Impact on physical, social, and family functioning of patients with metachromatic leukodystrophy and their family members in Japan: A qualitative study

Metachromatic leukodystrophy is a rare autosomal recessive disease. There are three forms of this disease, all of which result in cognitive and motor dysfunctions. Although enzyme replacement and gene therapies have been developed, they are not expected to be effective in patients with advanced diseases. Therefore, it is important to focus on treatment effects and patients' quality of life; however, qualitative findings on the experiences of patients and their families have not been adequately reported. Interviews were conducted with the family members of patients with metachromatic leukodystrophy in Japan. Verbatim transcripts were analyzed using a qualitative content analysis approach. We interviewed the mothers of five patients. Verbatim interview transcripts were classified into 81 codes. The codes were then aggregated into 15 categories and 3 themes: challenges of life for the patients, challenges in the healthcare system, and challenges of family function. Disease progression greatly affects patients' lives. Moreover, social systems supporting patients and their families are inadequate, especially as the disease progresses. Family members face life restrictions and role changes because of the patient's diagnosis. Patients with metachromatic leukodystrophy and their families require comprehensive support.

What does consumer and community involvement in health-related education look like? A mixed methods study

Consumer and community involvement (also referred to as patient and public involvement) in health-related curricula involves actively partnering with people with lived experience of health and social care systems. While health professions education has a long history of interaction with patients or consumers, a shift in the way consumer and community engage in health-related education has created novel opportunities for mutual relationships valuing lived experience expertise and shifting traditional education power relations. Drawing on a mixed methods design, we explored consumer and community involvement practices in the design and delivery of health-related education using the capability, opportunity, motivation and behaviour framework (COM-B). In our results, we describe educator capabilities, opportunities and motivations, including identifying barriers and enablers to consumer and community involvement in health-related education. Educators have varying philosophical reasons and approaches for involving consumers and community. There is a focus on augmenting student learning through inclusion of lived and living experience, and on mutual transformative learning through embedding lived experience and co-creating learning. How these philosophical positionings and motivations shape the degree by which educators involve consumers and community members in health-related curricula is important for further understanding these educational partnerships within universities.

Qualitative analysis of patient interviews on the burden of neuronopathic Gaucher disease in Japan

BACKGROUND

Gaucher disease (GD) is a rare, autosomal recessive lysosomal storage disorder that adversely affects life expectancy and health-related quality of life (HRQOL). Although HRQOL questionnaires are available for type 1 GD, they are not suitable for patients with the neuronopathic types 2 and 3 GD who have neurological symptoms that develop during early childhood or adolescence. Here we report the development of a language-validated HRQOL questionnaire specifically for patients with neuronopathic types 2 and 3 GD in Japan, which is the first step toward HRQOL questionnaire provision for all types of GD in the future.

METHODS

In February and March 2021, semi-structured interviews were conducted by the authors (supported by qualified interviewers) with patients and/or their caregivers (for patients < 16 years old) who were recruited from a Japanese patient association, the Association of Gaucher Disease Patients in Japan. Qualitative analysis of interview transcripts was used to identify major themes and key topics within those themes. Hierarchical cluster analysis and co-occurrence network analysis were performed to map relationships between commonly occurring words. The study is registered at the UMIN Clinical Trials Registry ( https://www.umin.ac.jp/ctr/index.htm [UMIN000042872]).

RESULTS

Three main themes emerged from qualitative analysis: treatment status, patient burden, and social support systems. Key topics within each theme included hearing impairment, visual impairment, difficulty swallowing, difficulty speaking, involuntary movement of extremities, epileptic seizures, and body aches (treatment status); anxiety about symptoms, difficulty with exercise and work, anxiety about continuing treatment, anxiety about going out, and tiredness from hospital visit or treatment (patient burden); and dissatisfaction about government service, lack of social support, and information exchange in the patient association (social support systems). Commonly used words and the relationships between words identified through the hierarchical cluster and co-occurrence network analyses supported these themes and topics.

CONCLUSIONS

The themes and topics identified in this analysis were specific to patients with types 2 and 3 GD and will be used to inform the development of a HRQOL questionnaire specifically for patients with all GD types.

An Early Interview Day with Feedback to Prepare General Surgery Applicants for Residency Interviews

BACKGROUND

Success in the residency interview is important in obtaining a position in general surgery residency. Preparing applicants for interviews is imperative yet can be resource intensive. The primary objective of our study was to investigate whether an early interview day with feedback (IDWF) provides interview preparation to internal applicants to general surgery residency without negatively impacting their rank list position at our program.

