Clinical questions    asked and pursuedby rehabilitation therapistsAn exploratory study of information needs              ...
Outline   BackgroundResearch questions     Methods      Findings   Conclusions    Limitations  Contributions Future resear...
Research objective                     2
Research objective   To explore the clinical questions of        rehabilitation therapistsin the context of their everyday...
BackgroundInformation needs of this group not known Difficulty formulating clinical questions  Research not transferred in...
Information behaviour                                      5(Wilson, 1997, p. 569)
Information behaviour  Information                              Information      need           Enablers/obstacles      se...
Information behaviour  Information                              Information      need           Enablers/obstacles      se...
Evidence-based practice                                   Formulating         Evaluating                                  ...
Evidence-based practice                                   Formulating         Evaluating                                  ...
Clinical question A formalized information need related to           the care of a patient.From Taylor’s (1968) typology o...
Clinical question structurePICO                    PESICO                PICO +Problem/Person          Person             ...
Clinical question structurePICOProblem/Person                         In adults with sinusitis, does a                    ...
Research questions       1       2                     13
Research questions    What clinical questionsdo rehabilitation therapists ask?              2                             ...
Research questions    What clinical questionsdo rehabilitation therapists ask?1a Types         1b Formulation             ...
Research questions         What clinical questions     do rehabilitation therapists ask?    How do rehabilitation therapis...
Rehabilitation therapistA certified professional whose aim is to improvethe functional independence of individuals with   ...
Methods                          deductiveRQ 1a    diaries                                12 foci                       th...
Recruitment & data gathering                               Interviews         Clinical                                    ...
Clinical question fociTreatment selection                            33%Clinical manifestations of disease             17%...
Clinical question fociTreatment selection                            33%Clinical manifestations of disease             17%...
Treatment selection“ Are compensatory strategies designed tomaximize airway protection during the swallow  efficacious in ...
Clinical manifestations of disease“What are the signs/symptoms oflateral medullary infarct/syndrome?                      ...
Prognosis“ is the prognosis for recovery inWhat frontal cerebrovascular accidents    (compared to other types)?           ...
Structural elements                           intervention  Is there a role for interval training          with gait re-ed...
Clinical question structure   Problem                         69%   Intervention                    41%   Population      ...
Clinical question structure   Problem                         69%   Intervention                    41%   Population      ...
28
29
Why pursue clinical questions?                 Memory    Belief in existence of an answer              Use of answer      ...
Conclusions    1    2              31
Conclusions    What clinical questionsdo rehabilitation therapists ask?1a Types         1b Formulation              2     ...
Conclusions  Therapists’ clinical questions can becharacterized by 1 of 12 foci, formulated  with 8 possible structural el...
Conclusions    How do rehabilitation therapistschoose which clinical questions to pursue?                                 ...
Conclusions7 themes explain why therapists choose to   pursue some clinical questions while       leaving others unanswere...
LimitationsNo direct observation       Recall   Not exhaustive                        36
Contributions          Theoretical Contributions• Builds on existing models of information behaviour• Supports Wilson’s (1...
Contributions    Practical Contributions      Reference interview Information literacy instruction  Database selection and...
Future researchInformation behaviour of stroke therapists        Clinical question analysis    Information needs in allied...
Acknowledgements             Dissertation committee      Joan Bartlett (chair), France Bouthillier,  NicolKorner-Bitensky,...
Selected publications & talksKloda, L. A., & Bartlett, J. C. (2012). Characterizing clinical questions of occupational    ...
Supplemental Slides
Figure 2-1: Wilson’s revised general model of            information behaviour(Wilson, 1997, p. 569, Figure 5)            ...
Table 2-2: Information behaviour investigated in             research on therapists                                       ...
Table 2-4: Comparison of question formulation                structures                                           45
Table 2-5: Question types in medicine and                rehabilitationa(Adapted   from Straus et al., 2011, p. 18); b(Ada...
