Browsing by Author "King-Shier, Kathryn M"

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    Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review
    (Wiley, 2017-04) Sinclair, Shane; Kondejewski, Jane; Raffin-Bouchal, Shelley; King-Shier, Kathryn M; Singh, Pavneet
    Background This meta-narrative review, conducted according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standards, critically examines the construct of self-compassion to determine if it is an accurate target variable to mitigate work-related stress and promote compassionate caregiving in healthcare providers. Methods PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases were searched. Studies were coded as referring to: (1) conceptualisation of self-compassion; (2) measures of self-compassion; (3) self-compassion and affect; and (4) self-compassion interventions. A narrative approach was used to evaluate self-compassion as a paradigm. Results Sixty-nine studies were included. The construct of self-compassion in healthcare has significant limitations. Self-compassion has been related to the definition of compassion, but includes limited facets of compassion and adds elements of uncompassionate behavior. Empirical studies use the Self-Compassion Scale, which is criticised for its psychometric and theoretical validity. Therapeutic interventions purported to cultivate self-compassion may have a broader effect on general affective states. An alleged outcome of self-compassion is compassionate care; however, we found no studies that included patient reports on this primary outcome. Conclusion We critically examine and delineate self-compassion in healthcare providers as a composite of common facets of self-care, healthy self-attitude, and self-awareness rather than a construct in and of itself.
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    Design and Evaluation of a Brief Motivational Intervention to Promote Enrolment in Outpatient Cardiac Rehabilitation: A Mixed-Methods Feasibility Study
    (2017) Rouleau, Codie R; Campbell, Tavis S.; King-Shier, Kathryn M; Tomfohr-Madsen, Lianne; von Ranson, Kristin M; Russell-Mayhew, Michelle K; Oh, Paul I
    Objective: Patients who are referred to exercise-based cardiac rehabilitation (CR) following an acute coronary syndrome (ACS) event stand to benefit from a range of positive CR-related outcomes, including reduced morbidity and mortality. Yet, only 19-34% of eligible patients participate in CR in the United States and Canada. Motivational interviewing could be useful for encouraging CR enrolment, but empirical support does not exist. Research that examines patients’ decision-making about CR enrolment is needed to inform effective motivational intervention in this context. Methods: A two-part study was conducted to design and evaluate a brief motivational intervention to enhance intention to attend a 12-week CR program. Part 1 involved a qualitative examination of decision-making about CR enrolment using semi-structured interviews with ACS patients following CR referral but prior to enrolment (n = 14). A brief motivational intervention was subsequently designed to target obstacles to CR identified by patients in Part 1. Part 2 involved a two-group randomized controlled trial to examine preliminary efficacy and mechanisms of the intervention, using a usual care control group (n = 96). The primary outcome was intention to attend CR. Secondary outcomes included CR beliefs, CR barriers, self-efficacy, illness perception, social support, CR enrolment/adherence, and intervention acceptability. Results: Thematic analysis of qualitative data in Part 1 suggested the intervention should aim to bolster anticipated benefits of CR; assist patients in overcoming concerns about exercise, transportation, finances, and scheduling; and address contextual variables such as emotional distress and knowledge gaps. Randomization to the motivational intervention was associated with greater intention to attend CR (p = .001), greater perceived necessity of CR (p = .036), lower exercise concerns (p = .011), and higher CR adherence (p = .008), compared to usual care. Conclusions: Results provide preliminary evidence for the efficacy of a brief motivational intervention to enhance intention to attend CR. Implementing strategies that enhance the perceived necessity of CR and reduce exercise concerns may help improve adherence to CR following an ACS event. This body of work will help optimize efforts to promote participation in an under-utilized, cost-effective program that significantly improves ACS outcomes.
