Cazale L, Tremblay D, Roberge D, Touati N, Denis J-L, Pineault R
Centre de recherche de l'Hôpital Charles-LeMoyne, 3120, boulevard Taschereau, Greenfield Park J4V 2H1, Québec, Canada.
Rev Epidemiol Sante Publique. 2006 Oct;54(5):407-20. doi: 10.1016/s0398-7620(06)76739-6.
In conjunction with a study focusing on the implementation and effect of an integrated care network for cancer patients in the Monteregie region in Quebec, the vignette research strategy was adopted to assess the quality of care provided by the interdisciplinary teams working with this clientele. This research strategy has only recently been used to assess professional practices. This article adopts a resolutely methodological angle in order to describe a rigorous, innovative, transferable experience from the standpoint of the elaboration of a vignette.
We adopted a six-step approach to elaborate the vignette. This vignette includes the description of collaboration with clinicians. The approach assured us of attaining high content validity from the standpoint of facets of its relevance, completeness and intelligibility to respondents. Our clinical vignette describes a sequence of events stemming from the care coordination of a 58-year-old man suffering from rectal cancer. Data were collected through group interviews with the interdisciplinary teams (n=5) under study. The professionals present were asked to describe their usual practices with respect to the events described in the vignette. We adopted two data analysis strategies: (i) a comparison of practices revealed through the interviews with anticipated responses in light of the guidelines of the "Programme québécois de lutte contre le cancer"; and (ii) an analysis according to facets of the quality of care.
Team professional practices seem to evolve towards the care package valued by the "Programme québécois de lutte contre le cancer". Differences were also observed between the teams from the standpoint of the continuity of care.
Our study shows that it is possible to develop a vignette that enables us to understand professional practices in an interdisciplinary context provided that a rigorous approach is adopted. This approach, which can be transferred to the study of similar phenomena, makes it possible to document the care offered and contribute to the renewal of professional practices.
在一项聚焦于魁北克蒙特利尔地区癌症患者综合护理网络的实施与效果的研究中，采用了案例研究策略来评估与该客户群体合作的跨学科团队所提供的护理质量。这种研究策略直到最近才被用于评估专业实践。本文从一个坚决的方法论角度出发，以便从案例阐述的角度描述一种严谨、创新且可推广的经验。
我们采用了六个步骤来阐述案例。这个案例包括与临床医生合作的描述。从其对受访者的相关性、完整性和可理解性等方面来看，该方法确保我们获得了较高的内容效度。我们的临床案例描述了一名58岁直肠癌男性患者护理协调过程中的一系列事件。数据通过与所研究的跨学科团队（n = 5）进行小组访谈收集。要求在场的专业人员描述他们针对案例中所述事件的常规做法。我们采用了两种数据分析策略：（i）根据“魁北克癌症防治计划”的指导方针，将访谈中揭示的做法与预期反应进行比较；（ii）根据护理质量的各个方面进行分析。
团队的专业实践似乎朝着“魁北克癌症防治计划”所重视的一揽子护理方向发展。从护理连续性的角度来看，各团队之间也存在差异。
我们的研究表明，只要采用严谨的方法就有可能开发出一个案例，使我们能够在跨学科背景下理解专业实践。这种可转移到类似现象研究中的方法，能够记录所提供的护理情况，并有助于专业实践的更新。
