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At least 19 recordsLinked to original sources
PubMed2004

Genetic discrimination: the clinician perspective.

Clinicians attending continuing education sessions in California were surveyed about their beliefs and attitudes regarding genetic discrimination and their knowledge of protective legislation. Two hundred seventy-one surveys were collected from physicians (n = 191) and nurses (n = 80). Most respondents lacked information or were misinformed about the existence of protective legislation (58.3%) or published cases of insurance discrimination (85.2%); 52.4% believed that mutation carriers have difficulty obtaining health insurance; 13% would not encourage genetic testing, despite a family history of cancer. Clinician concerns about potential genetic discrimination, and lack of information regarding protective legislation, may influence access to care.

Genetic Counseling↗
PubMed1990

Hemoptysis: clinicians' perspectives.

Clinicians who were interested and considerably experienced in assessing patients with hemoptysis were surveyed during a computer-assisted interactive presentation at the 1988 ACCP Annual Scientific Assembly. The approach to ambulatory patients with minor bleeding was consistent with recently published guidelines: fiberoptic bronchoscopy has a central role, with a less apparent impact of other new technologies. Although specific diagnostic results were significantly more useful (p less than 0.01), even nonspecific bronchoscopy findings were though to have clinical value. External factors such as medicolegal concerns and obligations to provide service were acknowledged to influence selection of patients for bronchoscopy, and community-based clinicians cited such effects more often than academicians (p less than 0.02). Approaches to patients with massive hemoptysis reflected caution essential to acute management. Bronchoscopy was performed earlier (p less than 0.01) than in patients with minor bleeding, but opinions differed regarding instrument selection, the best method of airway support, and the roles of interventional angiography. This survey suggests that real-world settings are addressed incompletely by published experiences accumulated in tertiary centers. Clarification of optimum approaches to patients with hemoptysis requires further input from practicing clinicians.

Ambulatory Care↗
PubMed1987

Thrombolytic agents: a clinician's perspective.

Clinicians and researchers often have different perspectives: Clinicians deal with patients as individuals; researchers deal with them as members of groups whose characteristics can be defined statistically. Clinicians should be cautious and skeptical about new therapies, therefore, because the applicability of group-successful treatment to individual subjects is not always appropriate. In deciding whether to use the new thrombolytic therapy in acute myocardial infarction, clinicians should consider the factors that limit as well as those that support its use. As a clinician, I ultimately favor its use because intracoronary thrombosis is almost ubiquitous in acute infarction, and thrombolytic therapy addresses this basic problem. Fortunately, acute infarction is an evolutionary process, giving us time to take action. Since the extent of necrotic myocardium determines prognosis, and reperfusion can limit infarction size, salvaging myocardium should improve the outcome. Thrombolytic therapy can usually be administered quickly, easily, and safely. It requires minimal laboratory monitoring but careful clinical monitoring. Signs of successful therapy are easily recognized clinically, as are the signs of reocclusion if it occurs. The problem of the best treatment to follow thrombolytic therapy remains unsolved. But the thrombolytic component of overall management of a patient with acute myocardial infarction is worthwhile.

Coronary Disease↗
PubMed2006

Radiology curriculum for medical students: clinicians' perspectives.

This study was conducted to establish clinicians' perspectives of a set of radiology curriculum topics for medical student teaching, which were held to be important by radiologists. A questionnaire was sent to clinicians in all specialties. Forty-six clinicians (51.1%) out of 90 returned the questionnaires. All curriculum topics were scored above an average of 4 (agree). The five highest ranking curriculum topics in order of importance were: developing a system for viewing chest radiographs (5.59), developing a system for viewing abdominal radiographs (5.56), developing a system for viewing bone and joint radiographs (5.33), distinguishing normal structures from abnormal in chest and abdominal radiographs (5.33) and identifying gross bone or joint abnormalities in skeletal radiographs (5.22). Correlative analysis between speciality groups showed surgical and medical specialities were significantly different in their responses of two learning outcomes: basic knowledge about the contrast media benefits and risks (P= 0.01) and ability to select the most appropriate and the most cost-effective methods of radiological investigations for clinical situations (P= 0.03). Acute specialities were not significantly different from the other two groups for these two learning outcomes. There was no statistically significant difference for other learning outcomes between the three speciality groups.

