• Decision making in the management of adults with malignant colorectal polyps: An exploration of the experiences of patients and clinicians

      Westwood, Clare; Lee, Tom; McSherry, Robert; Bettany-Saltikov, Josette; Catlow, Jamie; University Hospital North Tees and Hartlepool NHS Foundation Trust; North Tyneside General Hospital; University of Chester; Teesside University (Wiley, 2021-05-18)
      Aim: A diagnosis of colorectal polyp cancer presents a treatment dilemma. The decision between segmental resection versus endoscopic surveillance is difficult due to lack of good quality clinical evidence for either option. The aim of this study was to understand the decision-making experiences of both clinicians and patients when faced with such a diagnosis. Methods: Qualitative, semi-structured interviews were undertaken with ten clinicians involved in the care of patients diagnosed with polyp cancer and five patients who had experience of a diagnosis of polyp cancer. All clinicians and patients were from four hospital Trusts across the North of England. Interviews were audio recorded, transcribed verbatim and analysed using the principles of Interpretative Phenomenological Analysis. Results: Analysis of the interview transcripts evidenced the difficulties faced by both groups when faced with treatment decisions following a diagnosis of colorectal polyp cancer. Some of these difficulties were specific to either the clinician or patient group. Themes which were common to both groups included: complexity of risk information; external influences, unexpected diagnosis; and time. In addition, hospital system factors were disclosed which also influenced clinician and patient experiences. Conclusion: This research study has evidenced several factors such as uncertainty, complexity of risk information and influences on decisions which are preventing patients being fully involved in treatment decisions following a diagnosis of colorectal polyp cancer. Recommendations for improvements in practice, including a framework to assist treatment decision making in the future have been highlighted. What does this paper add to the literature? This qualitative study is, to the authors knowledge, the first exploring clinician and patient experiences of treatment decision making following a colorectal polyp cancer diagnosis. Key factors influencing how treatment decisions are made have been identified. As a result, a framework is proposed highlighting critical factors for consideration to deliver patient centred care.
    • Evidence-informed practice: simplifying and applying the concept for nursing students and academics

      Bettany-Saltikov, Josette; Van Schaik, Paul; McSherry, Robert; Kumah, Elizabeth; University of Chester, University of Teesside
      Abstract Background: Nurses’ ability to effectively apply evidence into practice is a critical factor in the delivery of quality patient care. Evidence-Based Practice (EBP) is recognized as the gold standard for the delivery of safe and effective person-centred care. Yet, after several decades of its inception, nurses continue to encounter difficulties in implementing the concept. Existing models for implementing EBP offer stepwise approaches, nevertheless, certain factors, such as the context of care and its mechanistic nature act as barriers to the effective and consistent implementation of EBP. It is, therefore, imperative that a solution to solving the way in which evidence is applied into practice is found. Evidence-Informed Practice (EIP) is an evolving concept. In recent times, there has been a focus on EIP as an alternative to EBP. This has generated an international debate as to which of the two concepts better facilitate the application of evidence into practice. While several EBP models and educational interventions exist, there is limited research directed towards understanding the concept of EIP and how it facilitates the application of evidence into clinical nursing practice. Aim: This article aims at clarifying the concept of EIP and provides an integrated systems-based model of EIP in facilitating the application of evidence into clinical nursing practice. This is achieved through the application of two nursing case scenarios. Case scenario 1 is about caring for a high-dependent patient and case scenario 2 involves a patient with a low white blood cell count. Method: this article takes the reader through the various factors, elements, and associated systems and processes of the EIP model. Results: The case scenarios detail the various factors and elements of the EIP model and defines how it facilitates the application of evidence into clinical nursing practice. Conclusion: The EIP model provides a framework for nurses (indeed all healthcare practitioners) to deliver clinically effective care, and to be able to defend the processes used and the service provided by referring to reliable evidence. Revised