Teaching College Writing in a High School Setting: The Impact of Concurrent Enrollment on Teacher Learning and Practice

Thesis (Ph.D.)--University of Washington, 2016-06

Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design

Background. Children of alcoholics are significantly more likely to experience high-risk environmental exposures, including prenatal substance exposure, and are more likely to exhibit externalizing problems [e.g. attention deficit hyperactivity disorder (ADHD)]. While there is evidence that genetic influences and prenatal nicotine and/or alcohol exposure play separate roles in determining risk of ADHD, little has been done on determining the joint roles that genetic risk associated with maternal alcohol use disorder (AUD) and prenatal risk factors play in determining risk of ADHD. Method. Using a children-of-twins design, diagnostic telephone interview data from high-risk families (female monozygotic and dizygotic twins concordant or discordant for AUD as parents) and control families targeted from a large Australian twin cohort were analyzed using logistic regression models. Results. Offspring of twins with a history of AUD, as well as offspring of non-AUD monozygotic twins whose co-twin had AUD, were significantly more likely to exhibit ADHD than offspring of controls. This pattern is consistent with a genetic explanation for the association between maternal AUD and increased offspring risk of ADHD. Adjustment for prenatal smoking, which remained significantly predictive, did not remove the significant genetic association between maternal AUD and offspring ADHD. Conclusions. While maternal smoking during pregnancy probably contributes to the association between maternal AUD and offspring ADHD risk, the evidence for a significant genetic correlation suggests: (i) pleiotropic genetic effects, with some genes that influence risk of AUD also influencing vulnerability to ADHD; or (ii) ADHD is a direct risk-factor for AUD.

Ethical issues in neuroimaging health research:an IPA study with research participants

Neuroimaging is increasingly used to understand conditions like stroke and epilepsy. However, there is growing recognition that neuroimaging can raise ethical issues. We used interpretative phenomenological analysis to analyse interview data pre-and post-scan to explore these ethical issues. Findings show participants can become anxious prior to scanning and the protocol for managing incidental findings is unclear. Participants lacked a frame of reference to contextualize their expectations and often drew on medical narratives. Recommendations to reduce anxiety include dialogue between researcher and participant to clarify understanding during consent and the use of a `virtual tour' of the neuroimaging experience.

Teacher use of personal narratives in the Japanese university english language classroom

While storytelling in conversation has been extensively investigated, much less is known about storytelling in the English language classroom, particularly teachers telling their personal experience stories, termed teacher personal narratives in this study. Teacher personal narratives, a combination of the ancient art of human storytelling and the current practices of teaching, offer an innovative approach to language teaching and learning. This thesis examines teacher personal narrative use in Japanese university English language classrooms and is of relevance to both practicing classroom teachers and teacher educators because it explores the role, significance, and effectiveness of personal stories told by teachers. The pedagogical implications which the findings may have for language teaching and learning as well as for teacher education programs are also discussed. Four research questions were posed: 1. What are the characteristics of teacher personal narratives? 2. When, how, and why do language teachers use personal narratives in the classroom? 3. What is the reaction of learners to teacher personal narratives? 4. How do teacher personal narratives provide opportunities for student learning? A mixed methods approach using the tradition of multiple case studies provided an in-depth exploration of the personal narratives of four teachers. Data collection consisted of classroom observations and audio recordings, teacher and student semi-structured interviews, student diaries, and Japan-wide teacher questionnaires. Ninety-seven teacher personal narratives were analyzed for their structural and linguistic features. The findings showed that the narrative elements of orientation, complication, and evaluation are almost always present in these stories, and that discourse and tense markers may aid in student noticing of the input which can lead to eventual student output. The data also demonstrated that reasons for telling narratives mainly fall into two categories: affectiveoriented and pedagogical-oriented purposes. This study has shown that there are significant differences between conversational storytelling and educational storytelling.

