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Dr. Lesley Degner
Distinguished Professor and CHSRF/CIHR Chair in Cancer
Psychosocial Oncology and Cancer Nursing Research
Research Focus
Dr. Degner’s current research is focused on how nurses can be assisted to use the latest research evidence in their daily practice. She is involved in two major studies to better understand how health care organizations can alter the context for care within their organizations to promote knowledge use by nurses and in turn improve patient outcomes. She is also interested in the effect such organizational interventions might have on the quality of nursing work life, and whether involvement in knowledge translation activities will promote the retention of new nurses moving into the work force.
This current interest has evolved after several decades of research on patient participation in decision making, patient information needs, the meaning that patients ascribe to their illness, and symptom management. Dr. Degner has been particularly interested in developing measures and interventions to help cancer patients become more involved in treatment decision making should they wish to do so, and one of her major articles in this field which was published in 1997 in the prestigious Journal of the American Medical Association is highly cited and used in teaching medical students internationally. She has also had a long standing interest in symptom management, particularly in lung cancer patients, who experience some of the most severe cancer-related symptoms. In an article published in the medical journal Cancer in 2005, she and her Swedish colleagues reported on a longitudinal study of 400 lung cancer patients and their symptom experiences, and provided a model for preventative symptom management in this population.
Why is this work important?
Dr. Degner’s past research led to the development of three measures: the Control Preferences Scale, the Information Needs Scale, and the Meaning of Illness Scale. All of these are now used internationally in both research and clinical practice. They have also been used in health care policy documents in Canada, the United States, and the United Kingdom, and have stimulated the evaluation of a number of clinical interventions to improve quality of life for cancer patients, particularly those with breast and prostate cancer. Her most recent measure of symptom distress in lung cancer provides a new approach for clinicians to understand which symptoms individual patients would find most distressing and therefore provide the information on which to design preventive symptom management.
Her current work involves testing models of organizational change that could lead to substantial improvements in patient outcomes and improvements in nursing work life. The goal is to ensure that new knowledge actually makes its way into daily health care practice, which is not always the case at present.
About Lesley Degner, R.N., Ph.D., FCAHS
Lesley Degner is an internationally recognized scholar and researcher in patient involvement in medical decision making. In 1987, Dr. Degner published, Life-Death Decisions in Health Care, a groundbreaking book outlining the factors that influence the way treatment decisions are made for patients with life-threatening illnesses. The theory described in this book formed the basis of Dr. Degner's subsequent development of the Control Preferences Scale and the Information Needs Scale, measurement tools which are now used by investigators internationally.
Dr. Degner's research into informational needs, decision making preferences and the meaning of illness in women with breast cancer also included comparative studies in England and Sweden. In a paper published in Cancer Nursing in 2003, she described a new way of measuring how women with breast cancer derive meaning from their experiences. This paper won the Research Article of the Year Award, and the model it describes is an important new tool for clinicians communicating with breast cancer patients.
A graduate of the universities of Manitoba, Washington, and Michigan, Dr. Degner joined the University of Manitoba in 1973. She currently holds a 10 year National Research Chair from the Canadian Health Services Research Foundation and the Canadian Institutes of Health Research, to support her program entitled, “Development of Evidence-Based Nursing Practice in Cancer Care, Palliative Care and Cancer Prevention.”
For more information, please contact:
Dr. Lesley Degner
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In Detail
Dr. Degner’s current research interests are focused in the field of knowledge translation, or how to get research evidence that could improve patient outcomes into practice.
1. Evaluation of an Organizational Intervention to Improve Nursing Work Life through Training in Knowledge Translation: Phase I: Creating a Nursing Work Life “Geography” of the Target Organization
Funded by the Canadian Institutes of Health Research, $300,000, 2005-2008
Dr. Degner is the Principal Investigator on this project. The proposed organizational intervention is the introduction of The Nursing Knowledge Translation (KT) Centre, a geographical site within a major tertiary hospital that would be staffed by individuals trained in KT who would in turn provide such training to front-line nurses. The conceptualization for the intervention emerged from participant observation with front-line nurses who are at present unable to participate in KT on a regular basis. Nurses in the intervention arm of the study would have four paid hours per month when they would be assigned to work in the Centre. Nurse volunteers from particular patient care units would select through a consensus process one patient outcome they would like to improve. That selected patient outcome would be measured every six months to provide the nurses with feedback on the extent to which they had been able to shift the outcome through KT. The primary endpoints for the intervention study will be nursing work life, including absenteeism and several indicators of nursing work life previously developed and validated by Laschinger and colleagues. The new brief forms of these inventories will be tested in Phase I of the research program. The concept is that we will create a nursing work life “geography” of the target organization in order to inform decisions about the selection of the research design for the intervention study and to permit calculation of the required sample sizes. The secondary endpoint is a new measure of knowledge utilization being developed by Estabrooks.
