Transferring critically ill patients home to die is poorly explored in the literature to date. Th... more Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals' (HCP) experience and views. To examine (1) HCPs' experience of transferring patients home to die from critical care, (2) HCPs' views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home ...
At the end of life, a move into or out of hospital is one of the most disruptive events for older... more At the end of life, a move into or out of hospital is one of the most disruptive events for older adults and their carers, with consequences for their mental, physical and emotional wellbeing. Evidence from elsewhere suggests that transitions are frequent and make little contribution to patients' wellbeing. Little is known about socioeconomic differences in end of life hospital admissions in England. To investigate patterns of end-of-life hospital admissions by socioeconomic disadvantage. Analysis of linked hospital episode statistics and mortality data for England. Between 2001 and 2010, 300,304 people aged over 75 were admitted to hospital in England at least once in their last year of life with a diagnosis of lung cancer or heart failure. Eighty five percent of people admitted with lung cancer and 72% of heart failure cases underwent a transition into hospital in the last 3 months of life. In multivariate analysis, lower socioeconomic status (given by the index of multiple de...
The end-of-life care needs of older adults with multiple conditions are complex and involve a ran... more The end-of-life care needs of older adults with multiple conditions are complex and involve a range of professionals working in different settings. This study focuses on transitions, as vulnerable points in care pathways experienced by a high proportion of the older population at the end of life. To understand how inter-professional relations influence transitions between settings for older adults at the end of life. In-depth qualitative interviews with 118 caregivers of decedents aged 66-98 years, who had died with heart failure, chronic obstructive pulmonary disease, stroke, selected cancers; 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services in England. Carers regretted that communication and handovers between professionals did not always take place where they felt them to be necessary, and perceived frequent, repeated assessments and interventions to be the consequence. Families felt compelled to take responsibility ...
Journal of Epidemiology and Community Health, 2015
Studying where people die across countries can serve as an evidence base for health policy on end... more Studying where people die across countries can serve as an evidence base for health policy on end-of-life care. This study describes the place of death of people who died from diseases indicative of palliative care need in 14 countries, the association of place of death with cause of death, sociodemographic and healthcare availability characteristics in each country and the extent to which these characteristics explain country differences in the place of death. Death certificate data for all deaths in 2008 (age ≥1 year) in Belgium, Canada, the Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (Andalusia), the USA and Wales caused by cancer, heart/renal/liver failure, chronic obstructive pulmonary disease, diseases of the nervous system or HIV/AIDS were linked with national or regional healthcare statistics (N=2 220 997). 13% (Canada) to 53% (Mexico) of people died at home and 25% (the Netherlands) to 85% (South Korea) died in hospital. The strength and direction of associations between home death and cause of death, sociodemographic and healthcare availability factors differed between countries. Differences between countries in home versus hospital death were only partly explained by differences in these factors. The large differences between countries in and beyond Europe in the place of death of people in potential need of palliative care are not entirely attributable to sociodemographic characteristics, cause of death or availability of healthcare resources, which suggests that countries' palliative and end-of-life care policies may influence where people die.
A study of the life world of individuals waiting for a kidney transplant aimed to provide a de-sc... more A study of the life world of individuals waiting for a kidney transplant aimed to provide a de-scriptive and conceptual understanding of how individuals experience their wait. Thirty qual-itative interviews were undertaken with individuals on the UK deceased donor kidney trans-plant list. The study employed grounded theory methodology. Participants' experiences of waiting for a transplant can be described as, seeking normality. On a daily basis participants sought to live as normal a life as possible, through the negotia-tion of symptoms and treatment into daily life, and through the processes of maintaining hope of a transplant and dealing with waiting. Certain contextual factors and resources, such as the ability to work, support of family and friends and information and support from health profes-sionals, enabled or constrained participants in the process of seeking normality. Participants were undergoing a continued process of maintaining their hope of a transplant. They use...
This paper explicates the nature and extent of the networks of care surrounding patients with can... more This paper explicates the nature and extent of the networks of care surrounding patients with cancer palliative care needs. Twenty-four patients with 15 different types/sites of cancer were recruited in one city in England, UK. During one in-depth interview patients identified who was 'involved in their care' and any known pathways of communication between them. One hundred of these people (35 doctors, 32 nurses, 17 professions allied to medicine, 8 family members and 8 others) were also interviewed. Maps of people/teams and the connections between them for each patient were then reconstructed using social networking software (PAJEK). The 24 patients identified a total of 619 people or teams (mean 26, median 22, range 9-45 per patient) contributing to their care. Selected care network maps are displayed, illustrating the extent and nature of the care networks supporting palliative care patients. Common members of care networks for patients with palliative care needs are reve...