The eye of the beholder: The impact of a district implementation plan of state mandates as perceived by the implementers

The purpose of this inquiry was to investigate the impact of a large, urban school district's experience in implementing a mandated school improvement plan and to examine how that plan was perceived, interpreted, and executed by those charged with the task. The research addressed the following questions: First, by whom was the district implementation plan designed, and what factors were considered in its construction? Second, what impact did the district implementation plan have on those charged with its implementation? Third, what impact did the district plan have on the teaching and learning practices of a particular school? Fourth, what aspects of the implemention plan were perceived as most and least helpful by school personnel in achieving stated goals? Last, what were the intended and unintended consequences of an externally mandated and directed plan for improving student achievement? The implementation process was measured against Fullan's model as expounded upon in The Meaning of Educational Change (1982) and The New Meaning of Educational Change (1990). The Banya implementation model (1993), because it added a dimension not adequately addressed by Fullan, was also considered.^ A case study was used as the methodological framework of this qualitative study. Sources of data used in this inquiry included document analysis, participant observations in situ, follow-up interviews, the "long" interview, and triangulation. The study was conducted over a twelve-month period. Findings were obtained from the content analysis of interview transcripts of multiple participants. Results were described and interpreted using the Fullan and Banya models as the descriptive framework. A cross-case comparison of the multiple perspectives of the same phenomena by various participants was constructed.^ The study concluded that the school district's implementation plan to improve student achievement was closely aligned to Fullan's model, although not intentionally. The research also showed that where there was common understanding at all levels of the organization as to the expectations for teachers, level of support to be provided, and availability of resources, successful implementation occured. The areas where successful implementation did not occur were those where the complexity of the changes were underestimated and processes for dealing with unintended consequences were not considered or adequately addressed. The unique perspectives of the various participants, from the superintendent to the classroom teacher, are described. Finally, recommendations for enhancement of implementation are offered and possible topics for further research studies are postulated. ^

Student perceptions of the school physical fitness testing program: The Fitnessgram

The purpose of this study was to determine fifth grade students' perceptions of the Fitnessgram physical fitness testing program. This study examined if the Fitnessgram physical fitness testing experience promotes an understanding of the health-related fitness components and examined the relationship between individual fitness test scores and time spent participating in out-of-school physical activity. Lastly, students' thoughts and feelings concerning the Fitnessgram experience were examined. ^ The primary participant population for the study was 110 fifth grade students at Redland Elementary School, a Miami-Dade County Public School (M-DCPS). Data were collected over the course of 5 months. Multiple sources of data allowed for triangulation. Data sources included Fitnessgram test scores, questionnaires, document analysis, and in-depth interviews. ^ Interview data were analyzed qualitatively for common broad themes, which were identified and defined. Document analysis included analyzing student fitness test scores and student questionnaire data. This information was analyzed to determine if the Fitnessgram test scores have an impact on student views about the school fitness-testing program. Data were statistically analyzed using analysis of frequency, crosstabulations (Bryman & Duncan, 1997), and Somers'd Correlation (Bryman & Duncan, 1997). The results of the analysis of data on student knowledge of the physical fitness components tested by each Fitnessgram test revealed students do not understand the health-related fitness components. ^ The results of determining a relationship between individuals' fitness test scores and time spent in out-of-school physical activity revealed a significant positive relationship for 2 of the 6 Fitnessgram tests. ^ The results of examining students' thoughts and feelings about each Fitnessgram test focused around 2 broad themes: (a) these children do not mind the physical fitness testing and (b) how they felt about the experience was directly related to how they thought they had performed. ^ If the goal of physical fitness was only to get children fit, this test may be appropriate. However, the ultimate goal of physical fitness is to encourage students to live active and healthy lifestyles. Findings suggest the Fitnessgram as implemented by M-DCPS may not be the most suitable measurement instrument when assessing attitudinal changes that affect a healthy lifelong lifestyle. ^

The impact of bandwidth in structured interviewing and criterion stability in predicting and assessing manager performance across transition and maintenance stages

The current study examined the role of three important components in the use of structured employment interviewing in performance prediction: construct bandwidth, observed communication skill, and the stability/dynamicity of performance criteria over time. A matched sample of 242 hospitality managers was derived from a field data set provided by a large hospitality management organization. Interview data and two years of performance appraisal data were provided. Bandwidth analysis demonstrated only minimal differences in prediction between matched predictor-criterion pairs compared with predictor to overall aggregate ratings (unmatched). The communication skill analysis revealed that this interviewer rated observation significantly predicted a number of the individual performance dimensions as well as overall performance over time. Of the five interview items, the strongest overall predictor of performance was interviewer rated communication skill. The stability/dynamicity analyses demonstrated the performance criteria to be generally stable over the two year period examined, which provides support for the long held notion that performance criteria is stabile over time. However, there were two exceptions. The interview dimension customer service orientation had shifting relationships over time with four of the criteria over the two year period. The performance criteria employee development also demonstrated some instability in its relationships with predictors. Thus, some evidence of dynamicity in performance criteria was revealed. Interestingly, both of the most noteworthy findings in the study involved items that were rated differently than the others in the study. The rated interview item communication skill and the rated performance criteria client satisfaction were ratings that involved a more direct level of observation. Additional analyses also revealed evidence of a general factor of performance. These two themes are more fully covered in the discussion.

