Deciding to pursue answers to clinical questions: An exploratory study of stroke clinicians
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Canadian Health Libraries Association Annual Conference, June 14, 2012 Hamilton, ON Lorie Kloda Joan Bartlett McGill University
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Deciding to pursue answers to clinical questions: An exploratory study of stroke clinicians
- 1. Deciding to pursue answers to clinical questions an exploratory study of stroke clinicians Lorie A. Kloda, MLIS, PhD, AHIP Joan C. Bartlett, MLS, PhD McGill University Canadian Health Libraries Association June 14, 2012, Hamilton
- 2. Research objective To explore the clinical questions of rehabilitation therapists in the context of their everyday practice
- 3. Information behaviour 3 (Wilson, 1997, p. 569)
- 4. Information behaviour Information Information need Enablers/obstacles seeking Person-in-context Information processing and use 4
- 5. Information behaviour Information Information need Enablers/obstacles seeking Person-in-context Information processing and use 5
- 6. Evidence-based practice Formulating Evaluating the the Process Question Searching Applying the the Results Evidence Appraising the Evidence 6
- 7. Evidence-based practice Formulating Evaluating the the Process Question Searching Applying the the Results Evidence Appraising the Evidence 7
- 8. Clinical question A formalized information need related to the care of a patient. From Taylor’s (1968) typology of information needs or questions: Q1. Visceral need Q2. Conscious need Q3. Formalized need Q4. Compromised need 8
- 9. Research question How do rehabilitation therapists choose which clinical questions to pursue?
- 10. Rehabilitation therapist A certified professional whose aim is to improve the functional independence of individuals with physical or cognitive disabilities. Physiotherapist (PT) Occupational therapist (OT) Speech-language pathologist (SLP) 10
- 11. Sampling& recruitment Stroke rehabilitation Purposeful, snowball sampling
- 12. Methods clinical narrative thematic question journal interview analysis
- 13. Informants 4 Occupational therapists 4 Physical therapists + 7 Speech-language pathologists ________ 15
- 14. Clinical questions pursued 129 Total clinical questions 92 37 Data gathered re: No data gathered pursued/answered 43 49 Pursued Not pursued 28 15 Answered Not answered 14
- 15. Findings Memory Belief in existence of an answer Use of answer Feeling of responsibility Effort required Self-efficacy Organizational support 15
- 16. “forget about it. Time goes and I I have other projects and there’s other Memory patients and because it’s busy, I just tend to drop this as the first thing to do.” (OT2) “Honestly, time and I forget, you know.” (PT4) 16
- 17. ”Well I, you know, I have great faith that every time I go to research something that there’s just so much Belief or doubt in information that I know that there is existence of an unbelievable amounts of information. I answer have faith that I will be able to answer, that I will find the information. But it’s not easy, you know.” (SLP2) “don't think that's likely to be I answerable because it's a combination of things and usually that’s exclusion criteria in all the studies.”(PT1) 17
- 18. Advance professional knowledge or understanding “There will probably be information about what they're doing, but I think it wouldn't vary much differently from what I'm already doing. So it might give Intended use of the me a few new ideas, but I don't think it answer would really change my practice all that much.”(PT3) 18
- 19. Establish Authority ”It would have helped. In this case, it would have helped because there was a discrepancy between what we were saying and what the family was saying.” (SLP4) Intended use of the answer 19
- 20. Decision making Impact on patient wellbeing Impact on future patients Intended use of the answer 20
- 21. “At least, once I wrote it down. I’d better look for the answers.” (SLP1) “think it’s going to be really I depressing because I’m not going to have time to answer it.” (OT2) really should look that up.”(SLP5) ” ”I’m notoriously... Bad bad Feeling of therapist.”(OT4) responsibility 21
- 22. “… have to wade through a lot of you stuff.”(SLP2) “ unlikely that this is the type of It’s question I would invest time in trying to track down an answer to, especially because it’s to the extent an answer exists, it’s likely to be in books or journals or whatever that I am not familiar with so it would be extra work for me to find it.” (SLP3) Effort required to find an answer 22
- 23. “ That’s part of the problem because to me looking at the literature sounds like Self-efficacy a big mountain. I don’t really know what to do although I kind of, you know, I had to do it in university but I kind of forgot. I remember the Medline and whatever but like today, if I have to go, I would be like what am I supposed to do? Where do I start? So it’s not like a fast thing because I’m not used to do it. It’s part of the problem. If it was fast, like if I knew exactly where to go and whatever, I would probably do it maybe a little bit more.” (PT4) 23
- 24. For locating evidence – Librarian – Resources (databases) Perceived – Computer access, internet access organizational support For implementing evidence 24
- 25. Conclusion Themes explain why therapists choose to pursue some clinical questions while leaving others unanswered
- 26. Limitations No direct observation Recall Not exhaustive 26
- 27. Implications EBP and information literacy instruction Clinical information services EBP framework
- 28. Acknowledgements Dissertation committee Joan Bartlett (chair), France Bouthillier, NicolKorner-Bitensky, Andrew Large & Pierre Pluye Funding Thomson Scientific / MLA Doctoral Fellowship Fondsquébecois de la recherchesur la société et la culture Canadian Library Association World Book Scholarship Study informants
Hinweis der Redaktion
- Research was exploratory in nature. Expectations is to raise more research questions.Part of a larger study. This was one of the research questions with the goal of characterizing CQs of this particular group of health professionals which has not been the focus of much research to date.A clinical question is an information need arising from everyday clinical practice that is formalized linguistically. It is not restricted to PICO or any specific formulation. It is not only a question which can conceivably be answered by literature. It is not the same as search terms entered into a resource or search engine. (Mention Taylor’s definition of information needs if there is time)
- This research is a study in the field of information behaviour, which is “the study of how people need, seek, give, and use information in different contexts, including the workplace and everyday living.” [Pettigrew et al, 2001]This here is Wilson’s revised model of information behaviour, a widely referenced model used to DESCRIBE the process of information behaviour. And I’ve highlighted the relevant components….
