Browsing by Author "Sauro, Khara"

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    Classification schemes for knowledge translation interventions: a practical resource for researchers
    (2017-12-06) Slaughter, Susan E; Zimmermann, Gabrielle L; Nuspl, Megan; Hanson, Heather M; Albrecht, Lauren; Esmail, Rosmin; Sauro, Khara; Newton, Amanda S; Donald, Maoliosa; Dyson, Michele P; Thomson, Denise; Hartling, Lisa
    Abstract Background As implementation science advances, the number of interventions to promote the translation of evidence into healthcare, health systems, or health policy is growing. Accordingly, classification schemes for these knowledge translation (KT) interventions have emerged. A recent scoping review identified 51 classification schemes of KT interventions to integrate evidence into healthcare practice; however, the review did not evaluate the quality of the classification schemes or provide detailed information to assist researchers in selecting a scheme for their context and purpose. This study aimed to further examine and assess the quality of these classification schemes of KT interventions, and provide information to aid researchers when selecting a classification scheme. Methods We abstracted the following information from each of the original 51 classification scheme articles: authors’ objectives; purpose of the scheme and field of application; socioecologic level (individual, organizational, community, system); adaptability (broad versus specific); target group (patients, providers, policy-makers), intent (policy, education, practice), and purpose (dissemination versus implementation). Two reviewers independently evaluated the methodological quality of the development of each classification scheme using an adapted version of the AGREE II tool. Based on these assessments, two independent reviewers reached consensus about whether to recommend each scheme for researcher use, or not. Results Of the 51 original classification schemes, we excluded seven that were not specific classification schemes, not accessible or duplicates. Of the remaining 44 classification schemes, nine were not recommended. Of the 35 recommended classification schemes, ten focused on behaviour change and six focused on population health. Many schemes (n = 29) addressed practice considerations. Fewer schemes addressed educational or policy objectives. Twenty-five classification schemes had broad applicability, six were specific, and four had elements of both. Twenty-three schemes targeted health providers, nine targeted both patients and providers and one targeted policy-makers. Most classification schemes were intended for implementation rather than dissemination. Conclusions Thirty-five classification schemes of KT interventions were developed and reported with sufficient rigour to be recommended for use by researchers interested in KT in healthcare. Our additional categorization and quality analysis will aid in selecting suitable classification schemes for research initiatives in the field of implementation science.
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    Exploring Transitions in Care Among Patients with Head and Neck Cancer: A Multimethod Study
    (2023-12-20) Kersen, Jaling Kathleen; Sauro, Khara; Ronksley, Paul; Roach, Pamela; Chandarana, Shamir
    Introduction: Head and Neck Cancers (HNC) are the 6th most common cancer worldwide. Due to the complex nature of HNC, treatments are multifaceted and focus on diverse anatomical structures. As such, patients with HNC experience many Transitions in Care (TiC), which occur when patients transfer between healthcare providers, institutions, and settings. Although a necessary component of patient care, TiC represent a vulnerable point in the journey and are associated with compromised patient safety, decreased patient satisfaction, and increased healthcare costs. However, our understanding of TiC among patients with HNC is lacking. The objective of this multimethod study was to understand TiC among patients with HNC and identify opportunities to improve care for patients with HNC. Methods: This multimethod study consisted of two phases: a retrospective cohort study and qualitative description. Phase I was a retrospective population-based cohort study that characterized the number and type of TiC that patients with HNC experienced using routinely collected populations-based administrative health databases including the Alberta Cancer Registry, Discharge Abstract Database, the National Ambulatory Care Reporting System, and Physician Claims between January 1, 2012, to December 1, 2019. Both patient demographic and TiC variables were dichotomously coded and described using descriptive statistics. In Phase II, semi-structured interviews were used to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Two independent reviewers used an inductive approach to thematically analyze the semi-structured interview transcripts. Results: In Phase I, there were 2,208 patients with HNC who were mostly male (71.1%), classified as Stage IV HNC at diagnosis (62.4%) and had two or more tumours (91.3%). Patients with HNC often underwent multiple treatment modalities (average: 1.5), with the most common treatment transitions being from surgery to radiotherapy (29.7%). Many patients with HNC were admitted to the hospital and emergency department during the study period, averaging 2.0 hospital admissions and 13.2 emergency departments per patient during the study period. Patients with HNC also experienced many TiC between healthcare providers, with the highest number of physician visits being to general practitioners (average= 62.24 per patient). In Phase II, there were 16 semi-structured interviews conducted with ten patients with HNC and six healthcare providers. The experiences of patients with HNC and their healthcare providers revealed three interconnected themes related to TiC: 1) Navigating the Healthcare System (subthemes include: Head and Neck Cancer Care Complexities, Disrupted Continuity of Head and Neck Cancer Care, and Healthcare System Pressures), 2) Relational Head and Neck Cancer Care (subthemes include: Patient Expectations during Transitions in Care, Feeling Valued as a Head and Neck Cancer Patient and Healthcare Provider Roles and Responsibilities) and 3) System and Individual Impact of Transitions in Care (subthemes include: Impact of Resource-intensive Nature of TiC and the Impact of Transitions in Care on Quality of Care). Conclusions: In sum, this study identifies the challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within HNC. This study suggests TiC may have an impact on the quality of care and provides crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of care during TiC within this patient population. These findings also identified potentially feasible interventions for further exploration, such as shared decision-making, telehealth, or a patient navigator within HNC care.