Curriculum↗
PubMed2001

Informed consent for pediatric leukemia research: clinician perspectives.

BACKGROUND: Good, fully informed consent is critical to the ethical conduct of clinical cancer research. The authors examined clinician perspectives on informed consent for pediatric research by surveying clinicians at five major medical centers that routinely enroll patients in Children's Cancer Group studies. METHODS: Building on a pilot study, a questionnaire was designed to elicit clinicians' general opinions, approaches, and suggestions related to informed consent in pediatric leukemia trials. Questionnaires were mailed to 132 clinicians. Eighty-nine questionnaires were returned, along with 13 nonparticipant forms notifying us of the clinician's inability to participate because of a lack of experience in pediatric informed consent. The response rate was 75%. RESULTS: Providing information so that families can decide about study entry was ranked as the most important goal of the informed consent process, whereas parents' state of shock was rated the most significant obstacle to good informed consent. Clinicians cited high levels of parental comprehension of key aspects of clinical research studies and reported information overload and increased anxiety as effects of the informed consent process on parents. Several key items were associated with clinicians' gender, race, and professional experience. Finally, one open-ended question yielded 126 suggestions for how to improve the informed consent process that were grouped into 10 meaningful categories. CONCLUSIONS: Clinicians report a range of approaches, opinions, concerns, and suggestions for improving the informed consent process. The article proposes that their views and suggestions be integrated with those of parents and patients in attempts to survey and improve informed consent in pediatric oncology.

Adult↗
PubMed2004

Mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits.

BACKGROUND: Recent national statistics indicate that, despite increases in the proportion of mothers who initiate breastfeeding, the proportion that continue to breastfeed their infants through 6 months of age remains below the Healthy People 2010 goal of 50%. National professional organizations recommend that clinicians routinely counsel mothers about the benefits of breastfeeding. Little is known, however, about the counseling provided during these visits and how mothers and their clinicians perceive breastfeeding counseling. OBJECTIVES: We sought to describe mothers' and clinicians' perspectives on breastfeeding counseling during routine preventive visits and identify potential gaps in communication about breastfeeding and management practices. METHODS: We conducted a prospective cohort study of low-risk mother-newborn pairs and their clinicians in a large multispecialty group practice. The participating mothers completed telephone interviews at 4 and 12 weeks postpartum, and their data were linked with their obstetric and pediatric clinicians' responses to a cross-sectional mailed survey conducted during the same time period. Overall, response rates were 63% for mothers (n = 429) and 82% for clinicians (obstetric clinicians: n = 54; pediatric clinicians: n = 67). RESULTS: Of the 429 low-risk mother-newborn pairs in the study, 61% were white, 16% were black, 10% were Hispanic, and 8% were Asian, with a mean (SD) age of 32.7 (5.1) years. At 4 weeks postpartum, 319 mothers (74%) were either exclusively or mixed breastfeeding. According to the interviews, few mothers discussed breastfeeding duration with their obstetric clinicians during their prenatal visits (15%) or with their pediatric clinicians during their infants' 2-week preventive visit (24%). Among 164 mothers whose obstetric providers said they usually or always discuss breastfeeding duration during prenatal visits, only 26 (16%) of the mothers reported that the topic was discussed with them (22% agreement; kappa = -.004). Among those mothers whose pediatric clinicians said they usually or always discuss breastfeeding duration during the 2-week preventive visit, only 25% of the mothers reported that the topic was discussed (32% agreement; kappa =.05). Many of the mothers had either returned to work by 12 weeks (29%) or planned to return to work within the next few months (43%). Although nearly all the obstetric (91%) and pediatric (97%) clinicians reported that they usually or always discuss whether a mother plans to continue breastfeeding after returning to work, only approximately half (55%) of the mothers seen by the clinicians reported that the topic was discussed. Overall, few mothers reported discussing with their clinicians specific ways to continue breastfeeding after returning to work. CONCLUSION: Mothers' reports of breastfeeding advice given during routine preventive visits identified several areas in which unintentional communication gaps may occur, including specifics about breastfeeding duration and methods of breastfeeding after returning to work. Developing approaches to enhance communication with mothers during routine preventive visits could improve the support of breastfeeding.

