Tracy Robinson

New Approaches to Continuing Medical Education: a QStream (spaced education) Program for Research Translation in Ovarian Cancer.

Continuing medical education (CME) is challenging and often has limited impact on clinician behavior or patient outcomes. This study examined the impact of an online Qstream education program on senior clinicians to determine its utility for increasing clinician knowledge about the latest guidelines regarding genetic assessment and consideration of genetic testing for women with particular types of ovarian, fallopian tube and primary peritoneal cancer. Participants were recruited into a pilot study that involved responding to case-based scenarios at spaced and repeated intervals. At the completion of the program, semi-structured interviews were conducted to ascertain the impact on their knowledge and referral behavior. Findings from interviews were subject to thematic analysis that involved the identification of categories and themes. Twenty-one participants commenced the program, seventeen completed and twelve participated in semi-structured interviews. Thematic analysis yielded several themes including knowledge change, curriculum and format and changes in referral patterns. A majority of participants (n = 10) agreed the program had helped update their knowledge about referring women, and eight agreed they would now change their referral patterns. The use of QStream as an approach to CME has significant advantages when working with busy clinicians. QStream has a well accepted format and most participants indicated it is very appropriate for disseminating updates to clinical guidelines and protocols. It is important to supplement CME programs with other implementation techniques, such as audit and feedback as multifaceted approaches are more likely to result in behavior change.

Rural and Remote Perspectives on Disability and Mental Health Research in Australia: 2000-2013

The Audit of Disability Research in Australia (hereafter the Audit) identified research about people with disabilities, including psychosocial disability, and their families and carers living in Australia. The Audit covered both scientific and grey literature published in Australia between the years 2000–2013. Because the National Disability Research and Development Agenda (Disability Policy and Research Working Group, 2011) identified four cohorts that experience particular disadvantage, including Aboriginal and Torres Strait Islander people, women with disabilities, those from culturally and linguistically diverse backgrounds and those living in rural and remote Australia, the Audit included a search based on geography. This paper reports on studies identified in the Audit that address disability and mental illness in the rural and remote context. In the literature unclear and overlapping definitions of mental illness and psychosocial disability were considerable challenges for the reviewers and these difficulties may potentially impact on how psychosocial disability is conceptualised. Of particular concern is the scant research that reflects the experiences of, and issues faced by, people living with disability and mental illness in rural and remote Australia.

Everybody wants it done but nobody wants to do it: an exploration of the barrier and enablers of critical components towards creating a clinical pathway for anxiety and depression in cancer

BackgroundThis study aimed to explore barriers to and enablers for future implementation of a draft clinical pathway for anxiety and depression in cancer patients in the Australian context.MethodsHealth professionals reviewed a draft clinical pathway and participated in qualitative interviews about the delivery of psychosocial care in their setting, individual components of the draft pathway, and barriers and enablers for its future implementation.ResultsFive interrelated themes were identified: ownership; resources and responsibility; education and training; patient reluctance; and integration with health services beyond oncology.ConclusionsThe five themes were perceived as both barriers and enablers and provide a basis for an implementation plan that includes strategies to overcome barriers. The next steps are to design and deliver the clinical pathway with specific implementation strategies that address team ownership, endorsement by leaders, education and training modules designed for health professionals and patients and identify ways to integrate the pathway into existing cancer services.

The evaluation of an online orientation to rural mental health practice in Australia

The aim of this study was to develop and evaluate an online, interprofessional education programme for clinicians commencing work in rural mental health services in New South Wales, Australia. Twenty-eight participants, including nurses, psychologists, social workers and occupational therapists, completed a 24-week education programme (Introduction to Rural Mental Health Practice programme) that orientated clinicians to working in rural settings. The online programme included an orientation to online learning and clinical skills such as risk assessment, therapeutic communication and de-escalation skills applied in rural settings. Twenty-four participants provided pre- and post-evaluation responses that were matched and analysed using paired t-tests to identify any significant differences in mean scores across the domains of interest. Fifty per cent (n= 13) of participants had a background in nursing and 49% were allied health clinicians (psychologists, social workers and occupational therapists). Statistically significant improvements (P < 0.05) were detected in participant confidence in responding to common mental health problems, knowledge about the role of different services in rural mental health care, perceived safety of work and perceived self-efficacy in dealing with challenging or aggressive behaviours. The Introduction to Rural Mental Health Practice programme was successful in orienting clinicians to rural mental health but the small sample size highlights the need to evaluate the programme with a larger cohort of rural clinicians. The attrition at the early stages of the study highlights significant challenges in the retention of rural clinicians in online education programmes. Factors that promoted participation and retention included the provision of study leave and orientation to the online environment.

