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Compassion is considered a component of quality healthcare that healthcare providers (HCPs) are increasingly expected to provide. While there have been some studies exploring facets of HCPs' perspectives on the barriers and facilitators to providing compassion, a comprehensive understanding based on direct reports from HCPs is lacking. The aim of this study was to explore HCP perspectives and experiences of perceived barriers and facilitators of compassion. This study used Straussian grounded theory to examine HCP perspectives. Semi-structured focus groups with frontline HCPs and individual interviews with peer-nominated exemplary compassionate care providers were audio-recorded, professionally transcribed, and analyzed. Fifty-seven participants were recruited from 3 healthcare settings within both rural and urban settings in Alberta, Canada, using convenience, snowball, and theoretical sampling. Qualitative analysis of the data generated two categories and associated themes and sub-themes delineating perceived barriers and facilitators to compassion. The first category, challenges to compassion, reflects participants' discomfort associating the notion of barriers to compassion, and contained several themes participants conceptualized as challenges: personal challenges, relational challenges, systemic challenges, and maladaptive responses. The second category, facilitators of compassion, included the themes of: personal facilitators, relational facilitators, systemic facilitators, and adaptive responses of intentional action. Although participants described certain factors such as system and time constraints along with interaction styles of patients and families that can challenge HCP compassion, these challenges were not considered insurmountable. While acknowledging these as challenges, participants identified HCPs themselves, including their responses towards the identified challenges of compassion, as significant factors in this process -a novel finding from thi

Background: Personalised information and support can be provided to cancer survivors using a structured approach. Assessment tools such as the Holistic Needs Assessment (HNA) in the UK and the Comprehensive Problem and Symptom Screening (COMPASS) in Canada have been recommended for use in practice. However, completion of the HNA/COMPASS is not widely embedded into practice and Clinical Nurse Specialists (CNSs) express concern about their ability to respond to issues raised by patients. Aims: To investigate CNS's views on HNAs/COMPASS and identify barriers and facilitators to implementation. Methods: This international on‐line survey using a snowball technique recruited CNSs across the UK and one Canadian province (Manitoba) in 2017. Results: A total of 306 CNSs in the UK and 162 in Canada completed the on‐line survey. In the UK, HNAs were completed primarily prior to and immediately after treatment. In Canada, COMPASS was usually completed at every appointment. Participants expressed concerns that HNAs/COMPASS were becoming “tick‐box exercises” which did not meet patients' needs. Barriers to completion were time, staff shortages, lack of confidence, privacy and signposting of resources. Facilitators were privacy for confidential discussions, training, confidence in knowledge and skills, and signposting of resources. Conclusions: That so many busy CNSs completed this survey demonstrates the importance they attach to HNAs and COMPASS. The challenges faced with implementing these assessments into everyday practice require training, time, support services and an appropriate environment. It is vital that the HNA and COMPASS are conducted at optimum times for patients to make the best use of time and resources.

Background Many patients who require an interpreter have difficulty remembering information from their medical consultations. Memory aids such as consultation audio-recordings may be of benefit to these patients. However, there is no established means of measuring patients’ memory of medical information. Objectives This study aimed to develop a method for eliciting and coding recall of medical information in non-English-speaking patients. Design This method, called Patient-Interpreter-Clinician coding (PICcode), was developed in the context of a phase II trial conducted in two outpatient oncology clinics in Melbourne, Australia, and was refined iteratively through consultation with an expert panel and piloting. Between-coder differences in early versions of the coding system were resolved through discussion and consensus resulting in refinements to PICcode. Results The final version of PICcode involved transcribing, translating and coding of audio-recorded consultations and semi-structured interviews (SSI). The SSIs were designed to elicit patients’ free-recall of medical information. Every unit of medical information in the consultation was identified and categorized in a coding tree. SSIs were coded to identify the extent to which information was recalled from the consultation. Discussion The iterative changes involved in developing PICcode assisted in clarifying precise details of the process and produced a widely applicable coding system. PICcode is the most comprehensively described method of determining the amount of information that patients who use an interpreter recall from their medical consultations. PICcode can be adapted for English-speaking patients and other healthcare populations.