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    Exploring transitions in care among patients with head and neck CANCER: a multimethod study
    (2024-09-05) Kersen, Jaling; Roach, Pamela; Chandarana, Shamir; Ronksley, Paul; Sauro, Khara
    Abstract Background Patients with head and neck cancers (HNC) experience many transitions in care (TiC), occurring when patients are transferred between healthcare providers and/or settings. TiC can compromise patient safety, decrease patient satisfaction, and increase healthcare costs. The evidence around TiC among patients with HNC is sparse. The objective of this study was to improve our understanding of TiC among patients with HNC to identify ways to improve care. Methods This multimethod study consisted of two phases: Phase I (retrospective population-based cohort study) characterized the number and type of TiC that patients with HNC experienced using deterministically linked, population-based administrative health data in Alberta, Canada (January 1, 2012, to September 1, 2020), and Phase II (qualitative descriptive study) used semi-structured interviews to explore the lived experiences of patients with HNC and their healthcare providers during TiC. Results There were 3,752 patients with HNC; most were male (70.8%) with a mean age at diagnosis of 63.3 years (SD 13.1). Patients underwent an average of 1.6 (SD 0.7) treatments, commonly transitioning from surgery to radiotherapy (21.2%). Many patients with HNC were admitted to the hospital during the study period, averaging 3.3 (SD 3.0) hospital admissions and 7.8 (SD 12.6) emergency department visits per patient over the study period. Visits to healthcare providers were also frequent, with the highest number of physician visits being to general practitioners (average = 70.51 per patient). Analysis of sixteen semi-structured interviews (ten patients with HNC and six healthcare providers) revealed three themes: (1) Navigating the healthcare system including challenges with the complexity of HNC care amongst healthcare system pressures, (2) Relational head and neck cancer care which encompasses patient expectations and relationships, and (3) System and individual impact of transitions in care. Conclusions This study identified challenges faced by both patients with HNC and their healthcare providers amidst the frequent TiC within cancer care, which was perceived to have an impact on quality of care. These findings provide crucial insights that can inform and guide future research or the development of health interventions aiming to improve the quality of TiC within this patient population.
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    Guidelines for Epilepsy Care – Gaps, Knowledge and Implementation
    (2016) Sauro, Khara; Wiebe, Samuel; Jetté, Nathalie; Quan, Hude; Holroyd-Leduc, Jayna; DeCoster, Carolyn
    Epilepsy is the second most common neurological condition and can be associated with significant morbidity, premature mortality, and high resource use. Epilepsy is a spectrum disorder due its diverse presentation, making it challenging to manage. As a result, treatment gaps exist. Clinical practice guidelines should facilitate the care of people with epilepsy. While evidence exists that guidelines are effective in improving the quality of care in some clinical settings, this has not been demonstrated for epilepsy. The objectives of this thesis are to: 1) Identify gaps in epilepsy guidelines, 2) Determine barriers and facilitators to implementation of epilepsy guidelines, and 3) Develop a knowledge translation (KT) strategy to optimize dissemination and implementation of epilepsy guidelines. Several methods were used to achieve the study objectives. A systematic review of epilepsy guidelines was conducted to identify gaps. A mixed-methods approach (quantitative survey and focus groups) was used to identify the determinants of guideline use among neurologists. Based on the results of the study examining determinants of guideline use, a theory-based KT strategy was proposed to facilitate future implementation of epilepsy guidelines in clinical practice. The systematic review identified 63 guidelines for the care of epilepsy covering 19 populations/conditions. Gaps in the availability of guidelines for high priority areas (i.e. elderly) and significant heterogeneity in quality were identified. Despite the number of guidelines available for the care of people with epilepsy, use of these guidelines clinically is poor. Reasons for the poor implementation of these guidelines among neurologists (end-users of epilepsy guidelines) were identified here, and include: lack of knowledge, poor credibility, applicability and motivation, insufficient resources, and lack of clarity regarding the target users. A three-pillared KT strategy to overcome the barriers of guideline use, and leverage facilitators is proposed to improve implementation in clinical practice. This body of work provides novel evidence into the current state of epilepsy guidelines, and the factors that determine their use clinically. This novel insight helps bridge a knowledge gap while the KT strategy outlined here provides the tools required to move towards improving implementation of guidelines for the care of people with epilepsy internationally.
