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Fulltext Effectiveness of debriefing towards healthcare professionals’ nontechnical skills: a critical review

Muhamad Nur Fariduddin Abdul Aziz, Wee, Lei Hum, Lilia Halim, Mohd Johar Jaafar

Jurnal Sains Kesihatan Malaysia, 2018;16(1):17-28.
MyJurnal

The importance of nontechnical skills among healthcare professionals is gaining widespread recognition as critical
elements complementing technical skills that are used to improve patients’ safety. These skills are typically acquired
through simulation training which has emerged as an effective way to complement clinical training. Effective simulation
requires structure and effective debriefing methods to enhance its learning outcome. In previous literature, evidence of the
effectiveness of healthcare simulation was available but studies evaluating debriefing method(s) remain sparse. In this
paper, the effectiveness of debriefing methods in eight studies on the acquisition of nontechnical skills among healthcare
professionals is reviewed. Articles published from 1st January 2016 across three different databases were referred to. The
results of the review show a statistically significant improvement in the performance of nontechnical and technical skills
across different professionals through various methods of debriefing. Nontechnical skills such as teamwork, effective
communication, decision-making, and situational awareness have improved significantly. In addition, integration of
realism in simulation learning has begun to emerge as an effective technique of providing a real world experience.
However, there was lack of detailed information on the length and type of debriefing conducted in the studies. These
methods clearly require further research since the key to successful simulation learning is through debriefing which is
the heart of simulation.
Fulltext Basic-SiM train-the-trainer: a model to prepare aviation educators for simulation based-first aid learning

Muhamad Nur Fariduddin, Wee, Lei Hum, Lilia Halim, Mohd Johar Jaafar

ASM Science Journal, 2018;11(1):32-44.
MyJurnal

Medical emergency on board is a new phenomenon that lack of attention. Despite the
presence of cabin crew who is certified to provide medical care to the passenger, failure to
acquire the non-technical skills and low level of knowledge and technical skills retention is
reported to be major challenges in developing a highly competent cabin crew in providing
effective medical care. Having the ability to design simulations, implement it into teaching,
and effectively evaluate simulated performance is starting to become a key role for educators
in health care. For most educators, a practical knowledge and skills gap resides between
the need for simulation learning and proficiencies in designing and utilising simulation. The
purpose of this model was to develop a ‘trained educators’ from the aviation industry with
the knowledge and skills to utilise simulation effectively. The steps involve identification,
development, and integration with a follow-up assessment. The implementation of the program
yielded a significant improvement on the participants’ knowledge, t (129) = -6.27, p
< .001 together with a total DASH-SV score of 6.32. The barriers, including difficulties
encountered executing the model, are discussed combined with the implication for future application.
This model is an effective approach for developing a trained educator in first aid
for aviation incorporated with simulation learning. The trained educator will then become
a pioneer and train another organisation.
Fulltext Structured debriefings in aviation simulations: a qualitative study on basic life support training for cabin crews in Malaysia

Muhamad Nur Fariduddin, Wee,Lei Hum, Halim Lilia, Jaafar Mohd Johar

Malaysian Journal of Medicine and Health Sciences, 2019;15(3):37-45.
MyJurnal

Introduction: To develop quality cabin crews, trainings involve simulation-based education (SBE) with structured debriefings – a significant component which plays a critical role in optimising learning outcomes. Previous studies have empirically tested the efficacy of the DIAMOND-structured debriefing model and found significant improve- ment and retention of the cabin crews’ knowledge and skills. This study was aimed to explore the elements of the DIAMOND-structured debriefing model that have been known to promote the acquisition and retention of knowl- edge and skills in basic life support (BLS). Methods: A qualitative study was conducted with a random sample of 16 individual cabin crew members who participated in an in-depth interview with 13 open-ended questions for 45 – 60 minutes. The interviews were transcribed and independently analysed using inductive thematic analysis. Results: The codes which have emerged during data analysis were clustered into three themes: (1) Cognitive, with three sub- themes: engagement, learning environment, and ability to reflect; (2) Methodology, with three sub-themes: concept of debriefing, techniques of questioning, and additional elements; as well as (3) Psychosocial, with five sub-themes: attitude, self-awareness, relationships, self-confidence, and work culture. Several suggestions have emerged, such as the implementation of the model. Conclusion: The DIAMOND-structured debriefing model was a method to reduce cognitive load, which in turn allowed individuals to organise their knowledge, reflect individually and collectively, as well as structure their ideas. It has showed that the elements has a positive impact on the cabin crews’ acquisition and retention of knowledge and skills which will improve the performance and patient safety.
Fulltext Effective practice of debriefing after simulation-based non-technical skills in healthcare professionals: a systematic review

