Thesis (M.Med.Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Wisconsin--Madison, 1990. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 157-161).

Thesis (Ph.D.)--Ohio University, March, 2005. / Title from PDF t.p. Includes bibliographical references (p. 100-116)

Thesis (D.C.P. / M. Sc.)--School of Psychology, Faculty of Science, University of Sydney, 2007. / Title from title screen (viewed on February 3, 2009) Degree awarded 2007; thesis submitted 2006. Submitted in fulfilment of the requirements for the degree of Doctor of Clinical Psychology/Master of Science to the School of Psychology, Faculty of Science. Includes bibliographical references. Also issued in print.

Introduction: Cancer incidence and prevalence rates are increasing and pain is the most frequent complication of cancer. Cancer pain can have detrimental effects on a patient's social function, mood, and quality of life. Pain is the most frequent symptom to prompt unscheduled medical care in patients with established cancer, and is an important reason for hospitalisation. There are aspects of cancer pain management which involve potentially modifiable patient and healthcare professional behaviours. Patients can have problems reporting pain, communicating about pain with healthcare professionals, using medications effectively, and getting help when problems arise. Healthcare professionals do not always assess pain adequately or prescribe optimally. The aim of this project was to develop an intervention to support patients and professionals in improving cancer pain control. Methods: An Intervention Mapping (IM) approach was taken to intervention development. Current challenges of managing cancer pain and potential solutions were investigated through systematic literature review and qualitative investigations with patients, caregivers, and professionals. The systematic literature review investigated whether patient reported measurements of pain could be collected and fed back to patients and/or healthcare professionals to improve cancer pain management, and described the components of such interventions. Medline, EMBASE, and CINAHL databases were searched from inception to identify randomised and non-randomised controlled trials. Titles, abstracts, and full text articles were dual screened, and assessed independently for risk of bias according to the Cochrane criteria by two researchers. Meta-analysis was performed for studies which reported changes in pain intensity on a zero to ten point scale, and a narrative synthesis was conducted. Qualitative semi-structured interviews with patients with cancer pain, their caregivers, and healthcare professionals and focus groups with healthcare professionals investigated current approaches to cancer pain management, and the challenges and problems experienced. Potential solutions and intervention ideas were explored, along with perceived opportunities for digital technologies to enhance cancer pain management. Qualitative data were analysed using a combination of Framework and thematic analysis. Existing literature and findings from the original qualitative research were used to model the problem, and through the Intervention Mapping approach; behaviour change theory was systematically applied to produce a digital intervention. Prototypes were pre-tested with professional stakeholders. Macmillan nurses recruited patients (with or without a caregiver) from their caseload who had cancer pain and were using strong opioids to provide early indications about the feasibility of the intervention. Nurses also recruited the patient's GP. Patients were invited to interact with the app over a four week period. Weekly patient analgesic and symptom reports were sent to their GP and nurse. At least one consultation with their Macmillan nurse was scheduled in which patient reported data could be discussed. Patients were interviewed by telephone on a weekly basis and all participants were interviewed at the conclusion of the study. All qualitative enquiries were analysed using a combination of Framework and thematic analysis. Patient generated symptom report data were analysed descriptively. Results: Literature review: Twenty nine reports of 22 unique trials of 20 interventions were included in the review. Patient reported outcome measures were used in four main ways: (1) to provide reports about pain and related symptoms to professionals (with the intention of increasing professional awareness of unrelieved symptoms); (2) to tailor patient education about self-management strategies and how to communicate about pain; (3) to prompt contact between a patient and professional when pain is above a set threshold; and (4) to link pain treatments to the severity of pain experienced by the patient via algorithmic management guidelines. Meta-analysis of 12 trials showed that average pain intensity was reduced by half a point out of ten in intervention group participants compared to controls. This result was statistically significant, mean difference -0.59 (95% CI -0.87, -0.30). Qualitative investigations with key stakeholders: Interviews were held with 14 patients, including six with their caregivers present. All patients had locally advanced or metastatic cancer. Nineteen multidisciplinary professionals took part in interviews (15 face to face and four telephone interviews), and 12 took part in one of two focus groups. Themes were organised within two categories: 'the work of managing cancer pain and its context', and 'digital tools to help with this work'. Patients gave accounts of cancer and cancer-related pain as burdensome conditions. Complete alleviation of pain was not the main goal for most patients. Pain was considered alongside functional and activity goals, overall symptom burden, and medication side effects. Professionals recognised patients' individual goals to varying extents. Most patients were regularly using digital technologies. Patients had ideas for digital pain management tools as sources of information and knowledge, to help with medicines management (particularly for reminders and prompts), and as symptom monitoring tools which could stimulate help-seeking. A key concern for all participants was that digital tools should add value over paper resources, should be simple to use, and that data presented were brief and easy to interpret. The intervention and results of early feasibility testing: A digital app was developed to help patients on strong opioids achieve personal treatment goals. The app includes a short film about pain and symptom management, and links to telephone/web-based help. The app allows easy recording of short-acting analgesic doses, linked algorithmically to help-screens. A weekly diary asks about pain, side effects, function, and medication adherence. The digital diary contains novel measures of pain, including a question about the level at which pain becomes bothersome to the individual patient. App reports are automatically shared with linked professionals so that feedback can be given. Recruiting patients with advanced symptomatic cancer was difficult. The app was feasibility tested with two patients, their linked GPs, and Macmillan nurses. Electronic patient reports were shared with linked healthcare professionals using secure NHS email. Professionals found patient reports thought-provoking. Reports were used to inform clinical encounters, and seemed to promote a shared understanding of patient symptom management goals. Conclusions: A digital intervention has been developed using a rigorous, theory-based methodological approach. There are early indications that the intervention could promote patient centred care and shared decision making in patients with cancer pain. Lessons have been learned about recruiting patients with symptomatic cancer, and the intervention is ready to be tested on a larger scale.

