Practice and law around informed consent in healthcare have undergone a revolution for the better over recent decades. However the way we obtain informed consent remains problematic and is imbued with irreducible but not ineliminable uncertainty. The reasons for this uncertainty are varied. The uncertainty is partly due to the conceptual opacity of important core concepts. The complexity of communication in clinical encounters is another. The role of autonomy, and the changing nature of the clinician patient relationship, have also contributed to this uncertainty remaining. This thesis is not a panacea for these difficulties. However there have been two quite profound revolutions in healthcare over the last decade or so, namely, the introduction of evidence-based medicine into clinical decision making, and the institutionalization of clinical governance and the application of quality improvement philosophy. I have examined ways in which these two “movements” can help in reducing some of the uncertainty in the practice of informed consent.

The researcher-clinician gap has been acknowledged in the literature and has been attributed to a variety of factors. According to Olswang and Prelock (2015), this term refers to a gap between "what we know, and what we do" in the profession, and is essentially the gap between knowledge and evidence. There is often, but not always, a disconnect between what researchers are publishing and what is actually being implemented in a clinical setting (Olswang & Goldstein, 2017). Olswang and Goldstein (2017) provided a suggestion for bridging this researcher-clinician gap, namely through an active partnership during the research and development process. Researchers need to work together with practicing clinicians in order to help better understand delivery needs, which results in an active partnership between research and delivery (Olswang & Goldstein, 2017). An active partnership supports researchers to discern service delivery needs and the realities of the clinical world, which allows for a more balanced way to address internal and external validity while developing treatment protocols which can be implemented into practice (Olswang & Goldstein, 2017). Research is a costly and complex process that requires the collaboration of many individuals. Speech-language pathologists have numerous obligations that may hold them back from playing an active role in research collaboration. According to Craig (2014), the three major barriers that prevent clinicians from research collaboration include lack of time, lack of education and training, and lack of funding. Despite these barriers, collaboration in the field of SLP is crucial for the development of evidence-based (EB) resources for clinicians and to ensure the best outcomes for clients. Furthermore, collaboration between researchers and practicing clinicians can create relationships that evolve and grow stronger over time, which will, in turn narrow the researcher-clinician gap and improve evidence-based practice being pulled into clinical use. Involving practicing clinicians in research by formulating and answering questions relating directly to clinical practice has been suggested to address the researcher-clinician gap (Olswang & Goldstein, 2017). A first step to bridge this gap is to determine the research interests and needs of practicing clinicians. This should lead to the identification of research areas of shared interest and can form the basis of new research collaborations. Such clinical research projects will have the potential to inform clinical practice and benefit the clients and families we serve. The purpose of this survey research is to determine and describe the research interests and needs of practicing clinicians in the Tri-Cities area in Tennessee (TN).Method: An exploratory, descriptive design with quantitative and qualitative analysis was used to explore research interests of practicing clinicians within the Tri-Cities, TN. An exploratory design was deemed appropriate due to the paucity of research on the topic. This study addressed the following questions: What role does research play in the local practicing clinicians' activities?; What are the barriers to consuming and conducting research by local practicing clinicians?; What are the primary research resources of local practicing clinicians?; What are the research needs of local practicing clinicians?; Are local practicing clinicians interested in collaborating on research?; How do local practicing clinicians view themselves contributing to collaborative research?; and What are the differences between work settings, research resources, and interest in research? An electronic survey was developed based on an in-depth literature on the topic and a review of survey research (e.g. Blessing & Forister, 2012; Irwin, Pannbacker & Lass, 2014). The survey consisted of four sections: Research Background, Research Interest, Research Collaboration, and Demographics. It contained 23 questions. The question and response format consisted of the following: 1 question was open-ended and 22 used a semantic differential scale (i.e., Likert-Scale and verbal frequency scale). IRB approval was obtained. Purposive sampling was used as local SLPs certified by ASHA were targeted. A cover letter served to recruit respondents via email. An online survey system, SurveyMonkey ™ was utilized to administer the survey to local practicing clinicians. Descriptive and inferential statistics will be used to analyze the data. Thematic analysis will be performed on the results obtained from the open question. Results: The results will be described both quantitatively and qualitatively. Results will be presented in terms of the practicing clinicians’ overall research needs and with differences between work settings, research resources, and interest in research. Correlations will be determined between variables such as work setting, time to collaborate on research, and research needs. The implications of the findings will be discussed in terms of suggestions for research resources, interests, and potential future collaboration between practicing clinicians and researchers. Recommendations for further research will be discussed. This preliminary research project will serve as a stepping stone to establishing practicing researcher-clinician collaboration in the Tri-Cities, TN area.Conclusion: The researcher-clinician gap remains a concern in the field of speech-language pathology. However, researchers and practicing clinicians can collaboratively create relationships that evolve and grow stronger over time. This in turn will narrow the researcher-clinician gap and improve evidence-based practice to the benefit of the clients served.

