106 research outputs found
Facilitating trial recruitment: a qualitative study of patient and staff experiences of an orthopaedic trauma trial
Get PDFBackground: Qualitative research has been used to explore patients' and healthcare professionals' experiences of surgical randomised controlled trials (RCTs). From this research, reasons why patients accept or decline participation and barriers to engaging clinicians in trials have been identified. In a trauma setting, recruitment to surgical trials can be particularly difficult as patients may require urgent treatment and their ability to consider their options, ask questions and reach a decision may be hindered by the impact of their injury. Little research, however, has explored patients' and healthcare professionals' experiences of surgical RCTs in a trauma setting. This study aimed to understand patients' and staff's experiences of an orthopaedic trauma trial. Methods: We carried out semi-structured interviews with 11 patients and 24 staff (10 surgeons and 14 research associates) participating in a UK multi-centre feasibility trial comparing intramedullary nails versus distal locking plates for fractures of the distal femur (TrAFFix). Interviews explored patients' experience of TrAFFix and their reason for participating and staffs' experience of recruiting to TrAFFix and trauma trials more generally. Interviews were audio recorded and transcribed verbatim. Transcripts were analysed using thematic analysis. Results: Three themes were identified. These were i) navigating research with patients after orthopaedic trauma, ii) knowing that it is the right decision and iii) making it work. These themes reflect: i) how research associates supported and guided patients through the consent process enabling them to participate, ii) the difficulty in engaging surgeons in a trial when individual equipoise and experience of the interventions are low despite the presence of community equipoise and iii) the way in which research teams worked together and encouraged the development of a research culture within the clinical teams in order to facilitate recruitment. Conclusions: Our findings highlight the pivotal role of research associates (RAs) in facilitating trial recruitment. RAs supported patients to enable them to make a decision about participation and assisted in developing a research culture within the team by promoting studies and communicating research to clinical staff. Our findings also reinforce surgeons' difficulty with equipoise and suggest that accepting community equipoise could facilitate recruitment.</p
A mixed-methods systematic review of patients' experience of being invited to participate in surgical randomised controlled trials
Get PDFRationale: randomised controlled trials (RCTs) of surgical interventions are increasing. Such trials encounter challenges that are not present in RCTs of non-surgical interventions because of the nature of the intervention. Several studies have explored patients' experiences of surgical trials to improve recruitment or identify barriers and facilitators to research in this setting. Synthesizing these studies may reveal further insights or confirm whether saturation of relevant themes has been achieved.Objective: this review aimed to understand the experiences of adults who are invited to participate in surgical RCTs.Method: MEDLINE, Web of Science, and CINAHL were searched to identify articles meeting the inclusion criteria. Assessment of quality was conducted with studies given an overall quality rating of good, fair, or poor. A segregated approach was used to synthesize the data. This method included a thematic synthesis of the qualitative data and a narrative review of the quantitative data. The findings of both syntheses were then integrated.Results: thirty-four articles reporting 28 trials were included. This review found that the decision to participate in a surgical trial is influenced by multiple factors including patients' individual circumstances and attitudes, and the characteristics of the trial itself. The study identified three themes which encompass both qualitative and quantitative findings. These themes reveal it was important for patients to i) make sense of the trial and trial processes, ii) weigh up the risks and benefits of their different treatment options and participation, and iii) trust the trial and staff.Conclusions: a patient-centred approach to trial recruitment may help staff build trusting relationships with patients and address their individual concerns about the trial and the risks and benefits of participation
A qualitative study of patients' experience of recovery after a distal femur fracture
Get PDFPurposeThis qualitative study was conducted as part of a feasibility study for TrAFFix, (ISRCTN92089567), a randomised controlled trial that will compare two surgical interventions used to fix distal femoral fractures. Our aim was to understand patients’ experiences of treatment and the early phase of recovery after a distal femoral fracture. While, much is known about the experience of recovery from hip fracture, little is known about whether patients with other lower limb fragility fractures experience the same concerns and challenges.Materials and MethodsSemi-structured interviews were conducted with 11 patients participating in TrAFFix or their relative. Interviews were conducted face to face or by telephone. With agreement from participants, interviews were audio recorded and transcribed. Transcripts were analysed inductively using thematic analysis. As part of the user involvement for TrAFFix, we held a focus group with PPI representatives who had experience or knowledge of lower limb fractures, to learn about factors that might influence patients’ recovery after a fragility facture. Data from the focus group relevant to themes from our thematic analysis are also presented.ResultsThree themes were identified within patients’ accounts of their experience. Our data revealed that: i) being informed about treatment and recovery was important to patients; ii) patients muddled through and found ways to manage at home, often needing the support of others; and iii) rehabilitation was arduous for patients who received limited rehabilitative support and at times lacked confidence to follow the instructions that they were given.ConclusionsOur findings highlight the struggle patients endure while recovering after a distal femoral fracture and the limited rehabilitative support they receive after discharge from hospital. They reinforce the need to ensure a patient feels informed about their treatment and recovery and the need for greater support for patients to manage at home and move with confidence
A qualitative study of parents’ and their child’s experience of a medial epicondyle fracture and what they think about the treatment options
No full textUnderstanding informal carers experiences of caring for older people with a hip fracture: a systematic review of qualitative studies
Get PDFThis systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice. Method: Meta-ethnography was used to inform the review, and 21 studies were included. Findings: The analysis identified a core theme of “engaging in care: struggling through”, as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown. Conclusions: The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.Fil: Saletti, Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad. Universidad Nacional de Córdoba. Centro de Investigaciones y Estudios sobre Cultura y Sociedad; ArgentinaFil: Tutton, Elizabeth. NHS Foundation Trust. Oxford University. Kadoorie Critical Care Research and Education Centre; Reino Unido. University of Warwick. Warwick Medical School. Royal College of
Nursing Research Institute; Reino UnidoFil: Lanstaff, Debbie. NHS Foundation Trust. Oxford
University Hospital. Trauma Unit, John Radcliffe Hospital; Reino UnidoFil: Willett, Keith. University of Oxford. Rheumatology and Musculoskeletal Science. Nuffield Department of Orthopaedics; Argentina. NHS Foundation Trust. Oxford University. Kadoorie Critical Care Research and Education Centre; Reino Unid
Fluid optimisation using a peripherally inserted central catheter (PICC) following proximal femoral fracture: Lessons learnt from a feasibility study
No full textThe aim of this study was to test the feasibility of using peripherally inserted central catheters (PICCs) in older people to enable fluid optimisation. Fourteen patients were randomised to three groups: (i) usual care, insertion of short peripheral intravenous cannulae and normal fluid prescription; (ii) PICC insertion and normal fluid prescription; (iii) PICC insertion and guided fluid prescription based on measurements of central venous pressure (CVP). A range of outcome measures were undertaken, plus two focus groups with ward staff and an interview with the research nurse to ascertain views concerning the implementation of the study. Descriptive findings identified that PICC use in this group of patients was extremely difficult. The practical issues affecting the feasibility of this study were: (i) the physical and psychological frailty of the patients, proxy consent, difficulties measuring outcomes, unsuccessful PICC placement due to aged veins, intolerance to lines; (ii) staff concerns relating to patient vulnerability, competent use of new technology, limited resources and work capacity. Most aspects of the trial were made more difficult due to the frailty of the patient group
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