Muhamad Nur Fariduddin, Wee Lei Hum, Lilia Halim, Mohd Johar Jaafar

Jurnal Sains Kesihatan Malaysia, 2019;17(2):51-62.
MyJurnal

The importance of non-technical skills among healthcare professionals is gaining a widespread recognition as critical elements complementing the technical skills used for improving patients’ safety. These skills are typically acquired through simulation training, which emerged as an effective way to complement clinical training. Non-technical skills frequently use high-fidelity simulation followed by a facilitated discussion known as debriefing. Debriefing by a skilled facilitator is thought to be essential for effective learning through reflective processes. Unfortunately, evidence to support the elements which contributes towards the effectiveness of debriefing remains sparse. We review the studies where elements of debriefing that have been manipulated and its effectiveness on the acquisition of non-technical skills among healthcare professionals through eight publications across four different databases. Non-technical skills performance improved after manipulated debriefing such as multimedia debrief, self-led debrief or no debrief. Besides, there was no added performance when video recording was added to facilitator-led debriefing. The application of learning theory on specific elements together with the application of selected debriefing models is highly encouraging for effective debriefing.
Fulltext Factors influencing sustainability of juara sihat obesity intervention from the perspective of children: a qualitative study

Mok, Wilfred Kok Hoe, Devanthini Dewi Gunasekaran, Wee, Lei Hum, Poh, Bee Koon, Ruzita Abd. Talib

Jurnal Sains Kesihatan Malaysia, 2019;17(3):157-167.
MyJurnal

Global prevalence of childhood overweight and obesity have increased drastically in the past years, including in Malaysia. School-based obesity intervention is important to promote healthy eating and behavioural change. Many obesity interventions have been conducted to combat childhood obesity; however, the sustainability of childhood obesity interventions are often overlooked. This study aimed to explore the factors that influenced sustainability of Juara Sihat intervention programme in Kuala Lumpur primary school. Face-to-face in-depth interviews were conducted with 26 children aged 12- 14 years old whom participated in the Juara Sihat intervention programme were purposively selected. Data was transcribed verbatim and analysed using thematic analysis. The main themes identified as motivators are (1) support from family, facilitators, school teachers, and friends; (2) physical activity and healthy eating practices after intervention; (3) self-awareness; (4) knowledge on food pyramid and healthy eating; and (5) home environment. While the barriers are (1) knowledge inconsistency; (2) own safety; (3) peers influence; (4) self-attitude; (5) boredom towards programme. The results showed that the main promoting factor for sustainability of Juara Sihat intervention programme is continued practice of physical activity and healthy eating, while the main barrier is knowledge inconsistency. Therefore, school-based obesity intervention programmes should consider these promoting and hindering factors that could influence the sustainability of intervention programmes. Future studies should consider those factors during program intervention planning especially when factors that influence implementation and sustainability are carefully considered and taken care of to ensure long-term success.
Stop smoking clinics in Malaysia: characteristics of attendees and predictors of success

Wee LH, Shahab L, Bulgiba A, West R

Addict Behav, 2011 Apr;36(4):400-3.
PMID: 21195553 DOI: 10.1016/j.addbeh.2010.11.011

