ORCID Profile
0000-0002-9312-0874
Current Organisation
Queen's University
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Publisher: Canadian Urological Association Journal
Date: 16-12-2017
DOI: 10.5489/CUAJ.4791
Abstract: Introduction: Use of chemotherapy for muscle-invasive bladder cancer (MIBC) is known to be low. To understand factors driving practice we use the Theoretical Domains Framework (TDF) to identify barriers and enablers of chemotherapy use.Methods: A convenience s le of Canadian urologists, medical oncologists (MOs), and radiation oncologists (ROs) participated in in idual, semi-structured, one-hour telephone interviews. An interview guide was developed using the TDF to assess potential barriers and enablers of chemotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation.Results: A total of 71 physicians were invited to participate and 34 (48%) agreed to be interviewed: 13 urologists, 10 MOs, and 11 ROs. We identified the following barriers to the use of chemotherapy (relevant TDF domains in parentheses): 1) belief that the benefits of chemotherapy are not clinically important (beliefs about consequences) 2) inadequate multidisciplinary collaboration (environmental context and resources) 3) absence of “ch ions” advocating the use of chemotherapy (social and professional role) and 4) a lack of organizational clarity olicy regarding the referral process (environmental context and resources). The predominant enablers identified included: 1) “ch ions” who believe in the value of chemotherapy (social and professional role) 2) urologists who refer all patients to MO (behavioural regulation memory, attention, and decision-making) and 3) system-level factors, including automatic multidisciplinary referral (environmental context and resources).Conclusions: We have identified several system-level factors associated with delivery of chemotherapy. Behaviour change interventions should optimize multidisciplinary care of patients with MIBC.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2020
DOI: 10.1097/ACM.0000000000003085
Abstract: While ideal curricular structures for effective teaching of evidence-based medicine (EBM) have not been definitively determined, optimal strategies ensure that EBM teaching is interactive and clinically based, aligns with major trends in education and health care, and uses longitudinally integrated, whole-task activities. The authors developed a longitudinal, semester-long project, embedded in a first-year medicine course, through which they taught EBM using Wikipedia as a platform. Students worked in idually and in small groups to choose a medicine-related Wikipedia article, identify information gaps, search for high-quality resources, appraise the sources, and incorporate the new information into the article (i.e., by editing Wikipedia). Students also applied their new appraisal skills to critique a second article. The authors used an online tool to track and record student editing, and they obtained qualitative data on student perceptions of the project via survey. Duplicate marking of a s le of assignments was performed using the Valid Assessment of Learning in Undergraduate Education critical thinking rubric developed by Finley and Rhodes. In fall 2017, 101 students made over 1,000 unique edits to 16 online Wikipedia articles, adding over 10,000 words. Through thematic analysis of qualitative data, the authors highlighted several aspects of the project that students appreciated, as well as barriers related to completing their projects. Correlation of the 17 consenting students’ final assignments with the critical thinking rubric supports the assignment structure as a tool for assessing critical thinking. This authentic task adheres to the principles of high-quality EBM instruction and could be implemented by a variety of health care educational programs. Modifications to the delivery model are underway to address challenges identified.
Publisher: MDPI AG
Date: 06-2015
DOI: 10.3747/CO.22.2277
Abstract: There is a clear evidence-to-practice gap in bladder cancer care. [...]
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.CLON.2017.09.001
Abstract: Bladder-sparing radiotherapy for muscle-invasive bladder cancer (MIBC) may be underutilised in North America. To understand factors driving practice we used the Theoretical Domains Framework (TDF) to identify barriers and enablers of bladder-sparing radiotherapy utilisation. A convenience s le of Canadian urologists, medical oncologists and radiation oncologists participated in in idual semi-structured 1 h interviews. An interview guide was developed using the TDF to assess barriers and enablers of bladder-sparing radiotherapy use. Interviews were recorded and transcribed. Two investigators independently identified barriers and enablers and assigned them to specific themes. Participant recruitment continued until saturation. In total, 71 physicians were invited to participate and 34 (48%) agreed to be interviewed 13 urologists, 11 radiation oncologists and 10 medical oncologists. We identified the following barriers to the use of bladder-sparing radiotherapy (relevant TDF domains in parentheses): (1) beliefs that radiotherapy has inferior survival compared with cystectomy (beliefs about consequences) (2) lack of referral from urology to radiation oncology (behavioural regulation memory, attention and decision-making) (3) lack of 'ch ions' who advocate for radiotherapy (social and professional role) and (4) inadequate multidisciplinary collaboration (environmental context and resources). Predominant enablers to the use of bladder-sparing radiotherapy included: (1) 'ch ions' who believe in the value of radiotherapy (social and professional role) (2) beliefs by urologists that radiation oncologists should present radiotherapy options to all patients (social and professional role) (3) institutional policy that all MIBC patients should be seen by multiple specialists (environmental context and resources) (4) system facilitators of radiation oncology referral (i.e. nurse navigator) (environmental context and resources) and (5) patient-driven consultations seeking alternatives to cystectomy (social influences). These findings identify important barriers and enablers to the use of bladder-sparing radiotherapy in MIBC. Physician beliefs, access to multidisciplinary care and institutional context should be considered in efforts to increase the use of bladder-sparing radiotherapy.
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.RADONC.2017.08.036
Abstract: To understand barriers and enablers to use of curative-intent radiotherapy (RT) for muscle-invasive bladder cancer using the Theoretical Domains Framework (TDF). Canadian urologists, radiation oncologists (ROs) and medical oncologists (MOs) participated in a web-based survey to assess barriers and enablers to use of RT. Survey questions were thematically mapped to TDF domains. Logistic regression was used to identify TDF domains associated with high referral/use of RT. 64 urologists, 29 ROs and 26 MOs participated. Participants reported comparable survival at five years with cystectomy (51%) and RT with concurrent chemotherapy (50%). Despite this, participants reported low RT referral/treatment rates: Urologists referred a median of 2/10 patients to RO ROs treated a median of 5/10 patients referred and MOs referred a median of 2/8 patients not referred to RO by urology. Among urologists, the TDF domains 'beliefs about consequences' (OR=8.1, 95% CI 1.5-44.9), 'social and professional role' (OR=11.2, 95% CI 2.3-53.6) and 'environmental context and resources' (OR=5.9, 95% CI 1.5-23.3) were associated with higher rates of RO referral. We have identified factors associated with referral for RT among patients with bladder cancer. These factors should be addressed as part of a concerted effort to increase utilization of RT.
No related grants have been discovered for Melanie Walker.