Cancer patients' attitudes toward cancer trials

Background. Accurate measurement of attitudes toward participation in cancer treatment trials (CTs) and cancer prevention trials (CPTs) across varied groups could assist health researchers and educators when addressing attitudinal barriers to participation in these trials. ^ Methods. The Attitudes toward Cancer Trials Scales (ACTS) instrument development was based on a conceptual model developed from research literature, clinical practice experience, and empirical testing of items with a sample of 312 respondents. The ACTS contains two scales, the Cancer Trials (CT) scale (4 components; 18 items) and the Cancer Prevention Trials (CPT) scale (3 components; 16 items). Cronbach's alpha values for the CT and CPT scales, respectively, were 0.86 and 0.89. These two scales along with sociodemographic and cancer trial history variables were distributed in a mail survey of former patients of a large cancer research center. The disproportionate stratified probability sampling procedure yielded 925 usable responses (54% response rate). ^ Results. Prevalence of favorable attitudes toward CTs and CPTs was 66% and 69%, respectively. There were no significant differences in mean scale scores by cancer site or gender, but African Americans had more favorable attitudes toward CTs than European Americans. Multiple regression analysis indicated that older age, lower education level, and prior CT participation history were associated with more favorable attitudes toward CTs. Prior CT participation and prior CPT participation were associated with more favorable attitudes toward CPTs. Results also provided evidence of reliability and construct validity for both scales. ^ Conclusions. Middle age, higher education, and European American ethnicity are associated with less positive attitudes about participating in cancer treatment trials. Availability of a psychometrically sound instrument to measure attitudes may facilitate a better understanding decision making regarding participation in CTs and CPTs. It is this author's intention that the ACTS' scales will be used by other investigators to measure attitudes toward CTs and CPTs in various groups of persons, and that the many issues regarding participation in trials might become more explicit. ^

The prevalence of burnout among psychologists and psychological associates in the state of Texas

This study investigates the prevalence of burnout among a sample of Texas psychologists and psychological associates as well as differences between the three categories of practitioners within that group (Licensed Psychology Health Care Providers (LPHCP), Licensed Psychologists - Certified Psychologists (LP-CP), Psychological Associates (PA)).^ The Maslach Burnout Inventory and a questionnaire seeking demographic information was used in this cross-sectional survey. Sample size was 654. A stratified proportionate random sample of Texas Psychologists was drawn. The response rate based on usable returns was 55% (n = 359). General demographic characteristics were determined mainly by frequency distributions. For comparing means of samples, t and multiple range tests were used. A series of one-way and two-way analysis of variance procedures were used to compare subgroup differences in burnout.^ The universe was representative for the sample and for the three categories of psychologists. Urban subjects were more likely to respond, as were male PAs. Practitioners were as likely male as female, working in an urban area, in their present job eight years, and in the occupation for fifteen. The LPHCP group were older, had been in psychology and at their present job longer, and were more likely to belong to both state and local professional organizations than the other two groups. Males outnumbered females in this group and in LP-CPs. This gender trend was reversed for PAs. Of the total sample, 76% reported high job satisfaction and 77% had high levels of perceived job autonomy. There was no significant difference between the study sample and the mental health norms in emotional exhaustion (EE). Our sample had significantly less feelings of depersonalization (DP) and higher feelings of personal accomplishment (PA). Psychological Associates felt significantly less personal accomplishment than the other groups. Predictors for the total sample indicated younger practitioners and those with low job satisfaction had significantly higher burnout, as did males when compared to their female cohorts. Some types of jobs were more likely to contribute to burnout than others. Membership in their local area professional organization lessened the chances for burnout significantly. Predictors for categories of psychologists indicated that males in the LPHCP and LP-CP groups were at higher risk than females. Further, for LP-CPs low job satisfaction and job autonomy, as well as job sites, were significant. Those in this group who worked as school psychologists were at the highest risk for burnout. Job dissatisfaction was the major predictor of burnout for psychological associates. Practitioners working in state or government agencies, school systems and administrative jobs generally had higher burnout than those on a university faculty or in private practice. (Abstract shortened by UMI.) ^

Translating knowledge into action: Information needs of decision-makers in healthcare

Purpose: The purpose of this study was to assess the healthcare information needs of decision-makers in a local US healthcare setting in efforts to promote the translation of knowledge into action. The focus was on the perceptions and preferences of decision-makers regarding usable information in making decisions as to identify strategies to maximize the contribution of healthcare findings to policy and practice. Methods: This study utilized a qualitative data collection and analysis strategy. Data was collected via open-ended key-informant interviews from a sample of 37 public and private-sector healthcare decision-makers in the Houston/Harris County safety net. The sample was comprised of high-level decision-makers, including legislators, executive managers, service providers, and healthcare funders. Decision-makers were asked to identify the types of information, the level of collaboration with outside agencies, useful attributes of information, and the sources, formats/styles, and modes of information preferred in making important decisions and the basis for their preferences. Results: Decision-makers report acquiring information, categorizing information as usable knowledge, and selecting information for use based on the application of four cross-cutting thought processes or cognitive frameworks. In order of apparent preference, these are time orientation, followed by information seeking directionality, selection of validation processes, and centrality of credibility/reliability. In applying the frameworks, decision-makers are influenced by numerous factors associated with their perceptions of the utility of information and the importance of collaboration with outside agencies in making decisions as well as professional and organizational characteristics. Conclusion: An approach based on the elucidated cognitive framework may be valuable in identifying the reported contextual determinants of information use by decision-makers in US healthcare settings. Such an approach can facilitate active producer/user collaborations and promote the production of mutually valued, comprehensible, and usable findings leading to sustainable knowledge translation efforts long-term.^