INTRODUCTION: As Stop Smoking Clinics (SSCs) become more common across the globe, it is important to know how far one can make broad generalisations concerning characteristics of smokers who attend these clinics and factors that predict their success. This involves accumulation of data from different countries.
OBJECTIVE: The aim of this study was to identify characteristics of smokers and factors leading up to quitting with clinics in Malaysia.
METHOD: Records from 629 smokers who had sought help from five selected SSCs in Malaysia from January 2006 to June 2007 were analysed.
RESULTS: The characteristics of smokers attending Malaysian smoking clinics were broadly similar to those in Western countries. Consistent with the findings from other countries, older age and longest duration of previous quit attempts were associated with successful smoking cessation. Greater baseline carbon-monoxide readings (OR 0.96, 95% CI 0.93-0.99; p=0.013), but not Fagerstrom Test for Nicotine Dependence (FTND), predicted failure to quit at six-month in multivariate analysis. Success rates varied greatly between clinics even after adjusting for all other predictors.
CONCLUSION: In these rare data from a non-Western culture some predictors of successful smoking cessation appeared to generalise from Western smokers but the universal validity of the FTND in particular needs to be examined further.
Fulltext Cross-Cultural Adaptation and Validation of the Attitudes Toward Suicide Questionnaire Among Healthcare personnel in Malaysia

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Wahab S

Inquiry, 2017 01 01;54:46958017707295.
PMID: 28486042 DOI: 10.1177/0046958017707295

Understanding attitudes toward suicide, especially among healthcare personnel, is an important step in both suicide prevention and treatment. We document the adaptation process and establish the validity and reliability of the Attitudes Toward Suicide (ATTS) questionnaire among 262 healthcare personnel in 2 major public hospitals in the Klang Valley, Malaysia. The findings indicate that healthcare personnel in Malaysia have unique constructs on suicide attitude, compared with the original study on a Western European sample. The adapted Malay ATTS questionnaire demonstrates adequate reliability and validity for use among healthcare personnel in Malaysia.
Perceptions on radioprotective garment usage and underlying reasons for non-adherence among medical radiation workers from public hospitals in a middle-income Asian setting: A qualitative exploration

Mohd Ridzwan SF, Bhoo-Pathy N, Isahak M, Wee LH

Heliyon, 2019 Sep;5(9):e02478.
PMID: 31687573 DOI: 10.1016/j.heliyon.2019.e02478

Background: Radioprotective garments protect medical radiation workers from exposure to radiation at workplace. However, previous studies have found poor adherence to the use of radioprotective garments.
Objectives: We explored the perceptions and practices related to the use of radioprotective garments among medical radiation workers in public hospitals, and sought to understand the reasons for non-adherence.
Design and setting: A qualitative approach was applied by conducting face-to-face in-depth interviews with 18 medical radiation workers from three university hospitals using a semi-structured interview guide.
Results: Five themes emerged with respect to perceptions on the use of radioprotective garments: (i) the dilemmas in practising radiation protection, (ii) indication of workers' credibility, (iii) physical appearance of radioprotective garments, (iv) practicality of radioprotective garment use, and (v) impact on workflow. Actual lack of radioprotective garment use was attributed to inadequate number of thyroid shield and other garments, radioprotective garments' unsightly appearance including being dirty and defective, impracticality of using radioprotective garments for some nuclear medicine procedures, disruption of workflow because of workers' limited movements, attitudes of workers, and organisational influences.
Conclusion: Medical radiation workers demonstrated a definitive practice of using radioprotective aprons, but often neglected to use thyroid shields and other garments. Availability and hygiene are reported as the core issues, while unclear guidelines on practical use of radioprotective garments appear to lead to confusion among medical radiation workers. To the best of our knowledge, this is the first qualitative study of its kind from a middle-income Asian setting.
Beliefs, Facilitating Factors, and Barriers in Using Personal Dosimeter among Medical Radiation Workers in a Middle-Income Asian Setting

Mohd Ridzwan SF, Bhoo-Pathy N, Wee LH, Isahak M

Ann Work Expo Health, 2021 10 09;65(8):940-954.
PMID: 34037205 DOI: 10.1093/annweh/wxab025

