Enabling awareness, agency and participation: Haematology patient experiences of an (in)patient portal's information affordances.

This study examines patient experiences of an inpatient portal's information affordances, including access to results, notes, vital signs, medication information and a schedule. Patient participants were recruited from an inpatient ward primarily catering to patients with haematological malignancies including leukaemia and bone marrow transplant recipients at the Royal Melbourne Hospital. Although focused on the inpatient experience of a portal's information affordances accessed via a hospital-provided tablet, due to limited patient access to notes in the inpatient context, this study also explored patient experiences of their outpatient portal notes accessed via their smartphone. This study demonstrates the value of an (in)patient portal in enabling patient awareness, agency and participation in their care. It shows how an (in)patient portal not only helps patients make informed decisions in their care, but can also initiate patient conversation and collaboration with clinicians. This study points how the digital mediation of healthcare can provide greater transparency in the patient-clinician relationship and address the information asymmetry that typically characterises this relationship, particularly in the Australian context, where inpatient portals are still in their infancy.

Using the Recommended Summary Plan for Emergency Care and Treatment in Primary Care: a mixed methods study.

Background: Emergency care treatment plans provide recommendations about treatment, including cardiopulmonary resuscitation, to be considered in emergency medical situations. In 2016, the Resuscitation Council United Kingdom developed a standardised emergency care treatment plan, the recommended summary plan for emergency care and treatment, known as ReSPECT. There are advantages and potential difficulties in initiating the ReSPECT process in primary care. Hospital doctors and general practitioners may use the process differently and recommendations do not always translate between settings. There are no large studies of the use of ReSPECT in the community. Study aim: To evaluate how, when and why ReSPECT is used in primary care and what effect it has on patient treatment and care. Design: A mixed-methods approach using interviews, focus groups, surveys and evaluation of ReSPECT forms within an analytical framework of normalisation process theory. Setting: A total of 13 general practices and 13 care homes across 3 areas of England. Participants: General practitioners, senior primary care nurses, senior care home staff, patients and their relatives, community and emergency department clinicians and home care workers, people with learning disability and their carers. National surveys of (1) the public and (2) general practitioners. Results: Members of the public are supportive of emergency care treatment plans. Respondents recognised benefits of plans but also potential risks if the recommendations become out of date. The ReSPECT plans were used by 345/842 (41%) of general practitioner survey respondents. Those who used ReSPECT were more likely to be comfortable having emergency care treatment conversations than respondents who used standalone 'do not attempt cardiopulmonary resuscitation' forms. The recommended summary plan for emergency care and treatment was conceptualised by all participants as person centred, enabling patients to have some say over future treatment decisions. Including families in the discussion is seen as important so they know the patient's wishes, which facilitates decision-making in an emergency. Writing recommendations is challenging because of uncertainty around future clinical events and treatment options. Care home staff described conflict over treatment decisions with clinicians attending in an emergency, with treatment decisions not always reflecting recommendations. People with a ReSPECT plan and their relatives trusted that recommendations would be followed in an emergency, but carers of people with a learning disability had less confidence that this would be the case. The ReSPECT form evaluation showed 87% (122/141) recorded free-text treatment recommendations other than cardiopulmonary resuscitation. Patient preferences were recorded in 57% (81/141). Where a patient lacked capacity the presence of a relative or lasting power of attorney was recorded in two-thirds of forms. Limitations: Recruitment for patient/relative interviews was less than anticipated so caution is required in interpreting these data. Minority ethnic groups were under-represented across our studies. Conclusions: The aims of ReSPECT are supported by health and social care professionals, patients, and the public. Uncertainty around illness trajectory and treatment options for a patient in a community setting cannot be easily translated into specific recommendations. This can lead to conflict and variation in how recommendations are interpreted. Future work: Future research should explore how best to integrate patient values into treatment decision-making in an emergency. Study registration: This study is registered as NCT05046197. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131316) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 42. See the NIHR Funding and Awards website for further award information.

How, when and why ReSPECT plans are made and used outside hospital and how they affect patient care. We listened to general practitioners, patients and their families, and examined ReSPECT plans in patient records. We listened to staff in care homes, homecare workers and other healthcare professionals. We surveyed general practitioners and the public. We worked with people with a learning disability to find out what support they needed to complete a ReSPECT plan. People thought that ReSPECT plans could be a good way to record a person's wishes about medical treatment. They thought that the plan should be made with a healthcare professional they knew and trusted. These conversations need time and preparation, especially for someone with a learning disability. Most people thought family involvement was important. General practitioners told us that it could be difficult to know what kind of emergencies and treatments to discuss and put in the plan. Most plans we looked at had recommendations about cardiopulmonary resuscitation and many plans had recommendations about other treatments. About half of plans recorded the patient's wishes. It was not always clear who the plan had been discussed with to find out their wishes. Care home staff told us that they were often frustrated when healthcare professionals in an emergency did not always follow the plan. Further research is needed on how to improve ReSPECT conversations so that plans clearly reflect what is important to the individual, and how to help health professionals use ReSPECT when an emergency happens.