Adult↗
PubMed2006

Outcome measures in urogynaecology: the clinicians' perspective.

There is currently a paucity of information regarding clinicians' expectations of treatment and whether their perception of bothersome symptoms is similar to that of the patient. Equally there is often a dichotomy of opinion when comparing clinician-centered evaluation with that of patients. The objectives of this study were to determine clinicians' expectations following treatment, to assess the methods of outcome assessment used in the clinical and research settings, and to compare clinician's expectations with those of patients. This was a prospective postal questionnaire-based study sent to members of the International Continence Society (UK). The questionnaire asked about expectations following treatment and use of outcome measures. These results were also compared to those of an identical patient questionnaire that have previously been published. Tests of agreement were performed between clinicians and patients using Cohen's kappa statistic. Two hundred ninety-nine questionnaires were distributed with a response rate of 52.7%. Overall, 85.9% of responding clinicians felt a good improvement in urinary symptoms, so that they no longer interfered with quality of life, was a realistic outcome. The majority of clinicians thought that small or infrequent episodes of leakage were acceptable following treatment, although frequent or large leaks were not. Irritative urinary symptoms such as urgency and urge incontinence were felt to be less acceptable as were the symptoms of frequency and nocturia. Overall, there was found to be poor agreement between clinicians and patients attitudes to acceptability of symptoms with values of kappa ranging from -0.103 to 0.105, indicating that this agreement was no better than chance. In the research setting, 61% felt both subjective and objective outcome measures should be used, whereas in clinical practice, 42% thought subjective improvement alone, and 36% subjective improvement in QoL, were appropriate. Clinicians have realistic expectations following treatment, although there is poor agreement with those expectations expressed by patients. These findings may help to explain why patients may be disappointed regarding treatment outcomes and why there may be a difference between subjective clinical impression of success and patient satisfaction. In addition there is a lack of conformity in the use of outcome measures in both the clinical and research settings.

Attitude of Health Personnel↗
PubMed2004

Barriers to assessment and treatment of posttraumatic stress disorder and other trauma-related problems in people with severe mental illness: clinician perspectives.

We conducted a state-wide survey of 251 clinicians serving people with severe mental illness (SMI) in community support programs, to identify barriers to the diagnosis and treatment of PTSD and other trauma-related problems. Most clinicians did not feel competent to effectively treat these problems. Competence/confidence and belief in utility of intervention were positively related to the percentage of clients with whom trauma and PTSD had been discussed, documented in charts, and addressed directly in treatment. Clinicians need training that develops skills and knowledge as well as conveys the value of addressing PTSD and other trauma-related problems in people with SMI.

Adult↗
PubMed2004

Clinicians' perspective on quality of life assessment in paediatric clinical practice.

AIM: This study was undertaken to investigate paediatric clinicians' views on and use of quality of life (QoL) assessment in clinical practice. METHODS: A survey was conducted among members of the Dutch Paediatric Association via e-mail. RESULTS: Over half of the 303 respondents (57%) believed that it was possible to use QoL questionnaires in clinical practice. The majority indicated that assessing QoL was beneficial and that it was especially necessary to assess QoL in children with a chronic disease (82%). Although only a minority (17%) currently used QoL questionnaires, most respondents would want to use QoL questionnaires in the future (76%). Obstacles that prevent the use of QoL questionnaires are the extra time needed for assessment, the unavailability of standardized questionnaires and insufficient knowledge about QoL. CONCLUSION: This survey shows that paediatric clinicians are positive towards QoL assessment, but that certain obstacles prevent the use of questionnaires. Thus, to facilitate future use, QoL questionnaires need to be developed from the perspective of the paediatrician. This means that they need to be developed for clinical use and brought to the attention of the paediatric health care community, demonstrating their validity to child health care.

Child↗
PubMed1999

Family planning and parenthood needs of women with severe mental illness: clinicians' perspective.