Collaborative research networks in health: a pragmatic scoping study for the development of an imaging network

BackgroundCollaborative research networks are often touted as a solution for enhancing the translation of knowledge, but questions remain about how to evaluate their impact on health service delivery. This pragmatic scoping study explored the enabling factors for developing and supporting a collaborative imaging network in a metropolitan university in Australia.MethodsAn advisory group was established to provide governance and to identify key informants and participants. Focus group discussions (n = 2) and semi-structured interviews (n = 22) were facilitated with representatives from a broad range of disciplines. In addition, a survey, a review of relevant websites (n = 15) and a broad review of the literature were undertaken to elicit information on collaborative research networks and perceived needs and factors that would support their involvement in a multi-disciplinary collaborative research network. Findings were de-identified and broad themes were identified.ResultsParticipants identified human factors as having priority for developing and sustaining a collaborative research network. In particular, leadership, a shared vision and a communication plan that includes social media were identified as crucial for sustaining an imaging network in health research. It is important to develop metrics that map relationships between network members and the role that communication tools can contribute to this process.ConclusionsThis study confirms that human factors remain significant across a range of collaborative endeavours. The use of focus group discussions, interviews, and literature and website reviews means we can now strongly recommend the primacy of human factors. More work is needed to identify how the network operates and what specific indicators or metrics help build the capacity of clinicians and scientists to participate in translational research.

Embedding continuous quality improvement processes in multidisciplinary teams in cancer care: exploring the boundaries between quality and implementation science

Objective The aim of the present study was to identify key enabling factors for engaging multidisciplinary teams (MDTs) in cancer care across the spectrum of translational research and quality improvement (QI) projects. Methods The study was conducted in two large Sydney metropolitan hospitals. Qualitative methods, including structured observations of MDT meetings and semi-structured interviews with MDT leaders and champions, were used to identify how teams interact with and generate research and implementation initiatives. Enabling factors for and barriers to the engagement of MDTs in translational research and QI were identified. Results Four key enabling factors emerged from the analysis of data generated from observing 43 MDT meetings and 18 semi-structured interviews: (1) access to high-quality data around individual and team performance; (2) research-active team leaders; (3) having experts, such as implementation scientists, embedded into teams; and (4) having dedicated research or QI-focused meetings. Barriers included a lack of time, administrative support, research expertise and access to real-time data. Conclusions The identification of enabling factors for and barriers to translational research and QI provides evidence for how multidisciplinary cancer care teams may best be engaged in research and QI that aims to improve service and care outcomes. What is known about the topic? MDTs are key to the delivery of cancer care in Australia, but there is scant research into how teams can best be engaged in translating research from basic science through to implementation science and QI. What does this paper add? This paper provides new evidence from an immersive study of cancer care MDTs in two large metropolitan hospitals in Sydney (NSW, Australia), regarding the key enabling factors for and barriers to successful engagement in translational research and QI in cancer care. What are the implications for practitioners? Cancer care professionals in MDTs are presented with an opportunity to embed translational research and QI into cancer care. MDTs can operate as an ideal vehicle to look beyond individual patient outcomes to broader trends and population health outcomes.

An integrative review of the psychosocial facilitators and challenges of continuous subcutaneous insulin infusion therapy in type 1 diabetes

AIM To use systematic methods to explore the psychosocial facilitators and challenges of insulin pump therapy among people with type 1 diabetes. BACKGROUND Insulin pump therapy is now widely accepted in the management of type 1 diabetes. Given the increasing use of insulin pumps, it is timely to review the evidence relating to the psychosocial impacts of this therapy which have not been addressed in previous reviews. DESIGN An integrative review of the literature (January 2005-February 2017). DATA SOURCES A systematic search of electronic databases: CINAHL, Cochrane, Medline, PsycINFO and Scopus. REVIEW METHODS Empirical literature reporting psychosocial facilitators and challenges of insulin pump therapy were eligible for inclusion. A constant comparative method was used to guide the review. Quality appraisal was performed using the Mixed Methods Appraisal Tool Version 2011. RESULTS Thirty-five potential articles identified from titles and abstracts were reviewed. Of these, 13 articles were included in the final review. Psychosocial facilitators of insulin pump therapy included the flexibility and freedom it provided for living with diabetes, enhancing social situations and daily management. In contrast, challenges included the demands of pump therapy, self-consciousness in wearing the pump and fear of hypoglycaemia and pump failure. CONCLUSION Findings can be used by health professionals to inform people embarking on insulin pump therapy and prepare them with regard to expectations of the treatment. Further research is required to explore the role of diabetes health professional in providing psychosocial support to people with type 1 diabetes on insulin pump therapy.