Purpose: Little is known about black African (BA) and black African-Caribbean (BAC) men's views towards cancer; yet culture and acculturation can contribute to the way in which people understand, explain and develop their attitudes towards cancer. Hence, cancer prevention and early detection strategies may not be sensitive to United Kingdom (UK)-based black men's views, affecting their awareness of risk factors and early detection services. This study explored the views of UK-based BA and BAC men towards cancer. Method: In collaboration with black community organisations based in four major cities in the UK, 25 participants were recruited using convenience and theoretical sampling methods. Data were collected using 33 semi-structured interviews, and analysed using grounded theory analytic procedures. Results: One core category (cancer through black eyes) and seven sub-categories emerged; ‘cultural views’, ‘religious beliefs’, ‘avoiding Babylon’, ‘alienation’, ‘suspicious mind’, ‘advertisements and information influence very little’, and ‘gap in service provision (bridging the gap)’. Participants' views towards cancer were linked to socially constructed perspectives, linked with cultural and religious beliefs, and shaped by what being a black male means in society. Risk factors such as smoking and obesity had different meanings and symbolisation through black eyes. There were macro- and micro-level similarities and differences between BA and BAC men. Conclusions: Cancer services and related public-health campaigns aimed at black men need to understand cancer through black eyes. Public health campaigns based solely on the clinical meaning of cancer are incongruent with black men's understandings of cancer, and therefore ineffective at reducing health inequality.

Objective: Question prompt lists (QPLs) and consultation audio-recordings (CARs) are two communication strategies that can assist cancer patients in understanding and recalling information. We aimed to explore clinician and organisational barriers and facilitators to implementing QPLs and CARs into usual care. Methods: Semi-structured interviews with twenty clinicians and senior hospital administrators, recruited from four hospitals. Interviews were recorded, transcribed verbatim and thematic descriptive analysis was utilised. Results: CARs and QPLs are to some degree already being initiated by patients but not embedded in usual care. Systematic use should be driven by patient preference. Successful implementation will depend on minimal burden to clinical environments and feedback about patient use. CARs concerns included: medico-legal issues, ability of the CAR to be shared beyond the consultation, and recording and storage logistics within existing medical record systems. QPLs issues included: applicability of the QPLs, ensuring patients who might benefit from QPL’s are able to access them, and limited use when there are other existing communication strategies. Conclusions: While CARs and QPLs are beneficial for patients, there are important individual, system and medico-legal considerations regarding usual care. Practice implications: Identifying and addressing practical implications of CARs and QPLs prior to clinical implementation is essential.

Background: Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent. Aim: The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice. Design: Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory. Setting/participants: Data were collected from 53 advanced cancer inpatients in a large urban hospital. Results: Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful. Conclusion: Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.

This study aimed to understand how the identity of Manitobans with early malignancy is affected through diagnosis, decision making and treatment. Using grounded-theory methodology, semi-structured interviews were conducted with 18 adult patients with early breast, colon, lung, prostate and gynecological cancers, before and after adjuvant treatment decision making. 15 adult friends and family members were also interviewed. Significant findings include: 1) After diagnosis, the “cancer identity” emerged as a new aspect of the patient’s identity; 2) Establishing a post-diagnosis routine was a significant source of distress for patients; 3) Ability to re-establish routine post-diagnosis may be enhanced by providing earlier notification of medical appointment times and information regarding how different treatment options will affect the patient’s identity. This study provides new insight into the experience of patients with malignancy in Manitoba. Additionally, it presents recommendations, based on the insights and concerns of its participants, for improving the cancer journey of Manitobans.

Cancer incidence and mortality continues to rise worldwide including in the country of Kenya. Burdened with infectious diseases, poverty, and lack of proper cancer preventive plans, the future of cancer care in Kenya is unknown. This is further exacerbated by the fact that Kenyan adolescents engage in smoking, unhealthy eating, physical inactivity, and alcohol intake that can increase their lifetime cancer risk. Despite this awareness, little is known about Kenyan adolescents’ understanding of cancer, cancer risk, and cancer prevention. Such awareness is needed to inform germane cancer prevention and health promotion initiatives. Accordingly, an ethnographic qualitative study was carried out to explore Kenyan adolescents’ understanding of cancer, cancer risk, and cancer prevention. This study took place at Nairobi Primary and OlKeri Mixed Secondary Schools in Kenya. Fifty-three Kenyan adolescents between ages 12 and 19 that were attending the participating schools took part. Participants were grouped as early (ages 12-14), middle (ages 15-17), and late adolescence (ages 18-19). Qualitative data was collected through individual open-ended interviews and focus group discussions. Data analysis occurred concurrently with data collection. Thematic and content analysis approaches were utilized. Ethical considerations were observed throughout the study. Study results generated three main findings about Kenyan adolescents’ conceptualization of cancer, cancer risk, and cancer prevention. In their conceptualization of cancer, adolescents described cancer in ways that are grouped into two themes: there is no other disease like it and lay understanding through metaphors. In their conceptualization of cancer risk, adolescents described cancer in ways that are grouped as cancer risk as lifestyle factors and the process of risk perception. Finally, in conceptualization of cancer prevention, adolescents described cancer prevention in ways that are grouped into the following themes