Family planning and parenthood are important issues for women with severe and persistent mental illness (SPMI). The role of adult mental health clinicians with regard to these issues has been under investigated. Clinicians treating patients with SPMI at a large community health center completed survey forms on 419 women. Clinicians reported that a large fraction of sexually active women were not thought to be using birth control. Despite this, many clinicians had not discussed birth control with these patients. Clinicians had concerns about childcare in 72% of cases where the patient with SPMI was the primary custodian of a younger child; however, the majority of these families were not receiving child or family services. Further consideration of the role of the adult mental health clinician in addressing issues of family planning and parenting is required.

Adult↗
PubMed2005

Clinicians' perspective of a training programme in syndromic management of sexually transmitted infections in Northern Tanzania.

This process evaluation study was designed to investigate clinicians' perception of a training programme on syndromic management of sexually transmitted infections (STIs) and their experiences in applying the skills learnt during the course. Out of 136 eligible course participants from Arusha and Kilimanjaro regions, Tanzania, 47 were invited to take part in the study and 40 agreed to participate (85%). The research instruments consisted of a structured interview including open- and close-ended questions, a self-administered questionnaire, and an observation checklist. While the clinicians reported to be satisfied with the course itself, the results revealed insufficient practical training. The clinicians reported problems with condom promotion and partner notification, and frequent shortage of equipment and drugs in the clinics was observed. Future courses on syndromic management of STI should focus on skills training related to health education and counselling, and have a stronger emphasis on practical, clinical work. There is need to address barriers to condom promotion and partner referral.

Health Education↗
PubMed2006

Clinicians' perspectives on cognitive-behavioral treatment for PTSD among persons with severe mental illness.

OBJECTIVE: As an intermediate step in the development of a cognitive-behavioral posttraumatic stress disorder (PTSD) treatment program for persons with severe mental illness, a focus group gathered feedback from clinicians and clinical supervisors within a public-sector mental health system. METHODS: Five qualitative focus group discussions were held with 33 clinicians and clinical supervisors within a state-funded community mental health center system. RESULTS: Clinicians perceived trauma to be a significant adverse factor in the lives of their mental health services consumers, were reluctant to address trauma with them, and yet believed that cognitive-behavioral treatments for PTSD may be effective and appropriate for them. Clinicians also offered practical suggestions to improve the feasibility and acceptability of the proposed cognitive-behavioral treatment program. Examples include creating gender-specific treatment groups; ensuring that trust and rapport with clients are established before the discussion of traumatic experiences; developing careful safety precautions for clients, especially for the exposure therapy component; preparing for the possibility that some consumers will lack the cognitive ability to understand treatment; and collaborating with other care providers to ensure optimal integration with other aspects of care and minimize clinic disruptions. CONCLUSIONS: These findings provide information relevant to the development and implementation of PTSD interventions for patients with severe mental illness treated in public-sector settings.

Attitude of Health Personnel↗
PubMedDate not supplied

Clinician perspectives on participation in research.

Midwifery practice settings offer ideal opportunities to conduct research on normal childbearing. Increasing the output of midwifery research would benefit midwives, as well as the women they serve. But finding ways to add research activities to a busy clinical schedule is a challenge. Factors thought to promote clinician participation in research are as follows: perceived relevance of the research topic, a relationship with a lead researcher, regular feedback to clinicians, minimal impact of a study on usual clinical care, and some level of compensation for clinicians who participate in research. Barriers include time constraints, lack of research updates and support, and limited research skills of clinicians. Joint projects by academic researchers teamed with active clinician groups are suggested as one way to move a midwifery research agenda forward.

Attitude of Health Personnel↗
PubMed2006

Clinician perspectives on decision-making capacity after acquired brain injury.

Acquired brain injury frequently alters an individual's ability to make health care decisions based on a clear understanding of the situation and options. This exploratory study investigated the ways health care providers address issues of decisionmaking capacity (DMC) on a daily, functional basis. 33 clinicians providing rehabilitation services to persons with acquired brain injury participated in 1 of 5 semi-structured focus groups. All 33 participants, representing 8 different occupations, agreed that DMC determinations affected their practice every day. Participants underscored a multidimensional rather than a unitary definition of DMC, with an emphasis on fluctuating capacities due to the injury. Important concerns were for the safety of the person with brain injury, the health care provider, and community members. Other themes included rehabilitation team involvement, family context, and professional socialization. Clinical determinations of DMC are context dependent and are affected by the abilities of the individual and the substance and consequences of the decision being made and include the concepts of regaining trust and reclaiming capacity.