The role of spirituality in transformative learning

The purpose of this phenomenological study was to explore the role of spirituality in Mezirow's (1978, 1990, 1991, 1997, 1998, 2000, 2003) 10-phase process of transformative learning. This study used Mezirow's transformative learning theory as its theoretical framework. Semi-structured interviews were conducted, transcribed, and analyzed for 12 doctoral students and candidates who had a transformative learning experience and who identified themselves as being spiritual. Interview data were analyzed using inductive, deductive, and comparative analyses. Four themes emerged from the inductive analysis of the data: (a) the nature of spirituality, (b) the variety of emotions, (c) the influences of spirituality, and (d) the nature of personal changes. The theory's 10 phases were used as a guide in deductively analyzing data concerning the participants' experiences. The deductive analysis revealed that spirituality played a role in at least 7 of the 10 phases of transformative learning for each participant. Overall, from the participants' perspectives, the role of spirituality was that of a guide in influencing their cognition and behavior, and that of a supporter in influencing their emotions. The comparative analysis revealed that at least three of the four themes from the inductive analysis were reflected in each of the 10 phases of transformative learning used in the deductive analysis. Based on the findings from this study, the researcher proposed a modification of Mezirow's phases of transformative learning. An additional phase was identified: framing and naming the transformed perspective, and two phases were renamed. The findings from this study imply that given the importance of the role participants attributed to spirituality in their transformative learning in influencing their cognition, behavior, and emotions, the role of spirituality should be considered for inclusion in transformative learning theory. Recommendations for further research on the validation and replicability of the proposed modification to transformative learning theory are given.

Toward understanding the study experience of culturally sensitive graduate students in *American distance education programs

The purpose of this research was to gain an understanding of the study experience of non-American graduate students living outside of the United States and formally engaged in graduate studies in an American Distance Education (DE) Program. These students have been labeled “culturally sensitive.” The nature of this study dictated a qualitative case study methodology using in-depth interviews to collect the data and the hermeneutic approach to understanding and description. This study aims at generating questions and hypotheses that will lead to further investigations that explore the need for cultural and contextual sensitivity in order to provide more equitable and accessible higher education for all. ^ The study attempted to answer the question: What is the study experience of “culturally sensitive” graduate students in American DE Programs? The underlying issue in this study is whether education designed and provided by educators of different socio-cultural backgrounds from that of the students could be content relevant and instructionally appropriate, resulting in educational enhancement and/or prepare students to function adequately in their own communities. ^ Participants in this study (n = 12) were engaged in Master's level (n = 2) and Doctoral level (n = 10) DE programs at American Universities, and were interviewed by E-mail, face-to-face, or using a combination of the two. Data analysis compared interviews and highlighted repetitive patterns. Interview data was triangulated with recent related literature and data from document reviews of archived E-mail conversations between students and their professors. The patterns that emerged were coded and categorized according to generative themes. The following themes were identified in order to analyze the data and confirmed through participant check-back: program benefits, communication, technology, culture and methodology, and reflectivity. ^ Major findings in this study indicate that culture plays an important role in cross-cultural encounters for students in American DE programs vis-à-vis student perceptions as to whether their study needs were being met. Most notably, it was found that the coupling of cultural perceptual differences with transactional distance created a potential barrier to communication that could affect short-term success in American DE programs. To overcome this barrier, students cited good communication as essential in meeting student's needs, especially those communications that were supportive and full of detail and context and from a primary source (ex. directly from the professor). Evaluation was a particularly sensitive issue, especially when students were unaware of their professor's cultural and contextual intricacies and therefore were uncertain about expectations and intended meaning. CSGS were aware of their position and the American rather than global context in which they were participating. Students appear to have developed “extended identities”, meaning that they acculturated in varying degrees in order to be successful in their program but that their local cultural identity was not compromised in any way. For participants from Venezuela access to higher DE has been a limiting factor to participation, due to the high cost of technology and telephone lines for communication. ^

