived in need of change. Most frequently prioritized strategies for change were improvement of systematic clientele follow-up, medication compliance, care pathway and support to improve adoption of healthier life habits. Twenty-one out of 22 action plans were found to target some level of improvement of interprofessional collaboration in primary care.
Our study results demonstrate that the COMPAS intervention enabled professionals to target priorities for practice improvements and to develop action plans that promote interprofessional collaboration. The COMPAS intervention aims to increase capability for continuous QI, readiness to implement process of care changes and team shared goals but available resources, climate and culture for change and leadership, are also important required conditions to successfully implement these practice changes.
We think that the proposed approach can be very useful to support and engage primary care professionals in the planning stage of quality improvement projects since it combines key successful ingredients: feedback, reflection and planning of action.
Electronic supplementary material
The online version of this article (doi:10.1186/s12913-015-1056-0) contains supplementary material, which is available to authorized users.
PMCID: PMC4574571  PMID: 26384648
Quality improvement; Primary care; Interprofessional collaboration; Continuing professional development; Chronic disease management; Administrative data; Reflection; Action planning
18.  Educational role of nurse practitioners in a family practice centre 
Canadian Family Physician  2014;60(6):e316-e321.
To examine the role of nurse practitioners (NPs) as educators of family medicine residents in order to better understand the interprofessional educational dynamics in a clinical teaching setting.
A qualitative descriptive approach, using purposive sampling.
A family practice centre that is associated with an academic department of family medicine and is based in an urban area in southern Ontario.
First-year (8 of 9) and second-year (9 of 10) family medicine residents whose training program was based at the family practice centre, and all NPs (4 of 4) who worked at the centre.
Semistructured interviews were conducted, which were audiotaped and transcribed. An iterative approach was used for coding and analysis. Data management software guided organization and analysis of the data.
Main findings
Four interconnected themes were identified: role clarification, professional identity formation, factors that enhance the educational role of NPs, and factors that limit the educational role of NPs. Although residents recognized NPs’ value in team functioning and areas of specialized knowledge, they were unclear about NPs’ scope of practice. Depending on residents’ level of training, residents tended to respond differently to teaching by NPs. More of the senior residents believed they needed to think like physicians and preferred clinical teaching from physician teachers. Junior residents valued the step-by-step instructional approach used by NPs, and they had a decreased sense of vulnerability when being taught by NPs. Training in teaching skills was helpful for NPs. Barriers to providing optimal education included opportunity, time, and physician attitudes.
The lack of an intentional orientation of family medicine residents to NPs’ scope of practice and educational role can lead to difficulties in interprofessional education. More explicit recognition of the evolving professional identity of family medicine residents might decrease resistance to teaching by NPs and ensure that interprofessional teaching and learning strategies are effective. Faculty development opportunities for all educators are required to manage these issues, both to ensure teaching competencies and to reinforce positive interprofessional collaboration.
PMCID: PMC4055343  PMID: 24925966
19.  The integration of occupational therapy into primary care: a multiple case study design 
BMC Family Practice  2013;14:60.
For over two decades occupational therapists have been encouraged to enhance their roles within primary care and focus on health promotion and prevention activities. While there is a clear fit between occupational therapy and primary care, there have been few practice examples, despite a growing body of evidence to support the role. In 2010, the province of Ontario, Canada provided funding to include occupational therapists as members of Family Health Teams, an interprofessional model of primary care. The integration of occupational therapists into this model of primary care is one of the first large scale initiatives of its kind in North America. The objective of the study was to examine how occupational therapy services are being integrated into primary care teams and understand the structures supporting the integration.
A multiple case study design was used to provide an in-depth description of the integration of occupational therapy. Four Family Health Teams with occupational therapists as part of the team were identified. Data collection included in-depth interviews, document analyses, and questionnaires.
Each Family Health Team had a unique organizational structure that contributed to the integration of occupational therapy. Communication, trust and understanding of occupational therapy were key elements in the integration of occupational therapy into Family Health Teams, and were supported by a number of strategies including co-location, electronic medical records and team meetings. An understanding of occupational therapy was critical for integration into the team and physicians were less likely to understand the occupational therapy role than other health providers.