The implementation of smart continence care for people with disabilities: A qualitative study of key stakeholders' first-hand experiences.

Introduction: Innovative technological applications like smart continence care (SCC) offer potential benefits in healthcare delivery, particularly for individuals with profound intellectual and multiple disabilities (PIMD). SCC aims to prompt caregivers to change continence materials, potentially improving clients' quality of life and reducing caregivers' workload. Although the use of SCC in PIMD care is promising, research is needed to improve its use in these complex settings. The aim of this study was to reflect on the SCC implementation process in care organizations for people with PIMD. Methods: Fifteen semi-structured interviews were conducted with key stakeholders, caregivers, and SCC project leaders, across four care organizations. Interviews utilized an integrated framework drawing from the centre for eHealth research roadmap and the nonadoption, abandonment, scale-up, spread, and sustainability framework, both addressing eHealth implementation. Thematic analysis and open coding were employed to identify key themes and sub-themes in the implementation process. Results: Four main themes emerged as crucial for successful SCC implementation: creating support, communication between stakeholders, problem-solving, and willingness to adopt SCC. The first three themes were perceived as contributors to the success of SCC implementation, whereas the last theme showed factors impacting willingness to adopt SCC. Early involvement of key stakeholders and clear communication about expectations of their roles was perceived as crucial and created clarity. Adequate problem-solving was identified as influential in SCC utilization and willingness to adopt person-centred continence care. Conclusion: Implementation of SCC requires changes in the work routines of those involved, and key stakeholders' early involvement appears to improve support for these changes. Fostering communication between key stakeholders and adequate problem-solving contributes to positive experiences and the perceived success of sustainable implementation. This study offered a rich understanding of day-to-day practices around implementing SCC in disability care organizations. The findings may also be relevant for the implementation of technologies in other care settings.

Feasibility, Fidelity and Acceptability of a Person-Centred Care Transition Support Intervention for Stroke Survivors: A Non-Randomised Controlled Study.

BACKGROUND: Care transitions from hospital to home are a critical period for patients and their families, especially after a stroke. The aim of this study was to assess the feasibility, fidelity and acceptability of a co-designed care transition support for stroke survivors. METHODS: A non-randomised controlled feasibility study recruiting patients who had had stroke and who were to be discharged home and referred to a neurorehabilitation team in primary healthcare was conducted. Data on the feasibility of recruitment and fidelity of the intervention were collected continuously during the study with screening lists and checklists. Data on the perceived quality of care transition were collected at 1-week post-discharge with the Care Transition Measure. Data on participant characteristics, disease-related data and outcomes were collected at baseline (hospitalisation), 1 week and 3 months post-discharge. Data on the acceptability of the intervention from the perspective of healthcare professionals were collected at 3 months using the Normalisation Measure Development Questionnaire. RESULTS: Altogether, 49 stroke survivors were included in the study: 28 in the intervention group and 21 in the control group. The recruitment and data collection of patient characteristics, disease-related data, functioning and outcomes were feasible. The fidelity of the intervention differed in relation to the different components of the co-designed care transition support. The intervention was acceptable from the perspective of healthcare professionals. Concerns were raised about the fidelity of the intervention. A positive direction of effects of the intervention on the perceived quality of the care transition was found. CONCLUSION: The study design, data collection, procedures and intervention were deemed feasible and acceptable. Modifications are needed to improve intervention fidelity by supporting healthcare professionals to apply the intervention. The feasibility study showed a positive direction of effect on perceived quality with the care transition, but a large-scale trial is needed to determine its effectiveness. PATIENT OR PUBLIC CONTRIBUTION: Stroke survivors, significant others and healthcare professionals were involved in a co-design process, including the joint development of the intervention's components, contextual factors to consider, participant needs and important outcomes to target. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT0292587.

Experiences and Perceptions of Medication Management Communication During Transitions of Care for Residents in Aged Care Homes and Their Caregivers: A Qualitative Meta-Synthesis.

