Papers by Patricia Strachan
Journal of the American Medical Directors Association, 2018
Objectives: This paper reports findings on the usability and staff use of five condition-specific... more Objectives: This paper reports findings on the usability and staff use of five condition-specific pamphlets of high prevalence in LTC: dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-oflife care. Design: A mixed-method (qualitative and quantitative) survey design was used. Step one collected survey data on the usability of the pamphlets. Step two collected survey data on pamphlet use. Settings and Participants: Two nurses with specialized palliative care training, two resident /family representatives, ten condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. 178 LTC home staff in four participating LTC homes reported on pamphlet use. Measures: Specialists and resident /family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability and relevance of the pamphlets. After six months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. Results: The pamphlets were reportedly accurate, relevant, and easy to understand. Following six months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (i.e. staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. Conclusions/Implications: Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training and discussions are required to improve staff comfort with distribution, and explore roles in distribution and follow-up.
Pain Medicine
Objective Although there is growing interest in medically authorized cannabis for chronic pain, l... more Objective Although there is growing interest in medically authorized cannabis for chronic pain, little is known about patients’ perspectives. We explored perceptions of people living with chronic pain regarding benefits and concerns surrounding their use of cannabis for therapeutic purposes. Setting A hospital-based clinic in Hamilton and two community-based interdisciplinary pain clinics in Burlington, Ontario, Canada. Methods In this qualitative descriptive study, we conducted semi-structured interviews with 13 people living with chronic pain who used cannabis therapeutically, living in Ontario, Canada. We used thematic analysis, with data collection, coding, and analysis occurring concurrently. Results People living with chronic pain reported important benefits associated with use of cannabis for therapeutic purposes, including reduced pain, improved functionality, and less risk of harms compared to prescription opioids. Most patients also acknowledged harms, such as grogginess a...
Amyotrophic lateral sclerosis & frontotemporal degeneration, 2022
Objective: The aim of this study was to refine the items of a preference-based amyotrophic latera... more Objective: The aim of this study was to refine the items of a preference-based amyotrophic lateral sclerosis health-related quality of life scale (PB-ALS HRQL scale) based on domains generated in a previous study. Methods: Survey methodology was used to assess item importance rating (IR) and independence. Median importance was calculated for each item and a rating of "very important" was required for the item to remain. Correlations were used to examine item independence. Highly correlated items (rs > 0.7) were considered for removal. Cognitive debriefing (CD) interviews, conducted by Zoom, telephone, or email based on participant preference and communication needs, were used to identify potential issues. Participants provided feedback about wording, clarity, response options, and recall period on randomly selected items. Items were considered finalized when three sequential CD participants approved the item with no revisions. Results: Thirty-four people with ALS (PALS,...
Patient Education and Counseling, 2022
International Journal of Qualitative Methods, 2021
Rapid qualitative research (RQR) studies are increasingly employed to inform decision-making in p... more Rapid qualitative research (RQR) studies are increasingly employed to inform decision-making in public health emergencies. Despite this trend, there remains a lack of clarity around what these studies actually involve in terms of methodological processes and practical considerations or challenges. Our team conducted a global RQR study during the COVID-19 pandemic. In this article, we provide a detailed account of our methodological processes and decisions taken related to ethics, study design, and analysis. We describe how we navigated limitations on time and resources. We draw attention to several elements that operated as facilitators to the rapid launch and completion of this study. Rendering methodological considerations and rationales for specific RQR studies explicit and available for consideration by others can contribute to the validity of RQR, support further discussion and development of RQR methods, and make findings for particular studies more credible.
Canadian Journal of Cardiology, 2010
Professioni infermieristiche, 2019
Within the context of evidence-informed decision making, health care professionals are critical c... more Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues spec...