Adult↗
PubMed2000

Treating substance abuse in the context of severe and persistent mental illness: clinicians' perspectives.

Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population.

Adult↗
PubMed2002

The prevalence and management of trauma in the public domain: an agency and clinician perspective.

This descriptive study surveyed the ways in which trauma survivor needs have been addressed within the public mental health system in one sector of Connecticut. Information was obtained about the prevalence of traumatic history among consumers, the existence of policy related to trauma, trauma screening and cross-referral mechanisms, and trauma-related supervision and education. The study maps current service system functioning related to the provision of trauma-specific services at both the agency and the clinician level. The study data indicate a need for service enhancement and increased service system collaboration and integration to permit access to a full range of trauma interventions. The data also indicate a need for increased clinician education and supervision specific to trauma both across agencies and among individual clinicians.

Adult↗
PubMed1995

Attitudes and behaviors towards clinical guidelines: the clinicians' perspective.

Objectives--To find out what attitudes hospital doctors have towards the culture of clinical guidelines; to ascertain perceived knowledge and use of clinical guidelines; and to investigate why hospital doctors think that clinical guidelines may not be used and how they think that the use of guidelines can be encouraged. Design--Postal questionnaire survey be tween October 1993 and January 1994. Setting--Hospitals within Oxford region. Subjects--409 doctors of all grades working in one of six specialties (anaesthetics, paediatrics, general surgery, general medicine, obstetrics and gynaecology and accident and emergency medicine). 47 were randomly picked as part of the pilot study, 362 were extracted from hospital staffing lists. Results--268 clinicians (66%) responded to the questionnaire. Most respondents (77%, 208) expressed welcoming attitudes towards guidelines but 51%(136) perceived the attitudes of their colleagues as being less favourable. Over three quarters of respondents claimed to use guidelines at least once a month. Most respondents learnt about guidelines from discussions with their peers (50%, 134 respondents) or senior doctors 37%, 99) or from journals (39%, 105). Reasons why guidelines may not be used included being unaware of particular guidelines (80%, 213 respondents) and the fact that guidelines had been poorly developed (64%, 171) or were impractical (49%, 132). The best ways to encourage the use of guidelines were thought to be encouragement from senior doctors (72%, 193 respondents) and peers (59%, 157) and by monitoring behaviour and providing feedback (68%, 181). Conclusion--The decision to use a guide line was based on the perceived value of each guideline and was influenced by other clinicians' behaviour. The results provide an insight into aspects of dissemination and implementation which are perceived as influential by the recipients of guidelines.

Attitude of Health Personnel↗
PubMed2002

What patients want to know about their medications. Focus group study of patient and clinician perspectives.

OBJECTIVE: To describe what patients want to know about their medications and how they currently access information. To describe how physicians and pharmacists respond to patients' information needs. To use patients', physicians', and pharmacists' feedback to develop evidence-based treatment information sheets. DESIGN: Qualitative study using focus groups and a grounded-theory approach. SETTING: Three regions of Canada (British Columbia, Nova Scotia, and Ontario). PARTICIPANTS: Eighty-eight patients, 27 physicians, and 35 pharmacists each took part in one of 19 focus groups. METHOD: Purposeful and convenience sampling was used. A trained facilitator used a semistructured interview guide to conduct the focus groups. Analysis was completed by at least two research-team members. MAIN FINDINGS: Patients wanted both general and specific information when considering medication treatments. They wanted basic information about the medical condition being treated and specific information about side effects, duration of treatment, and range of available treatment options. Physicians and pharmacists questioned the amount of side-effect and safety information patients wanted and thought that too much information might deter patients from taking their medications. Patients, physicians, and pharmacists supported the use of evidence-based treatment information sheets. CONCLUSION: Patients and clinicians each appear to have a different understanding of what and how much information patients should receive about medications. Feedback from patients can be used to develop patient-oriented treatment information.

Drug Therapy↗