This qualitative study explores the medical radiation workers' (MRWs) beliefs with the support of the theory of planned behaviour's constructs regarding the use of personal dosimeters in order to identify the facilitating factors and barriers to practising good personal dose monitoring. The exploration was conducted through semi-structured face-to-face interviews with 63 MRWs from the public, private, and university hospitals. Belief statements from the informants were organized under the behavioural, normative, and control belief, as guided by the theory. A thematic analysis found that a majority of informants acknowledged the benefits of using dosimeters. However, several factors influenced the actual usage. The informants were hesitant to use the dosimeter as the loss of the device involved an expensive penalty. They also mentioned that delayed dosimeter supplies due to late budget approval in the hospitals and some other reasons had got them disconnected from the monitoring system. The workers' attitudes and social norms highly induced their dosimeter usage as well; some perceived themselves to be at low risk for high exposure to radiation, and forgetfulness was also mentioned as a reason for lack of adherence. Device physical factor influenced low dosimeter use too. This study highlighted some unique findings in Asian settings. A better understanding of the underlying reasons for the lack of dosimeter use will be useful in developing strategies to increase good practices in personal radiation monitoring.
Fulltext Assessing predictors of intention to prescribe sick leave among primary care physicians using the theory of planned behaviour

Swarna Nantha Y, Wee LH, Chan CM

BMC Fam Pract, 2018 01 16;19(1):18.
PMID: 29338699 DOI: 10.1186/s12875-017-0690-5

BACKGROUND: Providing sickness certification is a decision that primary care physicians make on a daily basis. The majority of sickness certification studies in the literature involve a general assessment of physician or patient behaviour without the use of a robust psychological framework to guide research accuracy. To address this deficiency, this study utilized the Theory of Planned Behaviour (TPB) to specifically gauge the intention and other salient predictors related to sickness certification prescribing behaviour amongst primary care physicians.
METHODS: A cross-sectional study was conducted among N = 271 primary care physicians from 86 primary care practices throughout two states in Malaysia. Questionnaires used were specifically developed based on the TPB, consisting of both direct and indirect measures related to the provision of sickness leave. Questionnaire validity was established through factor analysis and the determination of internal consistency between theoretically related constructs. The temporal stability of the indirect measures was determined via the test-retest correlation analysis. Structural equation modelling was conducted to determine the strength of predictors related to intentions.
RESULTS: The mean scores for intention to provide patients with sickness was low. The Cronbach α value for the direct measures was good: overall physician intent to provide sick leave (0.77), physician attitude towards prescribing sick leave for patients (0.77) and physician attitude in trusting the intention of patients seeking sick leave (0.83). The temporal stability of the indirect measures of the questionnaire was satisfactory with significant correlation between constructs separated by an interval of two weeks (p
Fulltext Predicting Overweight and Obesity Status Among Malaysian Working Adults With Machine Learning or Logistic Regression: Retrospective Comparison Study

Wong JE, Yamaguchi M, Nishi N, Araki M, Wee LH

JMIR Form Res, 2022 Dec 07;6(12):e40404.
PMID: 36476813 DOI: 10.2196/40404

BACKGROUND: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status.
OBJECTIVE: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia.
METHODS: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41% male; n=7048, 41.8% with overweight or obesity) in the Malaysia's Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2.
RESULTS: The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79-0.82), 0.80 (95% CI 0.79-0.81), 0.80 (95% CI 0.78-0.81), and 0.78 (95% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models.
CONCLUSIONS: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia.
Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia

Wee LH, West R, Bulgiba A, Shahab L

Nicotine Tob Res, 2011 Feb;13(2):151-6.
PMID: 21186253 DOI: 10.1093/ntr/ntq221

INTRODUCTION: Much is known about the predictors of success in quitting smoking. In particular, nicotine dependence, but not strength of motivation to stop, appears to predict abstinence. However, to date, studies have come almost exclusively from Western countries. More data are needed on the cross-cultural generalizability of these findings.
METHODS: One hundred and ninety-eight smokers attending 5 stop-smoking clinics in Malaysia completed a questionnaire prior to their target quit date and were followed up 3 months after this date. Predictors included sociodemographic variables, smoking patterns, past history of quitting, characteristics of current quit attempt, and smoking motives as well as nicotine dependence (Fagerström Test for Nicotine Dependence [FTND]) and self-rated strength of motivation of stop.
RESULTS: At 3-month follow-up, 35.4% (95% CI: 28.7-42.0) of participants reported being abstinent. A backward elimination multiple logistic regression identified a number of significant predictors of success, including strength of motivation to stop (adjusted odds ratio [OR]: 3.05, 95% CI: 1.28-7.25). FTND did not predict success.
CONCLUSIONS: Motivation and nicotine dependence may play different roles in explaining variation in ability to stop smoking in different cultures.
Study site: Quit smoking clinics, Federal Territories and Putrajaya Hospital, Malaysia
Should the threshold for expired-air carbon monoxide concentration as a means of verifying self-reported smoking abstinence be reduced in clinical treatment programmes? Evidence from a Malaysian smokers' clinic

Wee LH, West R, Mariapun J, Chan CM, Bulgiba A, Peramalah D, et al.

Addict Behav, 2015 Aug;47:74-9.
PMID: 25889913 DOI: 10.1016/j.addbeh.2015.03.021

BACKGROUND: It has been proposed that the expired-air carbon monoxide (CO) threshold for confirming smoking abstinence in clinical practice be reduced below 10 ppm. Optimal thresholds may vary across regions. Data are needed to assess the impact of such a change on claimed success.
METHODS: A total of 253 smokers who attended the Tanglin quit smoking clinic in Malaysia were followed-up 1, 3 and 6 months after the target quit date. All participants received a standard behavioural support programme and were prescribed either varenicline or nicotine replacement therapy. Expired-air CO was measured at every visit. Respondents' smoking status was assessed using a range of different CO thresholds (3, 5 and 10 ppm) and the impact on quit rates was calculated. Predictors of success as defined using the different thresholds were assessed.
RESULTS: The 6-month abstinence rates were: 1 month - 54.9% at 10 ppm, 54.9% at 5 ppm and 48.6% at 3 ppm; 3 months - 36.0% at 10 ppm, 35.2% at 5 ppm and 30.4% at 3 ppm; 6 months - 24.1% at 10 ppm, 24.1% at 5 ppm and 20.6% at 3 ppm. Older smokers were more likely to be recorded as abstinent at 6 months regardless of the threshold used.
CONCLUSIONS: Reducing the threshold for expired-air carbon monoxide concentrations to verify claimed smoking abstinence from 10 ppm to 5 ppm makes minimal difference to documented success rates in Malaysian smoker's clinic patients. Reducing to 3 ppm decreases success rates slightly. Predictors of success at stopping appear to be unaffected by the threshold used.
KEYWORDS: Carbon monoxide; Predictors for abstinence; Smoking cessation; Success rates
Fulltext Prevalence of Insufficient Sleep and Its Associated Factors Among Working Adults in Malaysia