The Sydney West Knowledge Portal: Evaluating the Growth of a Knowledge Portal to Support Translational Research

Background The Sydney West Translational Cancer Research Centre is an organization funded to build capacity for translational research in cancer. Translational research is essential for ensuring the integration of best available evidence into practice and for improving patient outcomes. However, there is a low level of awareness regarding what it is and how to conduct it optimally. One solution to addressing this gap is the design and deployment of web-based knowledge portals to disseminate new knowledge and engage with and connect dispersed networks of researchers. A knowledge portal is an web-based platform for increasing knowledge dissemination and management in a specialized area. Objective To measure the design and growth of an web-based knowledge portal for increasing individual awareness of translational research and to build organizational capacity for the delivery of translational research projects in cancer. Methods An adaptive methodology was used to capture the design and growth of an web-based knowledge portal in cancer. This involved stakeholder consultations to inform initial design of the portal. Once the portal was live, site analytics were reviewed to evaluate member usage of the portal and to measure growth in membership. Results Knowledge portal membership grew consistently for the first 18 months after deployment, before leveling out. Analysis of site metrics revealed members were most likely to visit portal pages with community-generated content, particularly pages with a focus on translational research. This was closely followed by pages that disseminated educational material about translational research. Conclusions Preliminary data from this study suggest that knowledge portals may be beneficial tools for translating new evidence and fostering an environment of communication and collaboration.

The Evolution of a Professional Practice Forum: Balancing Peer-to-Peer Learning With Course Objectives.

Background The Opioid Treatment Accreditation Course (OTAC) is a mandatory accreditation requirement in New South Wales, Australia, and aims to prepare medical practitioners for the provision of safe and effective Opioid Substitution Treatment to people with opioid dependence. The course has a strong focus on safe prescribing practices and the course design includes a Professional Practice Forum that is engaging for participants and effective at imparting complex ideas and concepts that do not place additional time constraints on already time-poor health professionals. Objective The study aimed to use participatory action research methods to develop and evaluate an online Professional Practice Forum that is a key component of the OTAC teaching and learning experience. Methods Three evaluation cycles were implemented with three cohorts of participants (N=40) to inform the design and review of the updated OTAC course. Overall, the study relied on participatory action research methods to enhance a sense of online community and to revise the Professional Practice Forum component of the course. Findings from survey feedback and an examination of Web metrics were used to monitor participant learning and were subsequently subject to thematic analysis in order to identify key themes. Results The use of participatory action techniques in the redesign of the OTAC course was a successful means of engaging with participants and resulted in four revisions based on feedback from facilitators and participants. The Professional Practice Forum was rated highly and received positive feedback from both moderators and participants. Conclusions The use of interactive forums in online learning in an educational module for adult learners can prove extremely valuable as a means for participants to share their expertise and improve their learning outcomes. In particular, the use of sticky and welcome threads were significant features that enhanced interactions between participants and facilitators and resulted in increased quantity and quality of postings. These findings can help inform future researchers on how to develop peer engagement modules that are amenable to assessment and that build an online sense of community.

Mental health emergency care in Australia: An educational program for clinicians

INTRODUCTION In Australia, recent changes in mental health emergency care (MHEC) service delivery models highlight the need for clinicians to increase their knowledge and skills in mental health. A workplace training program was developed and implemented across the state of New South Wales (NSW) between 2009 and 2010. The program focused on the assessment, management, and support of people who present to Emergency Departments with common mental health problems. The study sought to assess whether there was a change in the knowledge, confidence, and skills of clinicians as a result of the workplace training program. METHODS A total of 127 (89.4%) mental health and emergency department staff returned precourse and postcourse surveys that measured their self-reported confidence in specific mental health skills areas, and perceived self-efficacy in dealing with aggressive behaviors. A 15-item researcher-developed test evaluated mental health knowledge. Perceptions of learning and connectedness were also assessed. Differences in scores were measured using parametric (matched pairs t-tests) and nonparametric (Wilcoxon matched-pairs signed-ranks test), with the magnitude of the effect determined using Cohens d. RESULTS Despite challenges in ensuring the involvement of emergency department staff, statistically significant improvements (P < 0.001) were detected in all confidence and skills questionnaire items, perceived self-efficacy in dealing with aggressive behaviors and the knowledge test, with medium to large effect sizes. DISCUSSION It is noteworthy that even when delivered primarily with mental health staff the program was highly beneficial. The significant investment in new models of MHEC across NSW and recruitment of less experienced staff highlights a need for further research and implementation of the program.