Yes / How to meaningfully partner with patients as data analysts remains obscure. A process evaluation of the ‘Improving the Safety and Continuity Of Medicines management at care Transitions’ (ISCOMAT) cluster randomised control trial of an intervention for improving medicines use for people living with heart failure is being conducted. The intervention includes patient held information on heart medicines and care, enhanced communication between hospital and community pharmacists, and increased engagement of community pharmacists with patient care post-hospital discharge. ISCOMAT patients living with heart failure were interviewed about experiences with the intervention. We sought to gain insights from patients on data collected to enhance our understanding of experiences with the intervention. To develop a method for involving patients as analysts of qualitative data in a process evaluation. Design: Patients and researchers co-analysed qualitative data. A framework method was applied involving; familiarisation, coding, developing an analytical framework and interpretation. The process was facilitated through home working and a workshop with a training component. Results: The co-designed framework enabled researchers to map all further patient interview data. Patients' specialist knowledge enhanced understanding of how the ISCOMAT intervention can be best implemented. Conclusions: Patients’ unique experiences can enhance validity and rigour in data analysis through sharing their interpretations of qualitative data. The involvement process is crucial in elucidating knowledge and avoiding tokenism. As analysts, patients gain an appreciation of research processes, building trust between researchers and patients. Group dynamics and involving patients throughout the whole research process are important considerations. / NIHR Grant RP-PG-0514-20009. NIHR Yorkshire and Humber Patient Safety Translational Research Centre.

Source: Dissertation Abstracts International, Volume: 70-03, Section: B, page: 1623. Adviser: Luisa Franzini. Includes bibliographical references (leaves 78-80).

<p>Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.</p><p> </p><p> </p><p> </p><p>Keywords: patient participation, nurse-patient relationship, nurse, care</p>

Patient participation is a central theme in health care policy in the United Kingdom (U.K.). Indeed, there is a trend in health care policy and practice towards encouraging patients to participate actively in their care, treatment and the services they use (Department of Health, 1989, 2003; 2004; 2005; 2006; 2008; 2009; 2010; 2011; 2012). Despite the current popularity surrounding such an approach to care, the concept remains elusive. Patient participation in nursing care specifically has not been examined adequately and remains one of the least understood ideas in clinical practice. The contribution that nurses make to this important activity has also not been explored. Furthermore, only a few studies have examined the nature of patient participation in nursing care from the frame of reference of the acute surgical patient (Henderson, 1997; Sahlston et al., 2008 and Larsson et al., 2011). Most studies have targeted clinically distinct patient groups and discrete aspects of patient participation within the context of chronic illness or medical and primary care practice. They are therefore limited by their precision and narrow focus (Cassileth et al., 1980; Haug & Levin, 1981; Vertinsky et al., 1984; Caress et al., 2005; Entwhistle et al., 2004; Collins et al., 2007; S. Parsons et al., 2010). Most have also drawn on positivist epistemologies and derived data from self-completed fixed choice questionnaires. An empirically grounded theory that explains the process of patient participation in surgical nursing care within the empirical world has yet to be published. The purpose of this grounded theory study was to explore the nature of patient participation in nursing care within the context of the acute surgical care setting. Ultimately the aim was to generate a substantive theory that could account for, and explain, the process by which patients’ participate in their surgical nursing care. A qualitative, inductive design, based on the classic grounded theory approach to data collection and data analysis (Glaser & Strauss, 1967; Glaser, 1978) was employed to examine the complex nature or natural history of patient participation within the context of contemporary surgical nursing practice. The informants of the research were patients and nurses on three acute surgical wards in an NHS Trust Hospital. Data were collected through 61 unstructured, audiotaped interviews (47 patients and 14 nurses) and 72 hours of participant observation. The interview and observational data were analysed using the constant comparative method of analysis (Glaser & Strauss, 1967; Glaser, 1978). The analytic process generated a substantive theory, labelled Engaging in Nursing Care. The theory explains how patient participation in nursing care within the acute surgical setting is established, developed, maintained or inhibited. It reveals an evolutionary context-sensitive process, which describes the complex and challenging nature of patient participation in nursing care as experienced by patients and nurses in the pre and post-operative period. Three dynamic phases: Establishing Readiness, Shaping Work and Incurring Rewards and Costs describe how patients engage in their nursing care prior to and after surgery. The phase Establishing Readiness describes the structural, organisational and environmental antecedents of patient participation within the context of the surgical care setting. Shaping Work describes the range and variation in participatory behaviour and the levels at which patients participate in their own nursing care throughout their surgical experience. The phase Incurring Rewards and Costs explains the varied effects of patient participation in surgical nursing care on the individual patient, the nurse and surgical ward performance and resources. A number of recommendations are made to enable nurses, educationalists, health care managers and policy makers to develop substantiated strategies and initiatives for the effective implementation of patient participation in modern surgical nursing practice.