Chan CMH, Siau CS, Wong JE, Wee LH, Jamil NA, Hoe VCW

Nat Sci Sleep, 2021;13:1109-1116.
PMID: 34285616 DOI: 10.2147/NSS.S295537

Introduction: Given the scarcity of data on sleep insufficiency in developing countries and its emerging importance in public health, this study aims to provide the prevalence and factors associated with insufficient sleep among working Malaysian adults.
Materials and Methods: A total of 11,356 working adults (≥18 years) were recruited from a cross-sectional online health and work survey. Sleep duration was self-reported and was categorised as insufficient sleep (<7 h) and sufficient sleep (≥7 h) based on the National Sleep Guidelines' daily sleep time recommendation for adults. The 10-item Kessler scale was used to assess psychological distress levels (cutoff score ≥20). Bivariate and multivariable regression analyses were performed to examine the factors associated with insufficient sleep.
Results: The mean age of the participants was 35.7 years (standard deviation, SD±9.2). There were more female (n=6613; 58.2%) respondents. The mean sleep duration was 6.49 h (SD±1.10). A total of 6212 individuals (54.7%) reported getting <7 h of sleep daily. After adjusting for gender, marital status and educational attainment, older age (odds ratio, OR=2.22, 95% confidence interval, 95% CI: 1.72-2.86), ever smoking (OR=1.38, 95% CI: 1.25-1.53), and high psychological distress (OR=1.33, 95% CI: 1.17-1.53) were found to be associated with insufficient sleep. Factors associated with sleep duration of <7 h per night included having children (OR=1.35, 95% CI: 1.21-1.50), lifestyle factors (OR=1.38, 95% CI: 1.25-1.53), poor sleeping conditions (OR=1.21, 95% CI: 1.07-1.36), and mental health issues (OR=1.32, 95% CI: 1.12-1.54).
Discussion and Conclusion: More than half of the participants reported sleep insufficiency. Older age, ever smoking, and high levels of psychological distress were significantly associated with insufficient sleep. Our findings recognise sleep as an emerging public health issue. Smoking cessation programmes and addressing high psychological distress may be beneficial to improve sleep.
Fulltext Reply to Course and predictors of posttraumatic stress disorder in a cohort of psychologically distressed patients with cancer: A 4-year follow-up study-methodological and statistical issues

Chan CMH, Ng CG, Taib A, Wee LH, Krupat E, Meyer F

Cancer, 2018 06 01;124(11):2457.
PMID: 29645084 DOI: 10.1002/cncr.31365
Gatekeeper Suicide Training's Effectiveness Among Malaysian Hospital Health Professionals: A Control Group Study With a Three-Month Follow-Up

Siau CS, Wee LH, Ibrahim N, Visvalingam U, Yeap LLL, Wahab S

J Contin Educ Health Prof, 2018;38(4):227-234.
PMID: 30036213 DOI: 10.1097/CEH.0000000000000213

INTRODUCTION: There is a lack of suicide-related training in the nonpsychiatric health professional's basic education. We suggest that a continuing education through a brief gatekeeper suicide training program could be a suitable platform to improve suicide-related knowledge, self-efficacy, and attitudes. This study aimed at examining the effectiveness of the Question, Persuade, Refer gatekeeper program on improving the knowledge, self-efficacy in suicide prevention, and understanding of/willingness to help suicidal patients of Malaysian hospital health professionals.
METHODS: The Question, Persuade, Refer program materials were translated and adapted for implementation in the hospital setting for nonpsychiatric health professionals. There were 159 (mean age = 35.75 years; SD = 12.26) participants in this study. Most participants were female (84.9%), staff/community nurses (52.2%), who worked in the general medical department (30.2%) and had no experience managing suicidal patients (64.2%). Intervention participants (n = 53) completed a survey questionnaire at pretraining, immediately after training, and after three months. Control participants (n = 106) were not exposed to the training program and completed the same questionnaire at baseline and three months later.
RESULTS: Significant improvement occurred among intervention participants in terms of perceived knowledge, self-efficacy, and understanding of/willingness to help suicidal patients immediately after training and when compared with the control participants 3 months later. Improvements in declarative knowledge were not maintained at the 3-month follow-up.
DISCUSSION: This study confirmed the short-term effectiveness of the gatekeeper training program. Gatekeeper suicide training is recommended for implementation for nonpsychiatric health professionals nationwide.
Fulltext Rationalizations and identity conflict following smoking relapse: a thematic analysis

Wee LH, Binti Ithnin AA, West R, Mohammad N, Chan CM, Hasan Nudin SS

J Subst Use, 2017 Jan 02;22(1):47-52.
PMID: 28217031 DOI: 10.3109/14659891.2016.1143045