METHODS

Internal applicants to the general surgery residency program at a single academic institution were invited to an early interview day after which they received individualized feedback and attended a workshop on interview techniques. Applicants were anonymously surveyed after The Match to measure their experiences with the IDWF. Two years of post-intervention program rank lists were compared to those from the five years pre-intervention to assess for change in rank list position of internal applicants. Participants included the 16 of 20 internal applicants who completed the survey. De-identified rank order data of internal applicants between 2014 and 2020 included 48 applicants.

RESULTS

All applicants believed the IDWF should be continued, and over half reported improved confidence and made changes from feedback. Rank list analysis demonstrated no statistically significant change in the proportion of internal applicants who ranked in the top 40 nor the average rank position of internal applicants.

CONCLUSIONS

An early interview day with feedback provides interview preparation in a resource-efficient manner without harming rank list position. The IDWF may be generalizable to other institutions to provide interview preparation to general surgery residency applicants.

Brave New World: Challenges and Opportunities in the COVID-19 Virtual Interview Season

The COVID-19 pandemic has forced the transition of the traditional residency interview to a virtual format. This new interview format creates additional challenges and opportunities for both programs and applicants. The specific challenges of the virtual interview format are described, as well as means to mitigate those challenges. In addition, opportunities to improve residency selection from the program end are described.

Stakeholder views regarding a planned primary care office-based interactive multimedia suicide prevention tool

OBJECTIVES

Nearly half of all men who die by suicide visit a primary care clinician (PCC) in the month before death, yet few disclose suicide thoughts. We solicited stakeholders' views to guide development of a tailored multimedia program to activate middle-aged men experiencing suicide thoughts to engage with PCCs.

METHODS

We conducted semi-structured interviews with 44 adults self-identifying as: suicide attempt survivor; family member/loved one of person(s) who attempted or died by suicide; PCC; non-PCC office staff; health administrator; and/or prevention advocate. We coded recorded interview transcripts and identified relevant themes using grounded theory.

RESULTS

Two thematic groupings emerged, informing program design: structure and delivery (including belief the program could be effective and desire for use of plain language and media over text); and informational and motivational content (including concerns about PCC preparedness; fear that disclosing suicide thoughts would necessitate hospitalization; and influence of male identity and masculinity, respectively, in care-seeking for and interpreting suicide thoughts).

CONCLUSION

Stakeholder input informed the design of a primary care tailored multimedia suicide prevention tool.

PRACTICE IMPLICATIONS

In revealing a previously unreported barrier to disclosing suicide thoughts to PCCs (fear of hospitalization), and underscoring known barriers, the findings may suggest additional suicide prevention approaches.

The utility of multiple mini-interviews: experience of a medical school

PURPOSE

This paper aims to introduce the design of multiple mini-interviews (MMIs) as a tool to assess medical school applicants' attributes in alignment with the school's educational goals and to evaluate its utility.

METHODS

In this MMI, candidates rotated through six stations (10 minutes per station), in which specific interview topics were drawn by mapping the school's educational goals with the core competencies for entering medical students. We conducted post-MMI surveys of all of the interviewers and candidates to investigate their experiences of MMIs. The G-coefficient and interclass correlation were analyzed to investigate the reliability of this test. Additionally, the candidates' MMI scores were compared across different backgrounds and a univariate analysis was used to estimate correlations between their MMI scores and prior academic achievements.

RESULTS

A total of 164 candidates (a 98.8% response rate) and 19 interviewers (a 100% response rate) completed the surveys in the years 2014 and 2015. Both candidates and assessors showed positive responses to MMIs. The G-coefficient of MMI scores was 0.88 and the interclass correlation coefficients ranged from 0.58 to 0.75. The participants' total MMI scores did not differ across genders or undergraduate backgrounds and were not associated with age, undergraduate graduate point averages, nor the Korean medical school admission test (Medical Education Eligibility Test) scores.

CONCLUSION

Our study illustrates the utility of MMIs that utilize the institution's educational goals to identify attributes to be pursued in the admission interviews in alignment with the institution's core values. Future research is warranted of the predictive validity of this MMI.

Detecting the effects of physician training in self-care interviewing skills: Coding of standardized patient (SP) visit recordings versus SP post-visit ratings

OBJECTIVE

To compare how coder ratings of standardized patient (SP) visit recordings and SP ratings of the visits detect primary care physician (PCP) training in self-efficacy enhancing interviewing techniques (SEE IT).

METHODS

Analyses of data from 50 PCPs who participated in a randomized controlled trial of SEE IT training, which led to increased SEE IT use during three SP visits 1-3 months post-intervention. Untrained SPs rated SEE IT use post-visit. Subsequently, three trained coders generated a consensus SEE IT rating from visit audio recordings. SPs and coders were blinded to provider study arm, and coders to SP ratings.