With an increased emphasis on interprofessional primary care, new professions will be integrated into primary healthcare teams. The study found that explicit strategies and structures are required to facilitate the integration of a new professional group. An understanding of professional roles, trust and communication are foundations for interprofessional collaborative practice.
PMCID: PMC3663696  PMID: 23679667
Inteprofessional primary care; Collaboration; Family health teams; Multiple case study design; Occupational therapy; Integration
20.  Exploring successful community pharmacist-physician collaborative working relationships using mixed methods 
Collaborative working relationships (CWRs) between community pharmacists and physicians may foster the provision of medication therapy management services, disease state management, and other patient care activities; however, pharmacists have expressed difficulty in developing such relationships. Additional work is needed to understand the specific pharmacist-physician exchanges that effectively contribute to the development of CWR. Data from successful pairs of community pharmacists and physicians may provide further insights into these exchange variables and expand research on models of professional collaboration.
To describe the professional exchanges that occurred between community pharmacists and physicians engaged in successful CWRs, using a published conceptual model and tool for quantifying the extent of collaboration.
A national pool of experts in community pharmacy practice identified community pharmacists engaged in CWRs with physicians. Five pairs of community pharmacists and physician colleagues participated in individual semistructured interviews, and 4 of these pairs completed the Pharmacist-Physician Collaborative Index (PPCI). Main outcome measures include quantitative (ie, scores on the PPCI) and qualitative information about professional exchanges within 3 domains found previously to influence relationship development: relationship initiation, trustworthiness, and role specification.
On the PPCI, participants scored similarly on trustworthiness; however, physicians scored higher on relationship initiation and role specification. The qualitative interviews revealed that when initiating relationships, it was important for many pharmacists to establish open communication through face-to-face visits with physicians. Furthermore, physicians were able to recognize in these pharmacists a commitment for improved patient care. Trustworthiness was established by pharmacists making consistent contributions to care that improved patient outcomes over time. Open discussions regarding professional roles and an acknowledgment of professional norms (ie, physicians as decision makers) were essential.
The findings support and extend the literature on pharmacist-physician CWRs by examining the exchange domains of relationship initiation, trustworthiness, and role specification qualitatively and quantitatively among pairs of practitioners. Relationships appeared to develop in a manner consistent with a published model for CWRs, including the pharmacist as relationship initiator, the importance of communication during early stages of the relationship, and an emphasis on high-quality pharmacist contributions.
PMCID: PMC3004536  PMID: 21111388
Pharmacists; Physicians; Collaborative working relationships; Pharmacist-physician collaborative index; Community
21.  External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change 
Facilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors.
We carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics.
A non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors.
Facilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams.
Electronic supplementary material
The online version of this article (doi:10.1186/s13012-016-0458-7) contains supplementary material, which is available to authorized users.
PMCID: PMC4947272  PMID: 27424171
Facilitation; Facilitation team; Change agent; Roles; Change implementation; Dynamics