AIM: To explore the experiences and perceptions of communication about managing medication across transitions of care for residents living in aged care homes and their family caregivers. BACKGROUND: Effective medication communication across transitions of care involves exchanging information, resident, and family caregiver's participation in decision-making, and shared responsibility. DESIGN: A qualitative meta-synthesis. METHOD: This review was conducted in accordance with the PRISMA 2020 guidelines and the accompanying 27-item checklist. A systematic search of seven electronic databases (Embase, PsycINFO, Medline Ovid, Scopus, CINAHL, EmCare and Web of Science) was performed from inception to December 2023. Studies eligible for inclusion in this review were required to be published in peer-reviewed English journals and focus on medication communication among healthcare providers, residents and family caregivers during transitions of care for aged care residents. The JBI Critical Appraisal Checklist for Qualitative Research was employed for the critical appraisal of the studies, and the COREQ checklist was used to evaluate their quality. RESULTS: Of the 2610 studies identified, 12 met the inclusion criteria. No study was excluded based on quality. Two main themes were generated: (1) Medication information exchange involving residents and families, and (2) resident and family factors influencing medication communication engagement. The findings revealed a lack of supportive structure for effective communication and collaboration among residents, family caregivers and healthcare providers during transitions of care, marked by one-way interactions and limited evidence of shared decision-making or family caregiver engagement in medication management communication, despite varying individual needs and preferences. CONCLUSIONS: Communication about medication management during transitions of care focused on sharing details rather than active engagement. Residents and their family caregivers have individual needs and perspectives regarding communication about medication management, which are not well addressed by healthcare providers during transitions of care. Healthcare providers' communication remains limited, and family caregivers are underutilised.

How to improve patient recovery after complex endovascular aortic repair: the experiences of patients and healthcare professionals.

OBJECTIVE: Complex endovascular aortic repair (EVAR) involves tertiary surgical care, with short in-hospital recovery. This study aimed to explore patients' and healthcare professionals' experiences of what can improve patient recovery after complex EVAR. METHODS: Three qualitative data collection stages building on each other were analysed with thematic analysis. Stages 1 and 2 separately explored patients' and healthcare professionals' experiences of what works well and what can be improved with current care. In stage 3, participants reviewed the relevance and feasibility of intervention suggestions. RESULTS: Three matching themes were identified in stages 1 and 2: Adequate information; Patient involvement; Continuity and follow-up. In stage 3: Individual care plan, Team meetings, and Contact nurse were all found relevant, while only Information routines was found both relevant and feasible. CONCLUSION: What patients and healthcare professionals experienced could improve patients recovery after complex EVAR seem universal for complex surgical patients, and relevant interventions were identified. However, the feasibility of person-centred interventions seem affected by various contextual factors, like current routines and availability of staff. PRACTICE IMPLICATIONS: Interventions that facilitate communication, both involving and supporting the patient, should be tested to strengthen patients' ability to self-care, and ensure access to care and support when needed.

Attitudes of nurses and physicians working in hard-to-heal wound management towards person-centred care.

OBJECTIVE: Person-centred care (PCC) is an important approach as it positively affects disease management. Guiding studies are needed on the use and development of PCC in hard-to-heal (chronic) wound management. This study aimed to determine attitudes and approaches of nurses and physicians working in hard-to-heal wound management towards PCC, and obtain their views and suggestions for its scope and improvement. METHOD: Participants of this descriptive survey study consisted of nurses and physicians responsible for hard-to-heal wound care and treatment in healthcare institutions at all levels in Turkey. Data were collected through a structured online survey shared with members of professional associations via social media platforms between March-November 2020. Descriptive statistics and qualitative inductive content analysis were used to analyse data. RESULTS: Participants (n=418) included physicians (84.2%) and nurses (15.8%). Mean participant-graded their person-centred behaviour level was 8.18±1.80 (out of 10 points). The majority of participants reported that they informed patients about care, treatment processes and options (87.3%) as well as including them in the decision-making process (74.6%). Responses of the participants regarding the scope of PCC were classified into five main categories, the most prominent being: 'individual', 'care', 'professional development' and healthcare system'. Suggestions for the improvement of PCC were classified into seven main categories, with 'personalised care', 'disease-specific care', 'continued training of healthcare professionals should be ensured' and 'home care system should be developed for the continuity of care' among the prominent subcategories. CONCLUSION: The findings of this study suggests that education on PCC is an important approach. Institutional protocols and guidelines can support person-centred hard-to-heal wound management. In this study, the level of person-centred behaviour of the participants was determined to be good. Although the results of the study cannot be generalised to all health professionals-the majority of the participants were physicians-it is recommended to develop and disseminate the PCC model in hard-to-heal wound management using the findings.

The impact and value of the Parkinson's nurse specialist to people with Parkinson's and their care partners: a grounded theory qualitative study.