Theorists propose that because psychodiagnosis is not a completely objective procedure, it is influenced by sociocultural values. It was hypothesized that religion might be one aspect of sociocultural values which influences psychodiagnosis. The present study sought to determine, by using a clinical analogue design, whether psychologists' formal diagnoses of clients are biased by their present religious affiliations and activity levels, their religious upbringing (assessed by their fathers' and mothers' religious affiliations and activity levels), the clients' religious affiliations and activity levels, or interactions between psychologist and client religious variables. Questionnaires were sent to 228 psychologists licensed to practice in Utah, inviting them to participate in the study. Items eliciting the psychologists' religious characteristics were disguised amidst irrelevant items on the questionnaire. Respondents were sent four case reports which were varied on the religious affiliation (LOS vs. Other) and activity level (Active vs. Inactive) of the fictitious clients. The reports included identifying data, referral reason, background information, behavior observations, psychological test interpretations, and summary. Subjects diagnosed the reports according to the typology of the American Psychiatric Association's DSM-II. Usable data were obtained from 60 psychologists. The cases elicited a wide variety of diagnostic labels. Data were arranged in 56 frequency count tables (14 hypotheses on each of the four cases), and were analyzed with the chi-square test, with alpha = .05. Two significant relationships between religious variables and diagnosis were found. Because of the number of analyses performed, these were viewed as chance findings. In addition, the distributions of diagnoses in eight categories across all four cases were visually inspected according to the religious affiliations of the clinicians making the diagnoses and the clients being diagnosed. This procedure also failed to produce evidence of religious bias. It was concluded that formal diagnoses of clients made by psychologists in Utah are not influenced by psychologist or client religion, or by interactions between the two, when diagnoses are compressed into broad categories.

Objectives: The purpose of this study is to determine how the information practices of rural clinicians in fifteen counties have changed over the last twenty years. This data is needed to design programs to meet the information needs of the population. Methods: This study is a longitudinal cross-sectional study. A validated survey methodology was used to gather data at a specific point in time. Physicians’ names were gathered from the state licensing verification database and librarians’ personal knowledge. Advanced practice and registered nurses were identified from a list from the state center for nursing. The questionnaires were sent by mail with a self-addressed stamped return envelope with a cover letter explaining the purpose of the survey. Returned surveys were accepted for a 6 week period. The physicians surveyed were the complete population of a fifteen county area and nurse/nurse practitioners were a random sample of the population. Previous iterations were done in 1998 and 2009. Results: In 1997, names of physicians and nurses in 17 rural Tennessee counties were obtained. A random sample (p=.05) was surveyed for a total of 707-(357 RNs and 350 MDs). In 2009, this exact procedure was replicated with slight adjustments to the survey instrument (477 RNs and 312 MDs=789). Eighteen percent (125) of the information questionnaires were returned in 1997. In 2009, sixteen percent (124) of usable surveys were returned. In 2015,one hundred thirty useful surveys were collected. Clinicians were measured as to information barriers, resources, access points, smartphone use, and practice demographics. Conclusions: We need to be out in the community improving access to health information. A longitudinal, cross-sectional study is a good methodology to map progress and trends. Making changes in the community is hard. Hospital purchases by large corporations affect outreach opportunities.