To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patie... more To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patient-reported outcome measure to detect patients' perceptions of change in quality of life (QoL) and issues of concern, and views of service benefit. Following pilot testing and cognitive interviewing, St Christopher's Index of Patient Priorities (SKIPP) was administered twice to hospice inpatients and homecare patients. QoL was rated 'now', and retrospectively 'before starting hospice care' or 'at the time of the first interview'. Patients nominated and rated progress with main concerns, rated the difference the service was making, and completed palliative care outcome scale. Patients completed SKIPP again within 24 h to measure test-retest reliability. QoL scores 'now' differed significantly from retrospective scores made at same time: QoL increased with hospice care when patients 'looked back' on previous QoL. Four-fifths reported that the...
To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and... more To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives. Stage 2 was a regional survey (65% response rate) concerned with hospital nurses' opinions of caring for terminally ill patients and their perceived competence. The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided with an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. There is a need for an inte...
Patients who have completed initial cancer treatment (cancer survivors) have been relatively negl... more Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development. Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies. The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evi...
Identifying the most important issues for palliative care patients and their families, and assess... more Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals. To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals. Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison. Seven themes were identified as most important to participants: symptom management; choice and control; dignity...
To assess the cultural acceptability and appropriateness of an English end-of-life survey questio... more To assess the cultural acceptability and appropriateness of an English end-of-life survey questionnaire translated into Bengali for use in east London. Group discussions with informal carers (n=3 groups) and professionals (n = l1 group). Informal carers within a Bengali-speaking community (n = 26) in east London participated in three groups discussions led by three community workers trained in interviewing procedures. These data were followed up with one group discussion with bilingual health and social care professionals (n = 6). Data subject to content analysis. Participants were supportive of the development of the translated questionnaire. However, attention should be paid to vocabulary, shared meanings, cultural equivalence and the ways people conceptualize health and illness, and death and dying. These findings, together with participants' views on the administration of the questionnaire, will prompt revisions to the research approach when targeting ethnic and cultural gro...
To identify facilitators and barriers to implementing outcome measures. An action-research approa... more To identify facilitators and barriers to implementing outcome measures. An action-research approach within a hospice and nursing home was used. Staff took part in semistructured interviews pre- and post-implementation of the Palliative Care Outcome Scale (POS), completed diaries and participated in monthly meetings. Qualitative content analysis identified barriers to implementation including: a top-down decision-making approach; outcome measures perceived as time-consuming to use; limited resources for data analysis; and a lack of knowledge of the importance of outcome measures. Facilitators to successful implementation include: involving all staff in decisions about implementation; and using a measure that can be adapted to organization needs and clinical practice. The benefits of using the measure are rapidly noticeable. Given the need to evaluate services and the role outcome measures can have within clinical governance, this article indicates methods by which measures may be mor...
A number of palliative care outcome measures are used to facilitate the provision of palliative c... more A number of palliative care outcome measures are used to facilitate the provision of palliative care. This short article reports the use of one palliative care outcome measure, the Palliative care Outcome Scale, with people with motor neurone disease (MND) living at home. The outcome measure was generally viewed positively by those involved. However, problems with this scale itself point to the need for a specialized instrument to assess palliative care outcomes for people living with MND.
Assessment of care quality is integral to health and palliative care provision and there is a nee... more Assessment of care quality is integral to health and palliative care provision and there is a need to develop and implement outcome measures to assess quality. This study aimed to: (1) describe the implementation of a palliative care outcome measure in non-specialist palliative care settings and (2) to understand the implementation of the measure. Twenty-five non-specialist palliative care settings were purposely sampled and invited to implement a palliative care outcome measure. Fifteen settings agreed to take part. The research team provided training and support in the use of the measure. Data were collected on actual use of the measure and, via interviews with patients and nurses, on their experiences. The number of assessments was low (21 patients assessed against an anticipated minimum of 240). The analysis of nurses' accounts identified important considerations in understanding the low response. Although nurses saw the implementation of the outcome measure as bringing oppo...