Table 3-2: Characteristics of informants                                           47
Figure 3-1: Coding clinical questions for          structural elements                                            48
Table 4-1: Clinical questions gathered                                         49
Figure 4-1: Clinical questions pursued and                 answered                              129                      ...
Table 4-2: Foci of clinical questions                                        51
Table 4-3: Structural elements identified                                            52
53
“forget about it. Time goes and I           I         have other projects and there’s otherMemory   patients and because ...
”Well I, you know, I have great faith                     that every time I go to research                     something ...
Advance professional                      knowledge or understanding                      “There will probably be informa...
Establish Authority                                            ”It would have helped. In this case, it                   ...
Decision making                      Impact on patient wellbeing                      Impact on future patientsIntended us...
“At least, once I wrote it down. I’d                 better look for the answers.” (SLP1)                 “think it’s goi...
“…  have to wade through a lot of                          you                     stuff.”(SLP2)                     “ u...
“  That’s part of the problem because to                me looking at the literature sounds likeSelf-efficacy   a big mou...
For locating evidence                  – Librarian                  – Resources (databases)Perceived         – Computer ac...
Table 5-1: Comparison of question formulation             structures revisited                                           63
Figure 5-1: Factors influencing therapists’   decision to pursue clinical questions                                       ...
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Sample coding for interview transcript                                         66
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Clinical questions asked and pursued by rehabilitation therapists: An exploratory study of information needs

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Doctoral Defense, McGill University, June 8, 2012

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Clinical questions asked and pursued by rehabilitation therapists: An exploratory study of information needs

  1. 1. Clinical questions asked and pursuedby rehabilitation therapistsAn exploratory study of information needs Lorie Kloda MLIS, PhD candidate School of Information Studies June 8, 2012 Oral Defense
  2. 2. Outline BackgroundResearch questions Methods Findings Conclusions Limitations Contributions Future research 1
  3. 3. Research objective 2
  4. 4. Research objective To explore the clinical questions of rehabilitation therapistsin the context of their everyday practice 3
  5. 5. BackgroundInformation needs of this group not known Difficulty formulating clinical questions Research not transferred into practice 4
  6. 6. Information behaviour 5(Wilson, 1997, p. 569)
  7. 7. Information behaviour Information Information need Enablers/obstacles seekingPerson-in-context Information processing and use 6
  8. 8. Information behaviour Information Information need Enablers/obstacles seekingPerson-in-context Information processing and use 7
  9. 9. Evidence-based practice Formulating Evaluating the the Process Question Searching Applying the the Results Evidence Appraising the Evidence 8
  10. 10. Evidence-based practice Formulating Evaluating the the Process Question Searching Applying the the Results Evidence Appraising the Evidence 9
  11. 11. 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 10
  12. 12. Clinical question structurePICO PESICO PICO +Problem/Person Person Problem/Person Environment Client’s setting Stakeholders Client’s valuesIntervention Intervention InterventionComparison Comparison ComparisonOutcome Outcome Outcome(Richardson, Wilson, (Schlosser, Koul, & (Bennett & Bennett,Nishikawa, & Hayward, Costello, 2007) 2000)1995) 11
  13. 13. Clinical question structurePICOProblem/Person In adults with sinusitis, does a 3-day course of antibiotics workIntervention as well as a 10-day course, withComparison feweradverse effects?Outcome(Richardson, Wilson,Nishikawa, & Hayward,1995) 12