Our vision for this special issue was simple: to inspire clinician innovators working in integrated care to not only consume the literature but also contribute to it.

The psychological literature consistently finds strong associationsbetween self-compassion, difficulties in emotion regulation, and occupational burnout, especially in populations with high amountsof occupational stress. In healthcare, clinician health and performance are implicated by these variables. Downstream effects are also detected, where increasing clinician burnout diminishestreatment efficacy. This reduced efficacy compounds on pre-existing issues of the treatment community, and generates additional barriers to achieving stability and health. This effect has been indirectly implicated in the Infant and Early Childhood Mental Health (IECMH) workforce, which includes professionals who engage and serve children and families, many of whom have high psychosocial risk. One way that the IECMH field has worked to address this pathway, is through the provision of RS/C (Reflective Supervision and Consultation). A key tenet of the IECMH practice, RS/C is designed to curb off the negative psychological aftermath ofoccupational stress. However, RS/C is largely unstudied, and requires additional evidence to gain traction as an intervention forhigh-stress occupations. As such, this study explored how RS/C interacts with self-compassion, difficulties in emotion regulation, and burnout in a population of IECMH professionals. Interest in protective factors led to test whether RS/C amplifies the protective capacity of self-compassion in the context of burnout (model 1), and whether of RS/C acts as a protective factor in the context of difficulties in emotion regulation and burnout (model 2). 141 clinicians who work in the IECMH field completed self-report measures of self-compassion, difficulties in emotion regulation, and occupational burnout, in the summer of 2020. Bivariate correlation indicated significant relationships between self-compassion and difficulties in emotion regulation (r = -.71, p < .01), self-compassion and burnout (r = -.57, p < .01), and difficulties in emotion regulation and burnout (r = .66, p < .01). Two simple moderation models were tested using Hayes’ PROCESS macro to determine if the relationships between X (self-compassion, in model 1, and difficulties in emotion regulation, in model 2) and Y (occupational burnout, in both models) were influenced by the presence of W (RS/C, in both models). Model 1 was not significant. For Model 2, the overall model was significant F(3, 93) = 27.51, R2 = .35, p < .001 and the interaction term was also significant (R2 change = .03, p = .02). Specifically, the relationship between X and Y remained significant across all levels of RS/C, and the strength of the relationship between X and Y was weakest when engagement in RS/C was highest, and strongest when engagement in RS/C was lowest. These results suggest that the reflective and supportive nature of RS/C may hold promising implications for protecting workforces from burnout via emotion regulation difficulties in high stress contexts.