RESULTS

SP and coder ratings were correlated (r=0.62). In detecting the intervention effect, the areas under the receiver operating characteristic curve were 0.80 (95% CI 0.74-0.87) and 0.76 (95% CI 0.69-0.84) for consensus coder and SP ratings, respectively (difference 0.04, 95% CI -0.04-0.11; z=1.04, p=0.30).

CONCLUSION

SP ratings were not significantly different from coder ratings of SP visit recordings in detecting PCP SEE IT training.

PRACTICE IMPLICATIONS

If similar findings are observed in larger studies, it would suggest a greater role for SP ratings in detecting provider interviewing skills training, given the relative simplicity, low cost, and non-intrusiveness of the approach.

Physician training in self-efficacy enhancing interviewing techniques (SEE IT): Effects on patient psychological health behavior change mediators

OBJECTIVE

To explore how physician training in self-efficacy enhancing interviewing techniques (SEE IT) affects patient psychological health behavior change mediators (HBCMs).

METHODS

We analyzed data from 131 patients visiting primary care physicians ≥4 months after the physicians participated in a randomized controlled trial. Experimental arm physicians (N=27) received SEE IT training during three ≤20min standardized patient instructor (SPI) visits. Control physicians (N=23) viewed a diabetes medications video during one SPI visit. Physicians were blinded to patient participation. Outcomes were self-care self-efficacy, readiness, and health locus of control (Internal, Chance, Powerful Others), examined as a summary HBCM score (average of standardized means) and individually. Analyses adjusted for pre-visit values of the dependent variables.

RESULTS

Patients visiting SEE IT-trained physicians had higher summary HBCM scores (+0.42, 95% CI 0.07-0.77; p=0.021). They also had greater self-care readiness (AOR 3.04, 95% CI 1.02-9.03, p=0.046) and less Chance health locus of control (-0.27 points, 95% CI -0.50-0.04, p=0.023), with no significant differences in other HBCMs versus controls.

CONCLUSION

Improvement in psychological HBCMs occurred among patients visiting SEE IT-trained physicians, PRACTICE IMPLICATIONS: If further research shows the observed HBCM effects improve health behaviors and outcomes, SEE IT training might be offered widely to physicians.

Generating or developing grounded theory: methods to understand health and illness

Grounded theory is a qualitative research methodology that aims to explain social phenomena, e.g. why particular motivations or patterns of behaviour occur, at a conceptual level. Developed in the 1960s by Glaser and Strauss, the methodology has been reinterpreted by Strauss and Corbin in more recent times, resulting in different schools of thought. Differences arise from different philosophical perspectives concerning knowledge (epistemology) and the nature of reality (ontology), demanding that researchers make clear theoretical choices at the commencement of their research when choosing this methodology. Compared to other qualitative methods it has ability to achieve understanding of, rather than simply describing, a social phenomenon. Achieving understanding however, requires theoretical sampling to choose interviewees that can contribute most to the research and understanding of the phenomenon, and constant comparison of interviews to evaluate the same event or process in different settings or situations. Sampling continues until conceptual saturation is reached, i.e. when no new concepts emerge from the data. Data analysis focusses on categorising data (finding the main elements of what is occurring and why), and describing those categories in terms of properties (conceptual characteristics that define the category and give meaning) and dimensions (the variations within properties which produce specificity and range). Ultimately a core category which theoretically explains how all other categories are linked together is developed from the data. While achieving theoretical abstraction in the core category, it should be logical and capture all of the variation within the data. Theory development requires understanding of the methodology not just working through a set of procedures. This article provides a basic overview, set in the literature surrounding grounded theory, for those wanting to increase their understanding and quality of research output.

The experience of being a partner to a spinal cord injured person: A phenomenological-hermeneutic study

This qualitative focuses on the personal experiences of partners to a spinal cord injured person. Using a Ricoeurian phenomenological-hermeneutic approach, we analysed seven partners’ narratives 1 and 2 years after their partner's injury. The study revealed how the injury was experienced from the partners’ perspective through the aftermath. In the acute phase after the injury, partners also felt harmed, and support was needed in relation to their own daily activities, eating, resting, and managing distress. During the institutionalized rehabilitation, partners felt torn between supporting the injured partner and the demanding tasks of everyday life outside the institution. After discharge, partners struggled for the injured partner to regain a well-functioning everyday life and for reestablishing life as a couple. The partner struggled to manage the overwhelming amount of everyday tasks. Some sought to reestablish their usual functions outside the family, whereas others focused on establishing a new life together. The partners experienced much distress and appreciated the support they got, but felt that they were mainly left to manage the difficult process on their own.