- Information behaviour begins with a person in a specific context. That person become aware of their own information need, and then may decide to pursue that need OR NOT, and engage in information seeking. Once they have obtained information, the person may then use the information.This dissertation focuses on the recognition and formulation of info needs and the transition to info seeking (or not)
- This dissertation focuses on the recognition and formulation of info needs and the transition to info seeking (or not)
- Another important framework is that of evidence-based practice. EBP is a movement in health care which advocates for the use of evidence – or information in the form of scientific research – to inform health care decisions, and ultimately, patient care.EBP offers a PRESCRPTIVE model for how health professionals should formulate their information needs, search for information, and use that information. It’s steps parallel those of the information behaviour process. Yet, it tells people how they should behave with respect to each of these steps.
- Again, this dissertation is concerned with the first step, and the transition to the 2nd step.
- A clinical question is a term often used in EBP. For this study, a clinical question is defined as a formalized information need relating to patient care. This definition draws from Robert Taylor’s description of information needs, or questions in his seminal paper on question negotiation in the reference interview, in which he described the different levels of questions.Taylor conceptualized the information need as starting with an unconscious sense of unease before being recognized by the individual. At some point, a person may choose to state their information need, either in writing or out loud. At that stage, it is considered formalized. In some cases, the person may go so far as to compromise the information need, by simplifying or shortening it, when sharing it with someone else. For example, when sharing it with a librarian, or typing in search terms into a search engine.A clinical question, therefore, is a need that has been formalized linguistically, but not yet compromised.It does not necessarily need to be answered by published information, and in fact it doesn’t necessarily have to have an answer.
- Rehab therapists, in this study, include PTs, Ots, and SLPs.This study was restricted to rehab therapists working in the context of stroke rehabilitation
- Population of interest: stroke rehabPurposeful, snowball sampling, with the goal of max variation5 different sites, ethics from each institution
- I conducted this research using an Interpretive, social constructivist approach. This entailed the careful selection of the sample, and the gathering and analysis of qualitative data resulting in categories or “themes”, which could then potentially be transferred to other settings.
- Acute and rehab hospitals, in/out-patients, various years of experienceClinicians recorded 129 clinical questions, and were interviewed to discuss some of their questions, as well as their information needs more generally.
- Range of CQs asked: between 1 and 17. mean was 8, more than I expected43 out of 92 (47%) CQ were pursued, of there, 28 out of 43 (65%) were answered (not necessarily “correctly” or fully, but enough that the clinician thought there was not more reason to seek info)Between 30% and 57% of clinical questions asked by physicians are pursued, and of those, 72% to 89% are reported as correctly answeredClinical Question breakdown:26 by OTs44 by PTs59 by SLPs97 stroke19 neuro13 other
- Several themes emerged from the interviews to explain a therapist’s decision to pursue an answer to a clinical question: First, a therapist has to remember the question, since they don’t always seek information immediately. Also, the must believe that an answer may exist. If they don’t think a question has an answer, they definitely won’t spend time trying to find one. The potential use of the answer as well as their feeling of responsibility also influence the decision. Other factors include the amount of effort required to get an answer, including time as well as the therapist’s perceived self efficacy, or their perception of their capability to locate an answer. Finally, the perception support from the organization for information seeking is also a factor. This support can take several forms, including, for example, the availability of a librarian.These themes conform Wilson’s model of information behaviour, where he proposed that activating mechanisms and intervening variables influence whether or not information seeking takes place.
- Reminder of clinical question through recording – goal setting?
- Different levels of urgency/importanceIf the answer is needed for immediate decision making, or for professional role (e.g. report writing), then that takes priority over personal understanding or future patients.
- pressureHomeworkGoal setting (inadvertently)Self-derogatory comments, referring to oneself as “lazy”What I want to convey here is affect – emotion. Also, frustration came up, but not as much
- “So I think it’s like more sort of you had dedicated time to sit down and do it, I don’t think it would take that long. It’s just trying to make yourself to actually do it.” (OT4)Effort & time/workload are related concepts
- No one mentioned wireless, but clinicians did mention librarian, online resources (databases, journal subscriptions) and proximity to a computerLibrarian was mentioned as a resource available for rehab hospital clinicians. Those in acute care were unaware for the most part.Few mentioned point of care resource access, and none mentioned wireless or mobile tech
- The structural elements that emerged in the analysis of the 129 clinical questions suggest that the PICO question-formulation structure is inadequate in representing rehabilitation therapists’ formalized information needs. The findings suggest that the evidence-based practice framework is inadequate for describing how rehabilitation therapists’ formulate their clinical questions.
- Some of the limitations of this study were:- there was no direct observation, as information needs are not observable behaviour. - As a result, there may have been problems with informants’ recall. However, studies have indicated the effectiveness of using diaries to mitigate recall bias.- The typology of question foci, structural elements, and themes are not meant to be an exhaustive representation of all possibilities arising in stroke rehabilitation.