Implementation of service -learning in higher education courses: Perceptions of faculty

This study examined the motivation of college and university faculty to implement service-learning into their traditional courses. The benefits derived by faculty, as well as those issues of maintenance, including supports and/or obstacles, were also investigated in relation to their impact on motivation. The focus was on generating theory from the emerging data. ^ Data were collected from interviews with 17 faculty teaching courses that included a component of service-learning. A maximum variation sampling of participants from six South Florida colleges and universities was utilized. Faculty participants represented a wide range of academic disciplines, faculty ranks, years of experience in teaching and using service-learning as well as gender and ethnic diversity. For data triangulation, a focus group with eight additional college faculty was conducted and documents, including course syllabi and institutional service-learning handbooks, collected during the interviews were examined. The interviews were transcribed and coded using traditional methods as well as with the assistance of the computerized assisted qualitative data analysis software, Atlas.ti. The data were organized into five major categories with themes and sub-themes emerging for each. ^ While intrinsic or personal factors along with extrinsic factors all serve to influence faculty motivation, the study's findings revealed that the primary factors influencing faculty motivation to adopt service-learning were those that were intrinsic or personal in nature. These factors included: (a) past experiences, (b) personal characteristics including the value of serving, (c) involvement with community service, (d) interactions and relationships with peers, (e) benefits to students, (f) benefits to teaching, and (g) perceived career benefits. Implications and recommendations from the study encompass suggestions for administrators in higher education institutions for supporting and encouraging faculty adoption of service-learning including a well developed infrastructure as well as incentives, particularly during the initial implementation period, rewards providing recognition for the academic nature of service-learning and support for the development of peer relationships among service-learning faculty. ^

Access to better education: The school choice experience of families served by low-performing elementary public schools in Miami-Dade County

Public school choice education policy attempts to create an education marketplace. Although school choice research has focused on the parent role in the school choice process, little is known about parents served by low-performing schools. Following market theory, students attending low-performing schools should be the primary students attempting to use school choice policy to access high performing schools rather than moving to a better school. However, students remain in these low-performing schools. This study took place in Miami-Dade County, which offers a wide variety of school choice options through charter schools, magnet schools, and open-choice schools. ^ This dissertation utilized a mixed-methods design to examine the decision-making process and school choice options utilized by the parents of students served by low-performing elementary schools in Miami-Dade County. Twenty-two semi-structured interviews were conducted with the parents of students served by low-performing schools. Binary logistic regression models were fitted to the data to compare the demographic characteristics, academic achievement and distance from alternative schooling options between transfers and non-transfers. Multinomial logistic regression models were fitted to the data to evaluate how demographic characteristics, distance to transfer school, and transfer school grade influenced the type of school a transfer student chose. A geographic analysis was conducted to determine how many miles students lived from alternative schooling options and the miles transfer students lived away from their transfer school. ^ The findings of the interview data illustrated that parents’ perceived needs are not being adequately addressed by state policy and county programs. The statistical analysis found that students from higher socioeconomic social groups were not more likely to transfer than students from lower socioeconomic social groups. Additionally, students who did transfer were not likely to end up at a high achieving school. The findings of the binary logistic regression demonstrated that transfer students were significantly more likely to live near alternative school options.^

Stereotype Threat and the Standardized Testing Experiences of African American Children at an Urban Elementary School

Stereotype threat (Steele & Aronson, 1995) refers to the risk of confirming a negative stereotype about one’s group in a particular performance domain. The theory assumes that performance in the stereotyped domain is most negatively affected when individuals are more highly identified with the domain in question. As federal law has increased the importance of standardized testing at the elementary level, it can be reasonably hypothesized that the standardized test performance of African American children will be depressed when they are aware of negative societal stereotypes about the academic competence of African Americans. This sequential mixed-methods study investigated whether the standardized testing experiences of African American children in an urban elementary school are related to their level of stereotype awareness. The quantitative phase utilized data from 198 African American children at an urban elementary school. Both ex-post facto and experimental designs were employed. Experimental conditions were diagnostic and non-diagnostic testing experiences. The qualitative phase utilized data from a series of six focus group interviews conducted with a purposefully selected group of 4 African American children. The interview data were supplemented with data from 30 hours of classroom observations. Quantitative findings indicated that the stereotype threat condition evoked by diagnostic testing depresses the reading test performance of stereotype-aware African American children (F[1, 194] = 2.21, p < .01). This was particularly true of students who are most highly domain-identified with reading (F[1, 91] = 19.18, p < .01). Moreover, findings indicated that only stereotype-aware African American children who were highly domain-identified were more likely to experience anxiety in the diagnostic condition (F[1, 91] = 5.97, p < .025). Qualitative findings revealed 4 themes regarding how African American children perceive and experience the factors related to stereotype threat: (1) a narrow perception of education as strictly test preparation, (2) feelings of stress and anxiety related to the state test, (3) concern with what “others” think (racial salience), and (4) stereotypes. A new conceptual model for stereotype threat is presented, and future directions including implications for practice and policy are discussed.