  14. 14. Research questions 1 2 13
  15. 15. Research questions What clinical questionsdo rehabilitation therapists ask? 2 14
  16. 16. Research questions What clinical questionsdo rehabilitation therapists ask?1a Types 1b Formulation 2 15
  17. 17. Research questions What clinical questions do rehabilitation therapists ask? How do rehabilitation therapistschoose which clinical questions to pursue? 16
  18. 18. Rehabilitation therapistA certified professional whose aim is to improvethe functional independence of individuals with physical or cognitive disabilities.  Physiotherapist (PT)  Occupational therapist (OT)  Speech-language pathologist (SLP) 17
  19. 19. Methods deductiveRQ 1a diaries 12 foci thematic analysis deductive 8 structuralRQ 1b diaries thematic analysis elements inductive themes explainingRQ 2 interviews why questions thematic analysis were pursued 18
  20. 20. Recruitment & data gathering Interviews Clinical questions Occupational therapists 4 26 Physiotherapists 4 44Speech-language pathologists 7 59 __________ ________ 15 129 19
  21. 21. Clinical question fociTreatment selection 33%Clinical manifestations of disease 17%Prognosis 13%Assessment tool selection 9%Terminology 9%Treatment procedures 9%Etiology 5%Practice-related self-improvement 4%Assessment tool procedures 3%Patient or family’s experiences and concerns 2%Anatomy, physiology, and pathophysiology 2%Epidemiology 1% 20
  22. 22. Clinical question fociTreatment selection 33%Clinical manifestations of disease 17% 63%Prognosis 13%Assessment tool selection 9%Terminology 9%Treatment procedures 9%Etiology 5%Practice-related self-improvement 4%Assessment tool procedures 3%Patient or family’s experiences and concerns 2%Anatomy, physiology, and pathophysiology 2%Epidemiology 1% 21
  23. 23. Treatment selection“ Are compensatory strategies designed tomaximize airway protection during the swallow efficacious in reducing silent aspiration? ” SLP3 22
  24. 24. Clinical manifestations of disease“What are the signs/symptoms oflateral medullary infarct/syndrome? ” PT2 23
  25. 25. Prognosis“ is the prognosis for recovery inWhat frontal cerebrovascular accidents (compared to other types)? ” PT4 24
  26. 26. Structural elements intervention Is there a role for interval training with gait re-education post-cerebrovascular accident?problem population 25
  27. 27. Clinical question structure Problem 69% Intervention 41% Population 39% Outcome measure 11% Temporality 7% Context 5% Professional stakeholder 3% Patient or family stakeholder 1% 26
  28. 28. Clinical question structure Problem 69% Intervention 41% Population 39% Outcome measure 11% Temporality 7% Context 5% Professional stakeholder 3% Patient or family stakeholder 1% 27
  29. 29. 28
  30. 30. 29
  31. 31. Why pursue clinical questions? Memory Belief in existence of an answer Use of answer Feeling of responsibility Effort required Self-efficacy Organizational support 30
  32. 32. Conclusions 1 2 31
  33. 33. Conclusions What clinical questionsdo rehabilitation therapists ask?1a Types 1b Formulation 2 32
  34. 34. Conclusions Therapists’ clinical questions can becharacterized by 1 of 12 foci, formulated with 8 possible structural elements 2 33
  35. 35. Conclusions How do rehabilitation therapistschoose which clinical questions to pursue? 34
  36. 36. Conclusions7 themes explain why therapists choose to pursue some clinical questions while leaving others unanswered 35
  37. 37. LimitationsNo direct observation Recall Not exhaustive 36
  38. 38. Contributions Theoretical Contributions• Builds on existing models of information behaviour• Supports Wilson’s (1997) revised model of information behaviour• Links research on clinical questions to Taylor’s definition of information needs• Adds to knowledge on the information behaviour of health professionals• Suggests improvements to evidence-based practice framework in rehabilitation 37
  39. 39. Contributions Practical Contributions Reference interview Information literacy instruction Database selection and designHealth sciences curricular design Organizational support 38
  40. 40. Future researchInformation behaviour of stroke therapists Clinical question analysis Information needs in allied health 39
