Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

An exploration of students’ perceptions and attitudes towards creativity in engineering education

This study used a mixed methods approach to develop a broad and deep understanding of students’ perceptions towards creativity in engineering education. Studies have shown that students’ attitudes can have an impact on their motivation to engage in creative behavior. Using an ex-post facto independent factorial design, attitudes of value towards creativity, time for creativity, and creativity stereotypes were measured and compared across gender, year of study, engineering discipline, preference for open-ended problem solving, and confidence in creative abilities. Participants were undergraduate engineering students at Queen’s University from all years of study. A qualitative phenomenological methodology was adopted to study students’ understandings and experiences with engineering creativity. Eleven students participated in oneon- one interviews that provided depth and insight into how students experience and define engineering creativity, and the survey included open-ended items developed using the 10 Maxims of Creativity in Education as a guiding framework. The findings from the survey suggested that students had high value for creativity, however students in fourth year or higher had less value than those in other years. Those with preference for open-ended problem solving and high confidence valued creative more than their counterparts. Students who preferred open-ended problem solving and students with high confidence reported that time was less of a hindrance to their creativity. Males identified more with creativity stereotypes than females, however overall they were both low. Open-ended survey and interview results indicated that students felt they experienced creativity in engineering design activities. Engineering creativity definitions had two elements: creative action and creative characteristic. Creative actions were associated with designing, and creative characteristics were predominantly associated with novelty. Other barriers that emerged from the qualitative analysis were lack of opportunity, lack of assessment, and discomfort with creativity. It was concluded that a universal definition is required to establish clear and aligned understandings of engineering creativity. Instructors may want to consider demonstrating value by assessing creativity and establishing clear criteria in design projects. It is recommended that students be given more opportunities for practice through design activities and that they be introduced to design and creative thinking concepts early in their engineering education.