The retrospective approach in palliative care research provides valuable insight into death and d... more The retrospective approach in palliative care research provides valuable insight into death and dying, and the effectiveness of palliative care. The method involves collecting information from proxies (usually significant others) after the patient's death. This exploratory study investigates whether proxies' accounts differ during bereavement, and provides possible explanations for why discrepancies might occur. Thirteen bereaved family members were interviewed, at three to five months and seven to nine months after the patient's death, about the patient's pain, anxiety, and depression, using semi-structured interviews and the symptom rating scale from the Views of Informal Carers-Evaluation of Services (VOICES) interview. Analysis of VOICES ratings over time indicated consistency for anxiety, while pain and depression ratings were variable and, in many cases, less severe and less frequent with the passage of time. Qualitative analysis of proxies' interview trans...
In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audi... more In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audit and research. The objective of this study was to elicit professionals' views and experiences of using outcome measures, paying special attention to the Palliative care Outcome Scale (POS). This article presents the results of a qualitative study of 26 professionals, experienced in using the POS, who were invited to participate in semi-structured telephone interviews. Of those invited, 22 people took part. Participants' comments were noted verbatim through the interviews and data subjected to content analysis. Analysis of data identified a number of key themes surrounding outcome measures, notably their reasons for use, application in clinical settings and a range of professionals' attitudes. The article concludes that understanding the process of outcome measures is important for improving their implementation. When undertaking further research, attention should be paid to ...
Transferring critically ill patients home to die is poorly explored in the literature to date. Th... more Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals' (HCP) experience and views. To examine (1) HCPs' experience of transferring patients home to die from critical care, (2) HCPs' views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home ...
At the end of life, a move into or out of hospital is one of the most disruptive events for older... more At the end of life, a move into or out of hospital is one of the most disruptive events for older adults and their carers, with consequences for their mental, physical and emotional wellbeing. Evidence from elsewhere suggests that transitions are frequent and make little contribution to patients' wellbeing. Little is known about socioeconomic differences in end of life hospital admissions in England. To investigate patterns of end-of-life hospital admissions by socioeconomic disadvantage. Analysis of linked hospital episode statistics and mortality data for England. Between 2001 and 2010, 300,304 people aged over 75 were admitted to hospital in England at least once in their last year of life with a diagnosis of lung cancer or heart failure. Eighty five percent of people admitted with lung cancer and 72% of heart failure cases underwent a transition into hospital in the last 3 months of life. In multivariate analysis, lower socioeconomic status (given by the index of multiple de...
The end-of-life care needs of older adults with multiple conditions are complex and involve a ran... more The end-of-life care needs of older adults with multiple conditions are complex and involve a range of professionals working in different settings. This study focuses on transitions, as vulnerable points in care pathways experienced by a high proportion of the older population at the end of life. To understand how inter-professional relations influence transitions between settings for older adults at the end of life. In-depth qualitative interviews with 118 caregivers of decedents aged 66-98 years, who had died with heart failure, chronic obstructive pulmonary disease, stroke, selected cancers; 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services in England. Carers regretted that communication and handovers between professionals did not always take place where they felt them to be necessary, and perceived frequent, repeated assessments and interventions to be the consequence. Families felt compelled to take responsibility ...
Journal of Epidemiology and Community Health, 2015
Studying where people die across countries can serve as an evidence base for health policy on end... more Studying where people die across countries can serve as an evidence base for health policy on end-of-life care. This study describes the place of death of people who died from diseases indicative of palliative care need in 14 countries, the association of place of death with cause of death, sociodemographic and healthcare availability characteristics in each country and the extent to which these characteristics explain country differences in the place of death. Death certificate data for all deaths in 2008 (age ≥1 year) in Belgium, Canada, the Czech Republic, England, France, Hungary, Italy, Mexico, the Netherlands, New Zealand, South Korea, Spain (Andalusia), the USA and Wales caused by cancer, heart/renal/liver failure, chronic obstructive pulmonary disease, diseases of the nervous system or HIV/AIDS were linked with national or regional healthcare statistics (N=2 220 997). 13% (Canada) to 53% (Mexico) of people died at home and 25% (the Netherlands) to 85% (South Korea) died in hospital. The strength and direction of associations between home death and cause of death, sociodemographic and healthcare availability factors differed between countries. Differences between countries in home versus hospital death were only partly explained by differences in these factors. The large differences between countries in and beyond Europe in the place of death of people in potential need of palliative care are not entirely attributable to sociodemographic characteristics, cause of death or availability of healthcare resources, which suggests that countries' palliative and end-of-life care policies may influence where people die.