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    Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study
    (2021-05-28) Mohsen, Samiha Tarek; Fiest, Kirsten; Sauro, Khara; Niven, Daniel
    Delirium, an acutely disturbed state of consciousness, manifests as a collection of symptoms such as confusion. There is potential for family members of critically ill patients to assist in non-pharmacological delirium prevention and management (e.g., re-orientation). Despite this, there are few studies on the impact of Intensive Care Unit (ICU) family presence on delirium. To bridge these knowledge gaps, our study employed a population-based retrospective cohort design to explore the association between family presence and both the incidence and duration of delirium in critically ill patients. The electronic health records of consecutive adult patients admitted to any of 14 adult medical-surgical adult ICUs in Alberta, Canada between January 1, 2014 and December 30, 2018 were examined. Family presence in the ICU (exposure), was extracted using a validated algorithm (1. family physically present, 2. family phone call only, 3. no family presence or call [reference group]). Delirium was measured using the Intensive Care Delirium Screening Checklist (ICDSC). Incident delirium was quantified (primary outcome) using an ICDSC cut-off of ≥4 points, after family presence (yes/no). Duration of delirium (secondary outcome) was measured as the total number of ICU days (24-hour periods) with a positive ICDSC score (≥4 points). Multivariable mixed-effects logistic and linear regression models (accounting for clustering by patient re-admission and ICU site, where appropriate) were used to evaluate the association between family member presence and the incidence and duration of delirium in critically-ill patients in the ICU, respectively. All regression models were adjusted for relevant covariates (e.g., ICU admission type, Glasgow Coma Scale [GCS]). We included 25,537 patients. Family presence in the ICU was associated with lower incidence of delirium during elective-surgical admissions in patients with intact GCS (OR 0.60, 95%CI:0.39-0.97, p=0.02) as compared to patients in the reference group. Family presence in the ICU decreased duration of delirium (adjusted mean difference -1.87 days, 95%CI: -2.01 to -1.81, p<0.001) as compared to patients in the reference group. Family presence in the ICU may decrease the incidence of delirium in patients admitted for elective-surgical reasons with intact GCS and duration of delirium in all patients by up to 2 days.
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    Transitions in Care and Healthcare Resource Use in Critically Ill Patients Living in Urban and Rural Settings: A Retrospective Cohort Study
    (2023-09-21) Thomas, Abigail; Sauro, Khara; Fiest, Kirsten; Ronksley, Paul; Parhar, Ken
    Objective: To examine healthcare resource use and patient outcomes among critically ill patients who live in urban versus rural settings. Design: Retrospective cohort study. Setting: Medical, medical-surgical, and cardiovascular intensive care units (ICUs) in Alberta, Canada between January 1, 2014, and April 30, 2018. Patients: Those who survived their index ICU stay, remained in ICU for ≥24 hours before ICU discharge, and had 1-year of follow-up post-index ICU admission. Interventions: None. Measurements and Main Results: Of 20,659 patients, 25.0% lived in a rural setting at the time of their index ICU admission. Urban and rural ICU patients had similar baseline demographic characteristics, with differences in admitting location and discharge destination. Rural ICU patients were admitted to ICU from inpatient units less than urban patients (76.3%, 84.2%). Differences in discharge destination were also apparent, with rural ICU patients seeing a general practitioner as their first provider after hospital discharge (53.3%), while urban patients saw specialists (59.7%). Rural and urban ICU patients did not differ in their use of continuous renal replacement therapy, though rural ICU patients in the lowest quintile of material deprivation had lower odds of requiring mechanical ventilation during their ICU stay than their urban counterparts (OR: 0.87, 95% CI: 0.76-0.99). Rural ICU patients had greater odds of adverse events while in hospital (OR: 1.39, 95% CI: 1.09-1.78) and 30-day ICU readmission after hospital discharge compared to urban patients, regardless of social deprivation and sex. Conclusions: While critically ill patients living in urban and rural settings are similar at the time of ICU admission and have similar clinical courses in ICU, their care and outcomes differ after ICU discharge. Lack of access to care in rural areas may be related to these differences. Strategies to improve healthcare access in these areas are needed to ensure high-quality care for critically ill patients living in rural settings.