Introduction: Little is known about how smokers respond cognitively and emotionally to the experience of "late" relapse after the acute withdrawal phase. This study assessed the kinds of thoughts and feelings that emerge in order to provide a basis for quantitative research assessing prevalence of different types of response and implications for future quit attempts. Methods: Face-to-face in-depth interviews were conducted among 14 people attending a quit smoking clinic in Malaysia who had relapsed after at least 6 weeks of abstinence. Transcripts were analyzed using thematic analysis to enable emergence of important aspects of the experience. Results: Following relapse, smokers often engaged in rationalizations and activities to minimize worry about the harmful effects of smoking by switching to a lower-tar cigarette, reducing the number of cigarette smoked, attempting to reduce cigarette smoke inhalation, comparing themselves with other smokers, and minimizing the health risks associated with smoking. In some cases, smokers retained a "non-smoker" identity despite having relapsed. Conclusion: Smoking relapsers rationalize their failure to quit and minimize their health risk in order to protect their image as non-smokers while it remains a source of identity conflict.
Study site: Quit Smoking Clinic, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia
Health-Care Workers' Perception of Patients' Suicide Intention and Factors Leading to It: A Qualitative Study

Wee LH, Ibrahim N, Wahab S, Visvalingam U, Yeoh SH, Siau CS

Omega (Westport), 2020 Dec;82(2):323-345.
PMID: 30482086 DOI: 10.1177/0030222818814331

This study explored health-care workers' perception of patients' suicide intention and their understanding of factors leading to particular interpretations. Semistructured face-to-face in-depth interviews were conducted with 32 health-care workers from a general hospital in Klang Valley, Malaysia. Interview data were transcribed verbatim and analyzed using the interpretative phenomenological analysis. The health-care workers were found to have four types of perceptions: to end life, not to end life, ambivalence about intention, and an evolving understanding of intention. Factors leading to their perceptions of patients' suicide intention were patient demographics, health status, severity of ideation/attempt, suicide method, history of treatment, moral character, communication of suicide intention, affective/cognitive status, availability of social support, and health-care workers' limited knowledge of patients' condition/situation. Insufficient knowledge and negative attitudes toward suicidal patients led to risk minimization and empathic failure, although most health-care workers used the correct parameters in determining suicide intention.
Preferences for patient-centered care among cancer survivors 5 years post-diagnosis

Chan CMH, Blanch-Hartigan D, Taib NA, Wee LH, Krupat E, Meyer F

Patient Educ Couns, 2020 08;103(8):1601-1605.
PMID: 32143985 DOI: 10.1016/j.pec.2020.02.033

OBJECTIVE: Our primary objective was to identify predictors associated with preferences for patient-centered care among cancer survivors and the association between cancer health literacy and patient-centered care preferences.
METHODS: Cross sectional analyses of N = 345 adult cancer survivors (5 years post cancer diagnosis) attending follow-ups at University Malaya Medical Centre, Malaysia. Face-to face-interviews were conducted using the 30-item Cancer Health Literacy Test and the Patient-Practitioner Orientation Scale to determine preference for patient-centered care.
RESULTS: Cancer survivors' preference for patient-centered care was associated with a higher cancer health literacy score, higher educational level, being employed, breast cancer diagnosis, and not desiring psychological support [F (14, 327) = 11.25, p
Malaysian Nurses' Attitudes Toward Suicide and Suicidal Patients: A Multisite Study

Siau CS, Wee LH, Adnan TH, Yeoh SH, Perialathan K, Wahab S

J Nurses Prof Dev, 2019 2 12;35(2):98-103.
PMID: 30741918 DOI: 10.1097/NND.0000000000000520

The aim of this study was to examine Malaysian nurses' attitudes toward suicide. Nurses from five hospitals participated in this study. Studying the attitudes of nurses toward suicidal patients and its application to nursing professional development practitioners is an important topic. Most nurses were agreeable to assuming responsibility and to be trained in suicide prevention. Suicide-related training should focus on improving the attitudes of nonpsychiatric nurses, those with no experience in caring for suicidal patients, and those with less nursing experience, all of whom reported more negative attitudes toward suicidal patients.

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