A study of the life world of individuals waiting for a kidney transplant aimed to provide a de-sc... more A study of the life world of individuals waiting for a kidney transplant aimed to provide a de-scriptive and conceptual understanding of how individuals experience their wait. Thirty qual-itative interviews were undertaken with individuals on the UK deceased donor kidney trans-plant list. The study employed grounded theory methodology. Participants' experiences of waiting for a transplant can be described as, seeking normality. On a daily basis participants sought to live as normal a life as possible, through the negotia-tion of symptoms and treatment into daily life, and through the processes of maintaining hope of a transplant and dealing with waiting. Certain contextual factors and resources, such as the ability to work, support of family and friends and information and support from health profes-sionals, enabled or constrained participants in the process of seeking normality. Participants were undergoing a continued process of maintaining their hope of a transplant. They use...
This paper explicates the nature and extent of the networks of care surrounding patients with can... more This paper explicates the nature and extent of the networks of care surrounding patients with cancer palliative care needs. Twenty-four patients with 15 different types/sites of cancer were recruited in one city in England, UK. During one in-depth interview patients identified who was 'involved in their care' and any known pathways of communication between them. One hundred of these people (35 doctors, 32 nurses, 17 professions allied to medicine, 8 family members and 8 others) were also interviewed. Maps of people/teams and the connections between them for each patient were then reconstructed using social networking software (PAJEK). The 24 patients identified a total of 619 people or teams (mean 26, median 22, range 9-45 per patient) contributing to their care. Selected care network maps are displayed, illustrating the extent and nature of the care networks supporting palliative care patients. Common members of care networks for patients with palliative care needs are reve...
To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patie... more To develop and conduct a preliminary psychometric analysis of a hospice and palliative care patient-reported outcome measure to detect patients' perceptions of change in quality of life (QoL) and issues of concern, and views of service benefit. Following pilot testing and cognitive interviewing, St Christopher's Index of Patient Priorities (SKIPP) was administered twice to hospice inpatients and homecare patients. QoL was rated 'now', and retrospectively 'before starting hospice care' or 'at the time of the first interview'. Patients nominated and rated progress with main concerns, rated the difference the service was making, and completed palliative care outcome scale. Patients completed SKIPP again within 24 h to measure test-retest reliability. QoL scores 'now' differed significantly from retrospective scores made at same time: QoL increased with hospice care when patients 'looked back' on previous QoL. Four-fifths reported that the...
To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and... more To describe Spanish nurses' preparedness to care for hospitalised terminally ill patients and how this translates into care delivery. An exploratory, sequential mixed methods study with two stages. Stage I used unstructured observations of 22 hospital nurses over 235 hours to understand their daily reality, followed by semi-structured interviews with 21 nurses to elicit their perspectives. Stage 2 was a regional survey (65% response rate) concerned with hospital nurses' opinions of caring for terminally ill patients and their perceived competence. The nurses felt competent to provide physical but not emotional care for terminally ill patients. They reported that care could be improved, particularly through providing more emotional care. This coincided with an observed focus on physical care. The nurses reported a lack of support in caring for terminally ill patients and wanted more education on emotional issues and dealing with their own feelings. There is a need for an inte...
Patients who have completed initial cancer treatment (cancer survivors) have been relatively negl... more Patients who have completed initial cancer treatment (cancer survivors) have been relatively neglected. We need data to help us better understand the needs of this group and to underpin evidence-based service development. Scoping reviews of research published in the last two decades focussing on the problems faced by cancer survivors, and the effectiveness of interventions for these problems were undertaken. The aim was to identify what we know, what we do not know and opportunities where research could provide new information. We searched for, retrieved and rapidly appraised systematic reviews sourced from the most common electronic databases supplemented by more recently published individual studies. The research evidence is surprisingly limited. We have some knowledge of the prevalence and nature of depression, pain and fatigue in cancer survivors. We know much less about cognitive and physical impairment, employment, financial well-being and relationships. Even where we have evi...
Identifying the most important issues for palliative care patients and their families, and assess... more Identifying the most important issues for palliative care patients and their families, and assessing whether services address these appropriately is important. Little is known about the views of United Kingdom service users and whether, and in what ways, they differ from those in the published literature from other countries, or from health professionals. To investigate what is important to measure at the end of life from the perspectives of United Kingdom patients, bereaved relatives and health care professionals. Ten focus groups, using a modified nominal group technique, with a total of 75 participants (10 patients, 35 professionals and 30 bereaved relatives) enabled issues participants thought important to measure at the end of life to be identified and prioritised using ratings and rankings. Thematic analysis of the data was conducted to enable cross-group comparison. Seven themes were identified as most important to participants: symptom management; choice and control; dignity...