22.  Primary Care Research Team Assessment (PCRTA): development and evaluation. 
BACKGROUND: Since the early 1990s the United Kingdom (UK) Department of Health has explicitly promoted a research and development (R&D) strategy for the National Health Service (NHS). General practitioners (GPs) and other members of the primary care team are in a unique position to undertake research activity that will complement and inform the research undertaken by basic scientists and hospital-based colleagues and lead directly to a better evidence base for decision making by primary care professionals. Opportunities to engage in R&D in primary care are growing and the scope for those wishing to become involved is finally widening. Infrastructure funding for research-active practices and the establishment of a range of support networks have helped to improve the research capacity and blur some of the boundaries between academic departments and clinical practice. This is leading to a supportive environment for primary care research. There is thus a need to develop and validate nationally accepted quality standards and accreditation of performance to ensure that funders, collaborators and primary care professionals can deliver high quality primary care research. Several strategies have been described in national policy documents in order to achieve an improvement in teaching and clinical care, as well as enhancing research capacity in primary care. The development of both research practices and primary care research networks has been recognised as having an important contribution to make in enabling health professionals to devote more protected time to undertake research methods training and to undertake research in a service setting. The recognition and development of primary care research has also brought with it an emphasis on quality and standards, including an approach to the new research governance framework. PRIMARY CARE RESEARCH TEAM ASSESSMENT: In 1998, the NHS Executive South and West, and later the London Research and Development Directorate, provided funding for a pilot project based at the Royal College of General Practitioners (RCGP) to develop a scheme to accredit UK general practices undertaking primary care R&D. The pilot began with initial consultation on the development of the process, as well as the standards and criteria for assessment. The resulting assessment schedule allowed for assessment at one of two levels: Collaborative Research Practice (Level I), with little direct experience of gaining project or infrastructure funding Established Research Practice (Level II), with more experience of research funding and activity and a sound infrastructure to allow for growth in capacity. The process for assessment of practices involved the assessment of written documentation, followed by a half-day assessment visit by a multidisciplinary team of three assessors. IMPLEMENTATION--THE PILOT PROJECT: Pilot practices were sampled in two regions. Firstly, in the NHS Executive South West Region, where over 150 practices expressed an interest in participating. From these a purposive sample of 21 practices was selected, providing a range of research and service activity. A further seven practices were identified and included within the project through the East London and Essex Network of Researchers (ELENoR). Many in this latter group received funding and administrative support and advice from ELENoR in order to prepare written submissions for assessment. Some sample loss was encountered within the pilot project, which was attributable largely to conflicting demands on participants' time. Indeed, the preparation of written submissions within the South West coincided with the introduction of primary care groups (PCGs) in April 1999, which several practices cited as having a major impact on their participation in the pilot project. A final sample of 15 practices (nine in the South West and six through ELENoR) underwent assessment through the pilot project. EVALUATION: A formal evaluation of the Primary Care Research Team Assessment (PCRTA) pilot was undertaken by an independent researcher (FM). This was supplemented with feedback from the assessment team members. The qualitative aspect of the evaluation, which included face-to-face and telephone interviews with assessors, lead researchers and other practice staff within the pilot research practices, as well as members of the project management group, demonstrated a positive view of the pilot scheme. Several key areas were identified in relation to particular strengths of research practices and areas for development including: Strengths Level II practices were found to have a strong primary care team ethos in research. Level II practices tended to have a greater degree of strategic thinking in relation to research. Development areas Level I practices were found to lack a clear and explicit research strategy. Practices at both levels had scope to develop their communication processes for dissemination of research and also for patient involvement. Practices at both levels needed mechanisms for supporting professional development in research methodology. The evaluation demonstrated that practices felt that they had gained from their participation and assessors felt that the scheme had worked well. Some specific issues were raised by different respondents within the qualitative evaluation relating to consistency of interpretation of standards and also the possible overlap of the assessment scheme with other RCGP quality initiatives. NATIONAL IMPLEMENTATION OF THE PRIMARY CARE RESEARCH TEAM ASSESSMENT: The pilot project has been very successful and recommendations have been made to progress to a UK scheme. Management and review of the scheme will remain largely the same, with a few changes focusing on the assessment process and support for practices entering the scheme. Specific changes include: development of the support and mentoring role of the primary care research networks increased peer and external support and mentoring for research practices undergoing assessment development of assessor training in line with other schemes within the RCGP Assessment Network work to ensure consistency across RCGP accreditation schemes in relation to key criteria, thereby facilitating comparable assessment processes refinement of the definition of the two groups, with Level I practices referred to as Collaborators and Level II practices as Investigator-Led. The project has continued to generate much enthusiasm and support and continues to reflect current policy. Indeed, recent developments include the proposed new funding arrangements for primary care R&D, which refer to the RCGP assessment scheme and recognise it as a key component in the future R&D agenda. The assessment scheme will help primary care trusts (PCTs) and individual practices to prepare and demonstrate their approach to research governance in a systematic way. It will also provide a more explicit avenue for primary care trusts to explore local service and development priorities identified within health improvement programmes and the research priorities set nationally for the NHS.
PMCID: PMC2560501  PMID: 12049028
23.  Social Interaction and Collaboration among Oncology Nurses 
Nursing Research and Practice  2015;2015:248067.