Objective: To gain an understanding of how patient satisfaction (PS) with the doctor (PSD) is conceptualized through an empirical review of how it is currently being measured. The content of PS questionnaire items was examined to (a) determine the primary domains underlying PSD, and (b) summarize the specific doctor-related characteristics and behaviors, and patient-related perceptions, composing each domain. Methods: A scoping review of empirical articles that assessed PSD published from 2000 to November 2013. MEDLINE and PsycINFO databases were searched. Results: The literature search yielded 1726 articles, 316 of which fulfilled study inclusion criteria. PSD was realized in one of four health contexts, with questions being embedded in a larger questionnaire that assessed PS with either: (1) overall healthcare, (2) a specific medical encounter, or (3) the healthcare team. In the fourth context, PSD was the questionnaire's sole focus. Five broad domains underlying PSD were revealed: (1) Communication Attributes; (2) Relational Conduct; (3) Technical Skill/Knowledge; (4) Personal Qualities; and (5) Availability/Accessibility. Conclusions: Careful consideration of measurement goals and purposes is necessary when selecting a PSD measure. Practice implications: The five emergent domains underlying PSD point to potential key areas of physician training and foci for quality assessment.

Background: A positive BRCA1/2 carrier status impacts an individual on various levels with implications to an entire family due to shared family genes. A gap exists in the research literature in the area of parental disclosure and non-disclosure of genetic test results to younger offspring. Additional studies in the area of parental disclosure and non-disclosure will help clinicians to better support parents and children during this process. Purpose: The purpose of this qualitative hermeneutic phenomenological research study was to attain an understanding of the lived experience of parents’ perceptions regarding the disclosure and non-disclosure of a positive BRCA1/2 test result to minors. Results: The essence of the lived experience of the 15 study participants was a parental desire for healthcare professionals to take the BRCA1/2 conversation a step further which was uncovered in the seven research themes. Discussion: For the study participants interviewed, stories reflected an identified need for axillary support that specifically pertained to the disclosure and non-disclosure decision-making process. Findings suggest ways in which parental support may be coordinated though intra and interdisciplinary team approaches to patient care. Implications: The findings from this study support the need for mixed methods studies of parental disclosure and non-disclosure of BRCA1/2 test results to minors. Specifically, studies assessing positive BRCA1/2 males and individuals from our gay community, members from our lower socioeconomic and diverse ethnic community, and fathers and children’s perceptions regarding the disclosure of parental BRCA1/2 test results to minors are warranted.

Aim: This article is a report of a citation analysis of research publications by Canadian nursing academics. Background: Citation analysis can yield objective criteria for assessing the value of published research and is becoming increasingly popular as an academic evaluation tool in universities around the world. Citation analysis is useful for examining the research performance of academic researchers and identifying leaders among them. Methods: The journal publication records of 737 nursing academics at 33 Canadian universities and schools of nursing were subject to citation analysis using the Scopus database. Three primary types of analysis were performed for each individual: number of citations for each journal publication, summative citation count of all published papers and the Scopus h-index. Preliminary citation analysis was conducted from June to July 2009, with the final analysis performed on 2 October 2009 following e-mail verification of publication lists. Results: The top 20 nursing academics for each of five citation categories are presented: the number of career citations for all publications, number of career citations for first-authored publications, most highly cited first-authored publications, the Scopus h-index for all publications and the Scopus h-index for first-authored publications. Conclusion: Citation analysis metrics are useful for evaluating the research performance of academic researchers in nursing. Institutions are encouraged to protect the research time of successful and promising nursing academics, and to dedicate funds to enhance the research programmes of underperforming academic nursing groups.

Objective: Arm morbidity post-breast cancer surgery is increasingly being recognized as a chronic problem for some women following breast cancer surgery. The purpose of this study was to examine demographic, disease, and treatment-related predictors of a comprehensive array of chronic arm morbidity (pain, lymphedema, functional disability, and range of motion) post-breast cancer surgery. Methods: Women (n=316) with a non-metastatic primary diagnosis of breast cancer were accrued from cancer centers in four Canadian cities. Patients completed a clinical assessment and measures of arm morbidity at 6–12 months post-breast cancer surgery. The independent variables in the MANOVA to predict arm morbidity included: Lymph node management type, number of axillary nodes dissected, type of surgery, disease stage, presence of post-operative infection, radiation to the axilla, body mass index (BMI), assessment time post-surgery, education, and partner status. Results: Pain was significantly predicted by axillary lymph node management, lack of a partner, and post-operative infection; lymphedema by axillary lymph node management, number of axillary nodes dissected, radiation to the axilla, and having a modified radical mastectomy; functional disability by post-operative infection and high BMI; and restricted external rotation by axillary lymph node management, low educational attainment, and advanced disease. Conclusion: Comprehensive behavioral management and rehabilitation programs are needed to treat arm morbidity following breast cancer surgery. These programs should address the full scope of symptoms and associated psychosocial and functional sequelae.