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Clinician Scientists werden im Kontext einer Translationalen Forschung als Schlüsselfiguren thematisiert, insbesondere seit ihnen das Potenzial zugesprochen worden ist, biomedizinische Grundlagenforschung und medizinische Praxis auf praktische Weise miteinander verbinden zu können. Damit adressiert das Berufsbild des Clinician Scientists auf individueller Ebene das sogenannte ‚valley of death‘, welches metaphorisch zentrale Übersetzungslücken im biomedizinischen Erkenntnis- und Entwicklungsprozess markiert. Ungeachtet ihrer besonderen Position befinden sich Clinician Scientists noch immer in einer beruflichen Nische, der es offensichtlich nicht gelingt, die Translationsanforderungen auf der praktischen Ebene tatsächlich erfolgreich zu vermitteln. Vor diesem Hintergrund fragt die vorliegende Arbeit nach dem Professionszustand des Clinician Scientists und bedient sich dabei eines neo-pragmatischen Zugangs, der es ermöglicht Kritik und Empörung, welche die im Feld befindlichen Akteure gegenüber ihrer translationsorientierten Umwelt formulieren, für eine Soziologie der Kritik zu nutzen. Der analytische Bezugsrahmen ermöglicht sodann eine Beleuchtung des Professionszustands über individuelle Krisenzustände, die eine öffentliche Kritik an den eigenen professionellen Zuständen freisetzt. Die Arbeit leistet damit eine Beschreibung kritischer Potenziale, die im Kontext von Professionsentwicklungen gedeutet werden und offenbart im Ergebnis ein ambivalentes Verhältnis zwischen den Konzeptionen Translation und Profession: Ungeachtet ihres theoretisch augenscheinlich professionsfördernden Charakters avanciert die Translationale Forschung zum individuell-situativen Krisenherd und be- bzw. verhindert somit zugleich eine professionelle Entwicklung des Clinician Scientists. / Clinician scientists are described as a key solution towards the problem of translational research in the field of (bio)medicine, especially since they are perceived to have the potential to combine biomedical research and clinical practice. Translational research overall addresses the ‘translation gap’ between biomedical research findings on the one hand and clinical practice and applications on the other, which constitutes a major challenge towards the current biomedical research system. Despite their importance for translational problems clinician scientists still constitute a ‘rare breed’, struggling in fulfilling expectations of translational research on the individual level. In the light of this problematization, the cumulative thesis aims to explore the professional nature of the clinician scientist with the help of a neo-pragmatic approach by making use of critique and indignation individuals utter against their translational ecology. The analytical framework therefore allows to analyze professional development via individual situations of crisis. The thesis thus contributes to a description of critical potentials from individuals involved and reveals an ambivalent relationship between the concepts of translation and profession: despite its obviously supporting character translational research turns into a moment of crisis actually hindering and, respectively preventing clinician scientists from becoming a profession.

Purpose: The systematic review explored whether self-management interventions improve patient activation in long-term conditions, and if any improvements are greater than the amount of change experienced by patients in usual care or active control conditions. It also aimed to determine if positive effects on activation are maintained at follow-up. The empirical study sought to explore relationships between patient activation, psychological factors (depression and valued living), perceived clinician empathy, perceived symptom severity, self-management and demographic variables. It also examined whether depression, valued living and perceived clinician empathy are unique predictors of activation, and if activation is a unique predictor of self-management for MS, when relevant confounding variables are controlled for. Methods: For the systematic review, a comprehensive search of multiple electronic databases was conducted to identify intervention research reporting on patient activation outcomes, as measured by the short-form Patient Activation Measure (PAM-13), in people with long-term conditions. For the empirical study, a cross-sectional survey of 118 people with MS explored patient activation, MS symptom severity, valued living, depression, perceived clinician empathy, self-management for MS and demographic factors. Correlation and hierarchical regression analyses were employed to explore relationships between variables. Results: Twenty-five studies were eligible for inclusion in the systematic review, reporting a wide range of long-term conditions. Twenty-one studies (10 RCTs; 1 non-randomised study; and 10 uncontrolled studies) found an improvement in patient activation at post-intervention. Nine studies reported a significantly greater improvement in activation in self-management conditions compared with usual care or an active control at post-intervention. In six out of eight studies, gains in patient activation were maintained in the intervention group at follow-up. However, in four of these six studies, patient activation in the control group also improved over time. Findings from the empirical study suggested that only valued living was a significant predictor of patient activation after controlling for demographic variables and MS symptom severity. Neither depression nor perceived clinician empathy significantly predicted activation. After controlling for valued living, depression and perceived clinician empathy, patient activation independently predicted 5.5% of variance in self-management for MS. Both activation and perceived clinician empathy were significant predictors of self-management for MS. Conclusions: Self-management interventions improve patient activation in long-term conditions compared with usual care or active control. Patient activation gains appear to be maintained longer-term; however, the impact of self-management interventions on activation is unclear due to increases in activation in control groups over time. Valued living is associated with patient activation in MS, while patient activation and perceived clinician empathy are associated with MS self-management. Self-management interventions targeting valued living and the patient-clinician relationship may be effective for addressing low levels of activation in some patients with MS.

