Concerns about safe driving practices in individuals with dementia often fall to caregivers, who are frequently faced with the difficult task of initiating the conversation about driving and driving cessation with their loved ones, a topic that can be a very emotional and sensitive for older adults. Several print-based resources are currently available to caregivers, however, emerging research suggests that disseminating information through a medium that depicts the complexities involved in decision-making about driving, such as applied theatre, may be more effective than these traditional print-based methods. Currently, there are no resource guides available for caregivers that incorporate applied theatre into their dissemination methods. In light of this research, this dissertation followed the principles of Knowledge Translation to work closely with caregivers to develop (Study 1) and evaluate (Study 2) a toolkit centered around an applied-theatre production called No Particular Place to Go. In Study 1, the comments and suggestions obtained from focus groups and individual interviews with 17 (eight informal and nine formal) dementia caregivers were incorporated into a toolkit called Down the Road, which consists of the play, No Particular Place to Go (in DVD-format), an accompanying viewer guidebook, and supplemental information cards. In Study 2, using a pre-post design, a total of 70 general caregivers (31 informal and 39 formal), including dementia caregivers, evaluated Down the Road by completing the Driving-Related Self-Efficacy Questionnaire (DRSEQ) and a User Satisfaction survey. Both informal and formal caregivers’ self-efficacy around various topics related to older driver safety increased after reviewing Down the Road. Additionally, caregivers favourably received the toolkit. This work moved beyond information gathering by incorporating the expressed needs of caregivers to translate knowledge into an effective, research-based toolkit that can provide caregivers with an interactive resource for use individually or in facilitated groups. / Graduate / 0621

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Cognitive Behavioural Therapy (CBT) is an underutilized evidence-based treatment for Anxiety Disorders. Increasing effective knowledge translation and implementation of CBT has significant public health implications. This study sought to increase the use of CBT by providing a 20-week-group-supervision program to Northern Ontario. Therapist measures of CBT knowledge competence were collected pre and post training, and treatment outcome measures were obtained by child and parent report. Clients in Northern Ontario were older (M=11.6years, Toronto M=10.0 years), were more likely on medication, and more likely to have a comorbid diagnosis than clients from an existing data-set in Toronto, Ontario. The training program was successful in increasing CBT knowledge competence and decreasing client anxiety in both locations, with greater improvements in self-reported anxiety in the Northern Ontario group. Therapist CBT knowledge competence was predictive of client symptom change as reported by parent but not child. Two therapist variables were found to be moderators.

Family members are in an optimal position to identify changes in behaviour of loved ones suffering from delirium. To date there are no known studies on educational interventions specifically targeting families of the elderly related to delirium outside of the hospital setting. Using the Knowledge to Action Process, families became involved in the development of a knowledge translation product related to delirium. It was found from two focus groups that participants’ knowledge of delirium was limited. Also, it was determined that participants were most interested in receiving an educational session in a group setting. The education session was developed using feedback from the focus groups as well as evidence based resources. The focus for the education session was on prevention and identification of delirium. There were a total of seven education sessions held and 16 eligible participants. In each session a pre and post-test for delirium knowledge was given to the participants. There was a significant increase in scores on the post-test following the session. Participants were also given a post session questionnaire to evaluate the education session. Overall the session was well received; participants were often interested in learning more about delirium. Half of the participants felt they would be able to identify delirium in someone close to them. The majority of participants thought that it is important for other families of the elderly to receive a similar session on delirium. Four to six weeks following the education session, semi-structured telephone interviews were conducted with five participants from the second phase in order to receive further feedback on the intervention. Most participants were able to recall information related to risk factors and signs of delirium. Three participants stated that the education sessions should be longer in order to provide more time for discussion. Participants still thought they would be able to recognize delirium as long as they were close to the person experiencing it. Since the education session none of the participants had witnessed anyone who was delirious. / Thesis (Master, Nursing) -- Queen's University, 2010-09-03 12:50:12.792

The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

The Canadian C-Spine (CS) and CT-Head (CT) Rules are tools aimed at improving the accuracy and efficiency of radiography use in emergency departments. This study evaluated whether the Theory of Planned Behaviour (TPB) could explain the inconsistent results from implementation studies of these two rules at 12 Canadian hospitals, where the same intervention resulted in a significant reduction in CS radiography but not CT radiography. It was demonstrated that the TPB model’s proposed relationships between constructs and behaviour could explain the ordering of CS but not CT radiography. However, after examining longitudinal changes of the TPB constructs, it was clear that these changes could not explain the changes in CS radiography ordering. Overall, TPB is unlikely to suggest important ways by which to improve radiography use, for CT because its constructs are not related to radiography ordering, and for CS because of high baseline levels of intention to clinically clear.