  41. 41. Acknowledgements Dissertation committee Joan Bartlett (chair), France Bouthillier, NicolKorner-Bitensky, Andrew Large & Pierre Pluye Funding Thomson Scientific / MLA Doctoral FellowshipFondsquébecois de la recherchesur la société et la cultureCanadian Library Association World Book Scholarship Study informants 40
  42. 42. Selected publications & talksKloda, L. A., & Bartlett, J. C. (2012). Characterizing clinical questions of occupational therapists, physical therapists, and speech-language pathologists. Medical Library Association Annual Meeting, Seattle, WA, May 18-23, 2012.Kloda, L. A., & Bartlett, J. C. (2010). From uncertainty to answerable questions: Question negotiation in evidence-based practice. Canadian Health Libraries Association (CHLA) Annual Conference, Kingston, ON, June 7-11, 2010.Kloda, L. A. & Bartlett, J. C. (2009). Clinical information behavior of rehabilitation therapists: A review of the research. Journal of the Medical Library Association, 97(3), 194-202.Kloda, L. Rehabilitation therapists’ clinical questions in the context of evidence-based patient care: An exploratory study. (2009). Canadian Association for Information Science (CAIS) 37th Annual Conference, Carlton University, Ottawa, ON, May 28-30, 2009.Kloda, L. A. & Bartlett, J. C. Rehabilitation therapists’ clinical questions (poster). (2009) American Society for Information Science & Technology (ASIS&T) Annual Meeting, Vancouver, BC, November 6-11, 2009.Kloda, L. A. (2008). Exploring rehabilitation therapists’ clinical questions for evidence based patient care. Information Research, 13(4), paper wks07. 41
  43. 43. Supplemental Slides
  44. 44. Figure 2-1: Wilson’s revised general model of information behaviour(Wilson, 1997, p. 569, Figure 5) 43
  45. 45. Table 2-2: Information behaviour investigated in research on therapists 44
  46. 46. Table 2-4: Comparison of question formulation structures 45
  47. 47. Table 2-5: Question types in medicine and rehabilitationa(Adapted from Straus et al., 2011, p. 18); b(Adapted from Bennett & Bennett, 2000, p. 174) 46
  48. 48. Table 3-2: Characteristics of informants 47
  49. 49. Figure 3-1: Coding clinical questions for structural elements 48
  50. 50. Table 4-1: Clinical questions gathered 49
  51. 51. Figure 4-1: Clinical questions pursued and answered 129 Total clinical questions 92 37 Data gathered re: No data gathered pursued/answered 43 49 Pursued Not pursued 28 15 Answered Not answered 50
  52. 52. Table 4-2: Foci of clinical questions 51
  53. 53. Table 4-3: Structural elements identified 52
  54. 54. 53
  55. 55. “forget about it. Time goes and I I have other projects and there’s otherMemory 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) 54
  56. 56. ”Well I, you know, I have great faith that every time I go to research something that there’s just so muchBelief or doubt in information that I know that there isexistence of an unbelievable amounts of information. Ianswer have faith that I will be able to answer, that I will find the information. But it’s not easy, you know.” (SLP2) “dont think thats likely to be I answerable because its a combination of things and usually that’s exclusion criteria in all the studies.”(PT1) 55
  57. 57. Advance professional knowledge or understanding “There will probably be information about what theyre doing, but I think it wouldnt vary much differently from what Im already doing. So it might giveIntended use of the me a few new ideas, but I dont think itanswer would really change my practice all that much.”(PT3) 56
  58. 58. 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 theanswer 57
  59. 59. Decision making Impact on patient wellbeing Impact on future patientsIntended use of theanswer 58
  60. 60. “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 badFeeling of therapist.”(OT4)responsibility 59
  61. 61. “…  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 tofind an answer 60
  62. 62. “ That’s part of the problem because to me looking at the literature sounds likeSelf-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) 61
  63. 63. For locating evidence – Librarian – Resources (databases)Perceived – Computer access, internet accessorganizationalsupport For implementing evidence 62
  64. 64. Table 5-1: Comparison of question formulation structures revisited 63
  65. 65. Figure 5-1: Factors influencing therapists’ decision to pursue clinical questions 64
  66. 66. 65
  67. 67. Sample coding for interview transcript 66
  68. 68. 67
  69. 69. 68

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