Access to Better Education: The School Choice Experience of Families Served by Low-Performing Elementary Public Schools in Miami-Dade County

Public school choice education policy attempts to create an education marketplace. Although school choice research has focused on the parent role in the school choice process, little is known about parents served by low-performing schools. Following market theory, students attending low-performing schools should be the primary students attempting to use school choice policy to access high performing schools rather than moving to a better school. However, students remain in these low-performing schools. This study took place in Miami-Dade County, which offers a wide variety of school choice options through charter schools, magnet schools, and open-choice schools. This dissertation utilized a mixed-methods design to examine the decision-making process and school choice options utilized by the parents of students served by low-performing elementary schools in Miami-Dade County. Twenty-two semi-structured interviews were conducted with the parents of students served by low-performing schools. Binary logistic regression models were fitted to the data to compare the demographic characteristics, academic achievement and distance from alternative schooling options between transfers and non-transfers. Multinomial logistic regression models were fitted to the data to evaluate how demographic characteristics, distance to transfer school, and transfer school grade influenced the type of school a transfer student chose. A geographic analysis was conducted to determine how many miles students lived from alternative schooling options and the miles transfer students lived away from their transfer school. The findings of the interview data illustrated that parents’ perceived needs are not being adequately addressed by state policy and county programs. The statistical analysis found that students from higher socioeconomic social groups were not more likely to transfer than students from lower socioeconomic social groups. Additionally, students who did transfer were not likely to end up at a high achieving school. The findings of the binary logistic regression demonstrated that transfer students were significantly more likely to live near alternative school options.

Adolescent boys’ health : managing emotions, masculinities and subjective social status

The health of adolescent boys is complex and surprisingly little is known about how adolescent boys perceive, conceptualise and experience their health. Thus, the overall aim of this thesis was to explore adolescent boys’ perceptions and experiences of health, emotions, masculinity and subjective social status (SSS). This thesis consists of a qualitative, a quantitative and a mixed methods study. The qualitative study aimed to explore how adolescent boys understand the concept of health and what they find important for its achievement. Furthermore, the adolescent boys’ views of masculinity, emotion management and their potential effects on wellbeing were explored. For this purpose, individual interviews were conducted with 33 adolescent boys aged 16-17 years. The quantitative study aimed to investigate the associations between pride, shame and health in adolescence. Data were collected through a cross-sectional postal survey with 705 adolescents. The purpose of the mixed methods study was to investigate associations between SSS in school, socioeconomic status (SES) and self-rated health (SRH), and to explore the concept of SSS in school. Cross-sectional data were combined with interview data in which the meaning of SSS was further explored. Individual interviews with 35 adolescents aged 17-18 years were conducted. In the qualitative study, data were analysed using Grounded Theory. In the quantitative study, statistical analyses (e.g., chi-square test and uni- and multivariable logistic regression analyses) were performed. In the mixed method study, a combination of statistical analyses and thematic network analysis was applied. The results showed that there was a complexity in how the adolescent boys viewed, experienced, dealt with and valued health. On a conceptual level, they perceived health as holistic but when dealing with difficult emotions, they were prone to separate the body from the mind. Thus, the adolescent boys experienced a difference between health as a concept and health as an experience (paper I). Concerning emotional orientation in masculinity, two main categories of masculine conceptions were identified: a gender-normative masculinity and a non-gender-normative masculinity (paper II). Gender-normative masculinity comprised two seemingly opposite emotional masculinity orientations, one towards toughness and the other towards sensitivity, both of which were highly influenced by contextual and situational group norms and demands, despite that their expressions are in contrast to each other. Non-gender-normative masculinity included an orientation towards sincerity, emphasising the personal values of the boys. Emotions were expressed more independently of peer group norms. The findings suggest that different masculinities and the expression of emotions are intricately intertwined and that managing emotions is vital for wellbeing. The present findings also showed that both shame and pride were significantly associated with SRH, and furthermore, that there seems to be a protective effect of experiencing pride for health (paper III). The results also demonstrated that SSS is strongly related to SRH, and high SRH is related to high SSS, and further that the positioning was done in a gendered space (paper IV). Results from all studies suggest that the emotional and relational aspects, as well as perceived SSS, were strongly related to SRH. Positive emotions, trustful relationships and having a sense of belonging were important factors for health and pride was an important emotion protecting health. Physical health, on the other hand, had a more subordinated value, but the body was experienced as an important tool to achieve health. Even though health was mainly perceived in a holistic manner by the boys, there were boys who were prone to dichotomise the health experience into a mind-body dualism when having to deal with difficult emotions. In conclusion, this thesis demonstrates that young, masculine health is largely experienced through emotions and relationships between individuals and their contexts affected by gendered practices. Health is to feel and function well in mind and body and to have trusting relationships. The results support theories on health as a social construction of interconnected processes. Having confidence in self-esteem, access to trustful relationships and the courage to resist traditional masculine norms while still reinforcing and maintaining social status are all conducive to good health. Researchers as well as professionals need to consider the complexity of adolescent boys’ health in which norms, values, relationships and gender form its social determinants. Those working with young boys should encourage them to integrate physical, social and emotional aspects of health into an interconnected and holistic experience.