Bakgrund: Femton procent av alla möten inom vården upplevs som besvärliga av vårdpersonal. Besvärliga möten inom vården har stora följdverkningar, inte bara för patienten utan även för vårdpersonalen. De “besvärliga” patienterna riskerar att få sämre vård och bemötas med mindre respekt än övriga patienter. Besvärliga patienter är inte någon väl definierad patientgrupp utan karaktäriseras av en mängd olika egenskaper och symptom. Det finns en kritik mot användandet av begreppet besvärlig patient då det riskerar att fungera stigmatiserande och diskriminerande. Syfte: Beskriva vilka strategier vårdpersonal har för att bemöta den “besvärliga patienten”. Metod: Uppsatsen är en litteraturöversikt av elva vetenskapliga artiklar. Artiklarna analyserades med avseende på likheter och skillnader i resultatet. Resultat: Fem kategorier framkom: Bygga relation, Kontakt och kommunikation, Närhet och distans, Stöd och support samt Undvikande och kontroll. Huvudfynden speglar de strategier som vårdpersonal använder i mötet med den “besvärliga” patienten. Där återfinns både strategier som främjar en god patientkontakt och strategier som i förlängningen leder till negativa konsekvenser för både patient och personal. Slutsats: Strategier vårdpersonal använder i mötet med patienter som upplevs som besvärliga handlar till stor del om att uppnå en fungerande kommunikation och en god relation. I detta ligger strategier som betonar att lyssna, ge tid samt uppträda empatiskt, respektfullt och ärligt. Det finns också strategier som kontrollerar patienten eller begränsar patientens personliga frihet. Klinisk betydelse: Kunskap om vilka strategier som finns ger vårdpersonalen viktiga verktyg i den kliniska vardagen i mötet med den så kallade besvärliga patienten. I slutändan kan detta leda till en ökad patientsäkerhet och en vård av högre kvalitet för en sårbar och utsatt patientgrupp, samt en förbättrad arbetsmiljö för vårdpersonalen. / Background: Fifteen percent of all encounters in hospitals or health care facilities are perceived by health care staff as difficult. Difficult encounters have wide range of consequences for both the patient and health care professionals. A “difficult” patient is more likely to receive inadequate treatment and be treated with less respect. What constitutes a difficult patient is not well-defned, and they may be characterized by a broad range of personal and behavioural characteristics as well as symptoms. There are critical arguments against the verbal use of the difficult patient concept, as it may have a stigmatizing and discriminating effect on such a patient. Aim: Describe the strategies used by health care professionals when dealing with the “difficult patient”. Methods: The study is a literature review, in which the results of eleven scientific journal articles are compared and contrasted. Results: The main results reflect the strategies health care staff use when dealing with the “difficult” patient. From the litterature, five strategic categories have emerged. These categories include: Build relationship, Contact and communication, Closeness and distance, Help and support and Avoidance and control. These include both strategies that promote a good relation with the patient and strategies that lead to negative consequences for both patients and health care professionals. Conclusions: Strategies used by health care professionals when caring for patients perceived as difficult focus on achieving effective communication and a good relationship. These strategies emphasize listening, giving time and acting with empathy, respect and honesty. There are also strategies that control the patient or restrict the patient’s personal freedom. Relevance to clinical practice: This thesis presents an overview of which strategies exist for dealing with so called difficult patients, knowledge of which is vital for health care professionals working in clinical practice. This can lead to improved patient safety and health care of higher quality for a vulnerable and exposed group of patients, as well as a better working environment for the health care staff.