Objective: To explore adult cancer symptom management by home care nurses. Scoping review: A scoping review was conducted to describe interventions used by nurses for cancer symptom management in the home care setting. Five included studies revealed that home care nursing contributed to positive client- and system-level outcomes. Study: A mixed-methods descriptive study explored usability of a set of 13 cancer treatment-related symptom management protocols for nurses in the home care setting. Thirty-eight nurses in home care participated. Qualitative and quantitative data indicated the protocols were highly usable. Several barriers suggested they would be better used as resources to support and train nurses rather than documentation tools. Conclusions: Few studies have evaluated interventions for cancer symptom management by home care nurses. This set of protocols was well-received, but further research is required to determine their effectiveness and interventions for implementing with home care nurses providing cancer symptom management.

The objective of this dissertation was to evaluate an integrated knowledge translation intervention in a community-based service agency providing services to adults with intellectual disabilities. The dissertation had two objectives: 1) to understand how stakeholders create knowledge, collaborate, and make decisions to implement knowledge on supporting sexuality, and 2) to examine the underlying processes of integrated knowledge translation and how these interplay in the context of community and intellectual disability research. First, we conducted a scoping review to identify strategies to support the sexuality of persons with intellectual disabilities. This knowledge was made available and discussed with stakeholders of the participating agency (i.e., persons with intellectual disabilities, front-line staff, caregivers, supervisors, and senior management) using various methods such as focus groups, an evidence brief and a stakeholder dialogue. Data collection included transcripts of discussions with stakeholders, facilitator notes, notes from the primary researcher, and two self-report questionnaires. The intervention resulted in two in-person workshops and an online program on sexual health for persons with intellectual disabilities and front-line staff. Second, we identified barriers and facilitators to conducting an integrated knowledge translation intervention in a community and disability setting. These included power dynamics and the accessibility of the integrated knowledge translation intervention to knowledge users. The findings from these two aims presented in this dissertation inform changes that may further increase the relevance and applicability of knowledge translation interventions in the community and disability setting.

Introduction: Referral for CS/HIPEC is variable, and barriers encountered by referring physicians are unknown. Identification of such barriers is useful for the creation of tailored knowledge translation (KT) strategies. Methods: Interviews of 20 medical oncologists and surgeons in the New York (NY) area were completed to identify barrier topics, using the Pathman framework of uptake of innovations (awareness, agreement, adoption, adherence) at the various levels of the individual, practice group, and organization. Barriers were used to structure a survey for evaluation of prevalence at the population level of medical oncologists and surgeons in NY State. Results: Barrier topics of awareness included training at a CS/HIPEC center, and availability of multidisciplinary cancer conferences. Agreement barriers centered mainly on quality of published literature, and the paradigm shift of carcinomatosis as a systemic to locoregional disease process. Adoption barriers included knowledge of outcomes of a CS/HIPEC surgeon, and concerns with morbidity/mortality rates. Adherence barriers included the lack of reflection of CS/HIPEC in current CPGs, financial/resource and logistic concerns of referrals, and lack of quality measures for the procedure. For the survey, 119 responded (12% response rate), including 42 medical oncologist and 77 surgeons. The majority were aware of CS/HIPEC (n=113, 95%). Medical oncologists were less likely than surgeons to agree with CS/HIPEC related to published evidence (76% vs 92 %, p = 0.02). Surgeons were more likely to be aware of where to refer patients for the procedure, and were less likely to have concerns regarding morbidity/mortality, compared with medical oncologists (p = 0.05, p = 0.04). Representation of CS/HIPEC in CPGs and quality measures/outcomes data was felt to result in adherence to a regular referral practice. Discussion: This prospective study of stakeholders for CS/HIPEC is the first to evaluate and characterize barriers to referral for this complex and controversial surgical innovation, with prevalence at the population level. / Thesis / Master of Health Sciences (MSc) / This thesis identifies problems encountered with referring patients to a specialist surgeon for a procedure that involves both surgical removal of tumors and treatment of the abdominal cavity with chemotherapy. These problems are evaluated from interviews with specialists in the field, and then evaluated at a higher level of all practicing referring specialists through a survey. The results will be used to improve patient outcomes in the future.