Shaping policy: the Canadian Cancer Society and the Hormone Receptor Testing Inquiry

Background

In 2007, the Government of Newfoundland and Labrador established the Commission of Inquiry on Hormone Receptor Testing to examine problems with estrogen and progesterone hormone receptor tests conducted in the province between 1997 and 2005. Using the Inquiry as a case study, we examine the knowledge transfer activities used by the Canadian Cancer Society – Newfoundland and Labrador Division (CCS-NL) to shape policy and improve cancer control in the province.

Implementation

CCS-NL established a panel to advise its legal counsel and asked academic researchers to prepare papers to submit to the Commission. CCS-NL also interviewed patients to better inform its legal arguments, used its province-wide networks to raise awareness of the Inquiry, and provided a toll-free number that people could call. It also provided basic information, resources, and contact information for people who were affected by the flawed hormone receptor tests. The effectiveness of CCS-NL’s activities is reflected by the inclusion of its key messages in the Commission’s recommendations, and the investment in cancer care following the Inquiry.

Discussion

The success of the CCS-NL knowledge transfer efforts stemmed from its reputation as an advocate for cancer patients and its long-standing relationship with researchers, especially at the local level. The case illustrates real-world application of knowledge transfer practices in the development of public policy, and describes how community-based non-government organizations can identify and draw attention to important issues that otherwise might not have been addressed.     

Narcissistic Personality Disorder and Pathological Mourning

This paper describes an approach to psychoanalysis conducted as a “talking cure” whereby the analyst privileges the patient's maturational capacity for speaking about experience. An optimal analytic process becomes a method of exploration and investigation through inquiry rather than interpretation. Interpretations facilitate talking, particularly those thoughts and feelings that are unwanted and unbidden. Accordingly, the analyst's chief concern is the resolution of resistances to speaking in contrast to an effort that aims to resolve resistances to insight or understanding. Insight, when it occurs, is a result of the change process and one's burgeoning capacity for talking with another who is interested in understanding. In this way making the unconscious conscious is worked through progressive speech and the enrichment of experience that results. Complementary to this effort is the analyst's subjective reflection on and use of countertransference states. Several features of the analytic process are described and elaborated: the centrality of the patient's voice, the value and function of inquiry, the analyst's crucial function as the sentient other for the patient's unconscious processes, and the leverage provided by the analyst's living into the transference experientially accompanied by personal acts of emotional freedom. A case example is provided to illustrate this approach.     

Qualitative meta-synthesis: a question of dialoguing with texts

AIMS: This paper discusses whether useful synthesis of research reports across different qualitative methodologies is possible, and whether qualitative meta-synthesis violates the tenets of the interpretive paradigm. BACKGROUND: Qualitative meta-synthesis is a recent development in qualitative inquiry that offers a means of enhancing the contribution of qualitative findings to the development of more formalized knowledge. However, there are a number of unanswered questions and areas that require debate. DISCUSSION: A brief overview of qualitative meta-synthesis as a method of inquiry is presented. The assumptions of phenomenology, ethnography and grounded theory are explored for their amenability to meta-synthesis and the possibility of coherent synthesis of findings across these methodologies. In addition, a summary of major philosophical commitments common to the interpretive paradigm is presented. Qualitative meta-synthesis as a methodology is then explored for its fit within this paradigm. An argument is made, with some caveats, for synthesis across qualitative methodologies. Gadamer's concepts of the hermeneutic circle, the fusion of horizons, and dialogue with the text are explored for the insight they provide into the place of qualitative meta-synthesis in inquiry. CONCLUSION: It is important for researchers to bring hermeneutic skill to the process of meta-synthesis in order to develop a comprehensive understanding of the various philosophical assumptions in which qualitative approaches are based. The particular challenge of combining analysis and interpretation from studies with markedly different approaches and intentions may prompt synthesists to create new and innovative approaches to the presentation of meta-synthesis.     

Empowerment of learning and knowledge: Appreciating professional development for registered nurses in aged residential care

Continued education and professional development ensures nursing competence and contributes positively to quality health outcomes, however it must also include a professional pathway that challenges the contextual confrontations faced by registered nurses within the workplace environment. This is especially relevant for the nursing workforce employed in the Aged Residential Care sector. This research was undertaken in New Zealand and uses Appreciative Inquiry to ‘Appreciate the professional development needs of registered nurses working in the sector’.The findings highlighted the uniqueness of the sector, along with the diversity of the nursing workforce which signals the need for ongoing formal and informal professional development methods. Currently, professional development and learning is not assimilated well into the sector and there remains a void in terms of a professional clinical pathway. This has implications for the future development of professional learning for registered nurses in other sectors. Quality is integral to developing any professional learning, accordingly there must be input from both clinical and education providers. This partnership, between the sector and academia, will integrate learning into the practice area and improve outcomes for residents in aged residential care facilities.     

Giving feedback in medical education

OBJECTIVE: We investigated naturally occurring feedback incidents to substantiate literature-based recommended techniques for giving feedback effectively. SETTING: A faculty development course for improving the teaching of the medical interview, with opportunities for participants to receive feedback. PARTICIPANTS: Seventy-four course participants (clinician-educators from a wide range of medical disciplines, and several behavioral scientists). MEASUREMENTS AND MAIN RESULTS: We used qualitative and quantitative approaches. Participants provided narratives of helpful and unhelpful incidents experienced during the course and then rated their own narratives using a semantic-differential survey. We found strong agreement between the two approaches, and congruence between our data and the recommended literature. Giving feedback effectively includes: establishing an appropriate interpersonal climate; using an appropriate location; establishing mutually agreed upon goals; eliciting the learner’s thoughts and feelings; reflecting on observed behaviors; being nonjudgmental; relating feedback to specific behaviors; offering the right amount of feeback; and offering suggestions for improvement. CONCLUSIONS: Feedback techniques experienced by respondents substantiate the literature-based recommendations, and corrective feedback is regarded as helpful when delivered appropriately. A model for providing feedback is offered.