Myths and Realities of Inter-professional Working

Introduction: Childhood cancers are rare and community based health care professionals have limited experience in caring for these children and often even less experience in providing their palliative care. It is well recognised that the provision of palliative care falls beyond the remit of any one profession, thus inter professional working is the standard model. This qualitative study aims to examine the experiences of the range of health care professionals involved in providing palliative care at home for children with cancer, focusing on how knowledge is exchanged; the level of communication and support both interprofessionally and at the community/specialist interface. It also aims to examine interprofessional collaboration in palliative care; identifying healthcare professional's perceptions of problems involved, interprofessional boundaries, specific areas of the organisation or provision of care that could be enhanced through changes in practice, support issues and the educational needs of health professionals. Methods The study involves three types of data collection; in-depth interviews, facilitated case discussion (FCD) and field notes from up to 20 cases (a "case" refers to the provision of palliative care to one child). Cases are selected from children who were treated at one regional childhood caner centre. For each case the community based health care professionals (for example the GP, community nurse or health visitor) involved in the care of the child at home are invited to participate in a one-to-one tape recorded in-depth interview followed by a group discussion in the form of a FCD. Field notes are completed following each interview. Data analysis follows a grounded theory approach. The term "social worlds theory" (SWT) his used to define a type of social organisation with no fixed or formal boundaries (such as membership boundaries), for example the range of health professionals that work together to provide palliative care. The boundaries of SW's are determined by the interaction and communication between recognised organisations, such as community nursing teams and general practitioners. SWT examines encounters between different professional groups and can be used to extend knowledge in both the organisation (for example general practice) and the content of what is being provisioned (for example, palliative care). The use of SWT in the analysis of the data is through examining the ethos of the different professions and the associated individual approaches to palliative care, exploring how this determines their roles in the provision of palliative care. Results 10 cases have so far been completed: 47 1:1 interviews (with a range of between 2-7 health care professionals being involved in each case): ( 9 x GP, 19 x CCN, 4 x DN, 3 x HV, 1 x HV assistant 7 x paediatric palliative care nurses, 1 x home support worker, 1 x OT, 1 x physiotherapist, 1 x community paediatrician) and 5 x FCD. The range of participants in the FCDs reflected that of the individual interview sampler. Data obtained to date gives clear insight into the personal experience of the individual health care professional in providing palliative care. Two themes emerging from the data will be focused upon: the continuity of care provision throughout treatment and palliation and the emotional burden experiences by the health care professional. Conclusions SWT can provide a useful framework in examining the social worlds of a disparate group of health care professionals working together for the first and maybe, the only time. A wide variation in the continuity of care provision has been found not only between professions, but also within professions. The emotional burden is evident across the professions.