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    Exploring structural barriers to diabetes self-management in Alberta First Nations communities
    (2018-12-03) Kulhawy-Wibe, Stephanie; King-Shier, Kathryn M; Barnabe, Cheryl; Manns, Braden J; Hemmelgarn, Brenda R; Campbell, David J T
    Abstract Background Type 2 diabetes is highly prevalent in Canadian First Nations (FN) communities. FN individuals with diabetes are less likely to receive guideline recommended care and access specialist care. They are also less likely to be able to engage in optimal self-management behaviours. While the systemic and racial contributors to this problem have been well described, individuals’ experiences with structural barriers to care and self-management remain under-characterized. Methods We utilized qualitative methods to gain insight into the structural barriers to self-management experienced by FN individuals with diabetes. We conducted a qualitative descriptive analysis of a subcohort of patients with diabetes from FN communities (n = 5) from a larger qualitative study. Using detailed semi-structured telephone interviews, we inquired about participants’ diabetes and barriers to diabetes self-management. Inductive thematic analysis was performed in duplicate using NVivo 10. Results The structural barriers faced by this population were substantial yet distinct from those described by non-FN individuals with diabetes. For example, medication costs, which are usually cited as a barrier to care, are covered for FN persons with status. The barriers to diabetes self-management that were commonly experienced in this cohort included transportation-related difficulties, financial barriers to uninsured health services, and lack of accessible diabetes education and resultant knowledge gaps. Conclusions FN Albertans with diabetes face a myriad of barriers to self-management, which are distinct from the Non-FN population. In addition to the barriers introduced by colonialism and historical injustices, finances, geographic isolation, and lack of diabetes education each impede optimal management of diabetes. Programs targeted at addressing FN-specific barriers may improve aspects of diabetes self-management in this population.
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    Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study
    (2017-02-15) Campbell, David J T; Manns, Braden J; Weaver, Robert G; Hemmelgarn, Brenda R; King-Shier, Kathryn M; Sanmartin, Claudia
    Abstract Background Some patients with cardiovascular-related chronic diseases such as diabetes and heart disease report financial barriers to achieving optimal health. Previous surveys report that the perception of having a financial barrier is associated with self-reported adverse clinical outcomes. We sought to confirm these findings using linked survey and administrative data to determine, among patients with cardiovascular-related chronic diseases, if there is an association between perceived financial barriers and the outcomes of: (1) disease-related hospitalizations, (2) all-cause mortality and (3) inpatient healthcare costs. Methods We used ten cycles of the nationally representative Canadian Community Health Survey (administered between 2000 and 2011) to identify a cohort of adults aged 45 and older with hypertension, diabetes, heart disease or stroke. Perceived financial barriers to various aspects of chronic disease care and self-management were identified (including medications, healthful food and home care) from the survey questions, using similar questions to those used in previous studies. The cohort was linked to administrative data sources for outcome ascertainment (Discharge Abstract Database, Canadian Mortality Database, Patient Cost Estimator). We utilized Poisson regression techniques, adjusting for potential confounding variables (age, sex, education, multimorbidity, smoking status), to assess for associations between perceived financial barriers and disease-related hospitalization and all-cause mortality. We used gross costing methodology and a variety of modelling approaches to assess the impact of financial barriers on hospital costs. Results We identified a cohort of 120,752 individuals over the age of 45 years with one or more of the following: hypertension, diabetes, heart disease or stroke. One in ten experienced financial barriers to at least one aspect of their care, with the two most common being financial barriers to accessing medications and healthful food. Even after adjustment, those with at least one financial barrier had an increased rate of disease-related hospitalization and mortality compared to those without financial barriers with adjusted incidence rate ratios of 1.36 (95% CI: 1.29–1.44) and 1.24 (1.16–1.32), respectively. Furthermore, having a financial barrier to care was associated with 30% higher inpatient costs compared to those without financial barriers. Discussion This study, using novel linked national survey and administrative data, demonstrates that chronic disease patients with perceived financial barriers have worse outcomes and higher resource utilization, corroborating the findings from prior self-report studies. The overall exposure remained associated with the primary outcome even in spite of adjustment for income. This suggests that a patient’s perception of a financial barrier might be used in clinical and research settings as an additional measure along with standard measures of socioeconomic status (ie. income, education, social status). Conclusions After adjusting for relevant covariates, perceiving a financial barrier was associated with increased rates of hospitalization and mortality and higher hospital costs compared to those without financial barriers. The demonstrable association with adverse outcomes and increased costs seen in this study may provide an impetus for policymakers to seek to invest in interventions which minimize the impact of financial barriers.