Title: NC MOST Provider Interview

Instrument F

Title: NC MOST Provider Interview

Designer: Anthony Caprio, MD and Ellen Roberts, MPH, PhD. Please cite this reference in any work you do:

Caprio AJ, Rollins VP, Roberts E. Health care professionals' perceptions and use of the medical orders for scope of treatment (MOST) form in North Carolina nursing homes.J Am Med Dir Assoc. 2012 Feb;13(2):162-8.

Suitable for Quality Improvement? Possibly, but this is a supplement to Instrument E that is very specific to the investigators’ research questions.

Suitable for research? Yes.

Description of Instrument:This face to face interview guidewas designed to supplement a written survey (Toolkit Instrument E NC MOST Health Care Provider Survey). Its purpose is to qualitatively elicit health care professionals’approach to discussing section B, Scope of Treatment and to elicit any other experiences or comments about MOST. The investigators’ results are described Caprio et al 2012. The responses should prove very useful in designing educational efforts.

How to use:

Step 1: Modify the interview to suit your purposes. Since this was designed as a supplement to Instrument E, it has only 2 questions with the investigators’ research questions in mind. Unless you have the same question, you may want to use their question as a good example of how to construct a qualitative question(s) of your own. We recommend that you pilot test your new questions with a small (3-4) group of your target audience to ensure that it gets you the results you need.

Step 2: Select who you will interview. The interview is designed for clinicians who have used the MOST form. Because face-to-face interviews are very time consuming to arrange, conduct, and analyze, the numbers will be necessarily be smaller. For example, the published study included 11 interviews total. Because of this, it’s important to try to interview people who can really speak well on behalf of your target audience. Some people are good interview subjects, others are not, and if you’ve got the choice it’s better to interview people who do well in interviews. If your goal is quality and dissemination, you could select people in positions to influence others.

Step 3:There is a well described methodology forqualitative research that is beyond the scope of this toolkit, but you should consider recording your interviews. It is better to start with more open ended questions like ‘tell me about the last time you completed a MOST form with a patient’. More specific questions you are interested in can be included as ‘probes’ like the investigators have done here.

Step 4: Analyze the results. Qualitative questions like the question in this survey are good for learning how different people think about a complex topic like ‘how do you describe the different scope of treatment options in section B?’. The purpose is not to be able to generalize (this is how people do it in our state) but to describe (these are some of the different ways people might do it in our state). If done properly, you’ll learn about things you had not even thought of and learn to better understand how your target audience thinks about the topics you discuss. This could particularly helpful in designing meaningful educational interventions.