Collaboration is a complex process influenced by organizational, professional, interpersonal, and personal factors. Research has demonstrated that collaboration may also be influenced by social factors. Nurses spend much of their time working in collaborative teams, yet little is known about how they socially interact in practice. This qualitative case study explored nurse perceptions of social interaction in relation to collaboration. Data were collected using telephone interviews and documentary reviews from fourteen oncology nurses employed at one cancer center in Canada. Thematic analysis revealed two themes: knowing you is trusting you and formal and informal opportunities. Nurses reported that social interaction meant getting to know someone personally as well as professionally. Social interaction was enacted inside of work during breaks/meals and outside of work at planned events. Social interaction was facilitated by having a long-term current and/or previous professional and personal relationship. The barriers to social interaction included a lack of time to get to know each other, workload issues, and poor interpersonal skills. Findings suggest that social interaction is an important factor in the collaborative relationship among oncology nurses. Nurse leaders need to promote social interaction opportunities and facilitate educational sessions to improve social and interpersonal skills.
PMCID: PMC4465712  PMID: 26113993
24.  Perceptions of Approved Clinical Instructors: Barriers in the Implementation of Evidence-Based Practice 
Journal of Athletic Training  2013;48(3):382-393.
As evidence-based practice (EBP) becomes prevalent in athletic training education, the barriers that Approved Clinical Instructors (ACIs) experience in implementing it with students need to be understood.
To investigate barriers ACIs face when implementing EBP concepts in clinical practice and in teaching EBP to professional athletic training students and to investigate the educational emphases to improve the barriers.
Qualitative study.
Telephone interviews.
Patients or Other Participants:
Sixteen ACIs (11 men, 5 women; experience as an athletic trainer = 10 ± 4.7 years, experience as an ACI = 6.81 ± 3.9 years) were interviewed.
Data Collection and Analysis:
We interviewed each participant by telephone. Interview data were analyzed and coded for common themes and subthemes regarding barriers and educational emphases. Themes were triangulated through multiple-analyst triangulation and interpretive verification.
Barriers to EBP incorporation and educational emphasis placed on EBP were the main themes reported. Resources, personnel, and student characteristics were subthemes identified as barriers. Resource barriers included time, equipment, access to current literature, and knowledge. Coworkers, clinicians, and coaches who were unwilling to accept evidence regarding advancements in treatment were identified as personnel barriers. Programmatic improvement and communication improvement were subthemes of the educational emphasis placed on EBP theme. The ACIs reported the need for better integration between the clinical setting and the classroom and expressed the need for EBP to be integrated throughout the athletic training education program.
Integration of the classroom and clinical experience is important in advancing ACIs' use of EBP with their students. Collaborative efforts within the clinical and academic program could help address the barriers ACIs face when implementing EBP. This collaboration could positively affect the ability of ACIs to implement EBP within their clinical practices.
PMCID: PMC3655752  PMID: 23675798
education; curricular integration; collaboration
25.  What influences seniors’ choice of medications for osteoarthritis? 
Canadian Family Physician  2006;52(3):343.
To explore with seniors what influences their choice of medication for osteoarthritis.
Qualitative study using semistructured in-depth interviews.
Interviews were conducted in patients’ homes in two cities in Nova Scotia.
Seniors with a physician-confirmed diagnosis of osteoarthritis.
Interviews were audiotaped and transcribed verbatim. A grounded-theory approach was used. Key words and phrases were identified independently by all members of the research team who then collectively grouped the data into conceptual categories.
Four themes emerged from discussions about medication choices: the role of family physicians in influencing use of cyclooxygenase-2 inhibitors, the effect of fear of making medication choices, the reasons for discontinuing cyclooxygenase-2 inhibitors, and views on other information sources. Distribution of free samples, family physicians’ recommendations, and fear of side effects influenced seniors’ choices of osteoarthritis medications. They claimed not to be influenced by direct-to-consumer advertising or the fact that cyclooxygenase-2 inhibitors are more expensive than other classes of drugs for osteoarthritis.
Because seniors’ choice of medications for osteoarthritis is often influenced by physicians’ recommendations and distribution of free samples, further research into how distribution of free samples affects medication choices in family practice is needed.
PMCID: PMC1479710  PMID: 16926961

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