To assess the cultural acceptability and appropriateness of an English end-of-life survey questio... more To assess the cultural acceptability and appropriateness of an English end-of-life survey questionnaire translated into Bengali for use in east London. Group discussions with informal carers (n=3 groups) and professionals (n = l1 group). Informal carers within a Bengali-speaking community (n = 26) in east London participated in three groups discussions led by three community workers trained in interviewing procedures. These data were followed up with one group discussion with bilingual health and social care professionals (n = 6). Data subject to content analysis. Participants were supportive of the development of the translated questionnaire. However, attention should be paid to vocabulary, shared meanings, cultural equivalence and the ways people conceptualize health and illness, and death and dying. These findings, together with participants' views on the administration of the questionnaire, will prompt revisions to the research approach when targeting ethnic and cultural gro...
To identify facilitators and barriers to implementing outcome measures. An action-research approa... more To identify facilitators and barriers to implementing outcome measures. An action-research approach within a hospice and nursing home was used. Staff took part in semistructured interviews pre- and post-implementation of the Palliative Care Outcome Scale (POS), completed diaries and participated in monthly meetings. Qualitative content analysis identified barriers to implementation including: a top-down decision-making approach; outcome measures perceived as time-consuming to use; limited resources for data analysis; and a lack of knowledge of the importance of outcome measures. Facilitators to successful implementation include: involving all staff in decisions about implementation; and using a measure that can be adapted to organization needs and clinical practice. The benefits of using the measure are rapidly noticeable. Given the need to evaluate services and the role outcome measures can have within clinical governance, this article indicates methods by which measures may be mor...
A number of palliative care outcome measures are used to facilitate the provision of palliative c... more A number of palliative care outcome measures are used to facilitate the provision of palliative care. This short article reports the use of one palliative care outcome measure, the Palliative care Outcome Scale, with people with motor neurone disease (MND) living at home. The outcome measure was generally viewed positively by those involved. However, problems with this scale itself point to the need for a specialized instrument to assess palliative care outcomes for people living with MND.
Assessment of care quality is integral to health and palliative care provision and there is a nee... more Assessment of care quality is integral to health and palliative care provision and there is a need to develop and implement outcome measures to assess quality. This study aimed to: (1) describe the implementation of a palliative care outcome measure in non-specialist palliative care settings and (2) to understand the implementation of the measure. Twenty-five non-specialist palliative care settings were purposely sampled and invited to implement a palliative care outcome measure. Fifteen settings agreed to take part. The research team provided training and support in the use of the measure. Data were collected on actual use of the measure and, via interviews with patients and nurses, on their experiences. The number of assessments was low (21 patients assessed against an anticipated minimum of 240). The analysis of nurses' accounts identified important considerations in understanding the low response. Although nurses saw the implementation of the outcome measure as bringing oppo...
The retrospective approach in palliative care research provides valuable insight into death and d... more The retrospective approach in palliative care research provides valuable insight into death and dying, and the effectiveness of palliative care. The method involves collecting information from proxies (usually significant others) after the patient's death. This exploratory study investigates whether proxies' accounts differ during bereavement, and provides possible explanations for why discrepancies might occur. Thirteen bereaved family members were interviewed, at three to five months and seven to nine months after the patient's death, about the patient's pain, anxiety, and depression, using semi-structured interviews and the symptom rating scale from the Views of Informal Carers-Evaluation of Services (VOICES) interview. Analysis of VOICES ratings over time indicated consistency for anxiety, while pain and depression ratings were variable and, in many cases, less severe and less frequent with the passage of time. Qualitative analysis of proxies' interview trans...
In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audi... more In palliative care, outcome measures are increasingly used to aid clinical practice, conduct audit and research. The objective of this study was to elicit professionals' views and experiences of using outcome measures, paying special attention to the Palliative care Outcome Scale (POS). This article presents the results of a qualitative study of 26 professionals, experienced in using the POS, who were invited to participate in semi-structured telephone interviews. Of those invited, 22 people took part. Participants' comments were noted verbatim through the interviews and data subjected to content analysis. Analysis of data identified a number of key themes surrounding outcome measures, notably their reasons for use, application in clinical settings and a range of professionals' attitudes. The article concludes that understanding the process of outcome measures is important for improving their implementation. When undertaking further research, attention should be paid to ...
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