Professioni infermieristiche, 2019
Within the context of evidence-informed decision making, health care professionals are critical ... more Within the context of evidence-informed decision making, health care professionals are critical consumers of research evidence. Clinician scientists, including nurse researchers, play a central role in producing this research evidence to inform and improve health practice, education, and policy. Health research is commonly conducted within one of three different paradigms: quantitative, qualitative or mixed methods. Each research approach is underpinned with unique philosophic assumptions, methods, and rhetoric. The evidence produced within each paradigm is necessary to provide health care decision-makers with information about the complex, and intrinsically diverse, human experiences of health and illness. Qualitative health research has been defined as a discipline, which has its roots in qualitative research and yet is unique in its focus, methods, and rules. The focus of qualitative health research is to describe, explore, and explain the health-illness continuum and issues spe...
Journal of Hospice & Palliative Nursing
Canadian Journal of Diabetes
Health & Social Care in the Community
Journal of Professional Nursing
JBI Library of Systematic Reviews
Gerontology and Geriatric Medicine
Objective: This article explores whether access to illness trajectory pamphlets for five conditio... more Objective: This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. Method: In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Results: Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from ...
Journal of Pain and Symptom Management
Sociology of health & illness, 2018
For patients living with chronic illnesses, self-care has been linked with positive outcomes such... more For patients living with chronic illnesses, self-care has been linked with positive outcomes such as decreased hospitalisation, longer lifespan, and improved quality of life. However, despite calls for more and better self-care interventions, behaviour change trials have repeatedly fallen short on demonstrating effectiveness. The literature on heart failure (HF) stands as a case in point, and a growing body of HF studies advocate realist approaches to self-care research and policymaking. We label this trend the 'realist turn' in HF self-care. Realist evaluation and realist interventions emphasise that the relationship between self-care interventions and positive health outcomes is not fixed, but contingent on social context. This paper argues socio-materiality offers a productive framework to expand on the idea of social context in realist accounts of HF self-care. This study draws on 10 interviews as well as researcher reflections from a larger study exploring health care t...
Current opinion in supportive and palliative care, Jan 27, 2017
Patients with advanced heart failure require communication about goals of care, yet many challeng... more Patients with advanced heart failure require communication about goals of care, yet many challenges exist, leaving it suboptimal. High mortality rates and advances in the use of life-sustaining technology further complicate communication and underscore the urgency to understand and address these challenges. This review highlights current research with a view to informing future research and practice to improve goals of care communication. Clinicians view patient and family barriers as more impactful than clinician and system factors in impeding goals of care discussions. Knowledge gaps about life-sustaining technology challenge timely goals of care discussions. Complex, nurse-led interventions that activate patient, clinician and care systems and video-decision aids about life-sustaining technology may reduce barriers and facilitate goals of care communication. Clinicians require relational skills in facilitating goals of care communication with diverse patients and families with he...
Canadian journal on aging = La revue canadienne du vieillissement, 2017
This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tension... more This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles wi...
Journal of cardiac failure, Jan 22, 2017
Conversations about goals of care in hospital are important to patients who have advanced heart f... more Conversations about goals of care in hospital are important to patients who have advanced heart failure (HF). We conducted a multi-centre survey of cardiology nurses, fellows, and cardiologists at 8 Canadian teaching hospitals. The primary outcome was the importance of barriers to goals of care discussions in hospital (1=extremely unimportant; 7=extremely important). We also elicited perspectives on roles of different practitioners in having these conversations. Questionnaires were returned by 770/1,024 (75.2%) eligible clinicians. The most important perceived barriers were: family members' or patients' difficulty accepting a poor prognosis (mean [SD] score 5.9 [1.1] and 5.7 [1.2], respectively), family members' or patients' lack of understanding about the limitations and harms of life-sustaining treatments (5.8 [1.1] and 5.7 [1.2], respectively), and lack of agreement between family members about goals of care (5.8 [1.2]). Interprofessional team members were viewed ...
Journal of Pain and Symptom Management, 2016
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Papers by Patricia Strachan