2. TREC: Translating Research in Elder Care
Funded by the Canadian Institutes of Health Research, $4.7 million, 2007-2012
Dr. Degner is the Manitoba Site Lead for this project, which is being conducted in the three prairie provinces, as well as leader of one of the three major projects (specifically the project to understand the effect of organizational context on knowledge use in practice) in this research program. Dr. Carole Estabrooks of the University of Alberta Faculty of Nursing is the Principal Investigator.
This is the second phase (2007-2012) of a long-term investigation into the determinants and processes of using research based knowledge in health care settings. The purpose of the overarching program (2002-2022) is to develop a robust theoretical understanding of knowledge translation in action to facilitate changes that result in better outcomes. The purpose of the five year program of research described here is to address the impact of context (i.e., organizational setting and environmental factors) on knowledge translation and the subsequent impact of knowledge translation on health outcomes (and secondarily on provider and system outcomes) in long term care facilities (nursing homes) in the three prairie provinces.
We will be guided by the Promoting Action on Research Implementation in Health Services (PARIHS) framework which proposes three components to successful research implementation. In this framework, context is one of three central concepts (along with facilitation and evidence) that influence the use of research by providers in healthcare settings. While we will use the entire framework, we will focus in particular on the context dimension. Context and its social processes are central to optimal knowledge production and use in healthcare settings and are increasingly recognized as central to understanding knowledge translation in complex health care organizations.
Program Aims:
- 1. To build knowledge translation theory about the role of context in influencing knowledge use in long term care settings and among non-professional care givers by:
- Developing an organizational monitoring system to profile context in long term care facilities
- Collecting in-depth organizational data including process change over time
- 1.3 Assessing the effect of context on the extent of implementation of an intervention over time and the reciprocal effect of implementing the intervention on context over time
- To pilot innovative knowledge translation interventions
- To contribute to enhanced use of new knowledge in long term care
The program of research is comprised of three major projects addressing aim one, and three pilot projects addressing aim two. Aim three is addressed throughout each project and by our return on investment activities. Project 1 builds our understanding of context by implementing an organizational monitoring program in long term care. This is a sophisticated 30 facility project where we will build a comprehensive quantitative profile of context, knowledge translation behaviours and resident outcomes with which to generate and test theory. We will do multi-level and other modeling to test the general hypothesis that a positive context results in more knowledge translation and better resident outcomes. Project 2 builds our understanding of context by conducting three comprehensive, in-depth, comparative case studies and six more focused comparative case studies in each province to develop thick descriptions of context and its processes, and to generate substantive theory. In Project 3 we implement and evaluate an enhanced audit and feedback intervention in 12 facilities in the prairies. Using three clinical areas (pain, falls, behaviour management), we will implement a series of rapid feedback cycles using tailored education materials and feedback reports derived from routinely collected resident data (MDS/RAI). The intervention will be conducted over 18 months, with six quarterly cycles. Analyses will occur within each project and we will also conduct integrated analyses where we use the findings of each project to inform the interpretations of the others. Pilot projects addressing new interventions to increase knowledge translation, one aimed at each level of provider (managers, regulated and unregulated providers) have been planned to launch in the first year in order to enable those investigators to use pilot data to develop full operating grants.
Serious advances in the understanding of knowledge translation require multidisciplinary and multi-method approaches. We have assembled a group of researchers bringing together several health and non-health disciplines. In addition, we are experienced in different methodological and multi-method approaches. We jointly focus on multiple levels of observation and analysis – micro (clinical, professional), meso (organizational), and macro (regional, provincial) – in our respective programs.
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