BACKGROUND: Where available, Parkinson's Nurse Specialists (PNS) provide a range of care, support, guidance, and advocacy for people with Parkinson's (PwP), and, where appropriate, their care partners (CP). Parkinson's is a complex and progressive condition. Consequently, evaluating health outcomes is not a reliable method to understand the value and impact of PNS. Previous research has identified PNS can improve the subjective well-being of PwP in the community, also that barriers to care include heavy caseloads and a lack of time. Yet little is known about the value of the role of the PNS, particularly about the impact of pharmacological management and review. This research aims to close this research gap by providing explanatory theories of the impact and value of PNS to PwP, their CP, and other professionals. METHODS: A social constructivist grounded theory approach was used. Semi-structured interviews were conducted with three groups, PNS, PwP, and CP. Interviews were analysed using NVivo for coding and categorising and Word for memo-writing. Data was analysed inductively and iteratively to identify contexts, social processes, actions, and behaviours, before final emergent theories were identified. RESULTS: 46 semi-structured interviews (PNS 18, PwP 19, CP 9) led to four data categories and 13 sub-categories that delineated PNS value. (1) Expert Counsel; provision of emotional support, education, and lifestyle guidance; CP inclusion; provision from diagnosis; and across all stages of Parkinson's. (2) Conduit of Care; signposting, referral, and connection to PwP, CP, others; PNS barriers and facilitators; (3) Team/Partnership; continuity and partnership, 'working together'; (4) Pharmacological Support, PNS prescribing; concordance; speed of treatment. Where PNS were accessible they could offer personalised support and partnership, so providing person-centred care that improves health and well-being. CONCLUSION: Where a PNS is accessible due to service availability and manageable caseloads, to provide person-centred care, they deliver several benefits to PwP and CP which improve health and perceived well-being. Where PNS are not available, PwP and CP often struggle to manage their Parkinson's with negative impacts on health and well-being.

Factors of importance for the development of evidence-based practice amongst radiographers in public healthcare.

INTRODUCTION: Research evidence suggests that radiographers often rely on previous training, traditional practices, work experience and protocols developed within the department rather than up-to-date research-based evidence in their daily practice. The aim of the study was to investigate factors that might impact the development of evidence-based practice amongst radiographers in clinical public settings in the Nordic countries. METHODS: An online survey was performed amongst 640 radiographers in four Nordic countries. Multivariate logistic regression was performed to investigate the odds ratio (OR) of facilitators for and barriers to radiographers' development of evidence-based practice. RESULTS: A reflective approach in everyday practice and being aware of the current research evidence were significant facilitators for radiographers' development of evidence-based practice (OR ≥ 3.10, p < 0.001). Discussing research with colleagues and managers was associated with engagement in the utilisation of evidence (OR 7.21, p < 0.001). Difficulties in evaluating research evidence represented the only significant barrier (OR 1.84, p 0.009). CONCLUSION: A critical approach amongst radiographers in their performance of healthcare in diagnostic imaging, and the development of their academic skills to improve awareness of the available research evidence are important factors for developing evidence-based practice in radiography. Leadership is crucial for the engagement of radiographers in the development of evidence-based practice. Management should facilitate the development of a learning culture within diagnostic imaging. IMPLICATIONS FOR PRACTICE: The results provide suggestions for the development of a learning culture, proactive and person-centred leadership, and strategic management for the provision of research infrastructure, all of which contribute to the further integration of evidence-based practice in radiography. Also, the study results suggest the importance of shared responsibility for creating a critical fellowship in diagnostic imaging.

Meaningful patient and public engagement in dissemination-embedding co-production in dementia research.

Background: Patient and Public Involvement and Engagement (PPIE) is still underutilised in both dementia research and corresponding dissemination activities. Aim: To describe the methods, format, and lessons learned in co-creating and co-producing a dissemination strategy for a research project focused on establishing patient-centred outcome measures into routine palliative community care for persons living with dementia (PLWD) and their informal carers. Materials and methods: A participatory, hybrid-format workshop was conducted to co-create the dissemination strategy with a PPIE group. A video presentation of findings and a list of prompts shared prior to the workshop were used to elicit views on dissemination strategies and knowledge translation. The workshop was followed up with a survey to consolidate the dissemination strategy. Workshop minutes and survey responses were analysed using qualitative thematic analysis. Results: 22 participants from our diverse PPIE group attended the workshop. Two major themes emerged: (a) Knowledge translation: building bridges between research and practise, and (b) Collaboration and dissemination: everyone's voice is needed. Participants suggested critical changes to dissemination methods and materials. Successful knowledge translation depends on a strong evidence base. For this, materials need to be tailored to specific audiences. Everyone's voice needs to be integrated through co-production in dissemination activities by PPIE members to influence societal change. Tailored dissemination activities within a dissemination strategy were co-created spanning all phases of the research cycle. Discussion: Informing and educating the public and policymakers about the needs of PLWD relies on disseminating and fostering knowledge translation throughout all phases of the research cycle.

Are completed ReSPECT plans facilitating person-centred care? An evaluation of completed plans in UK general practice.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) includes agreed clinical recommendations for a person's care in a future emergency which have been informed by discussion of the person's preferences. Previous evaluation of ReSPECT plans in acute NHS hospitals found inconsistencies in recording patient's preferences and involvement in the plan, and infrequent justification for recommendations. Aim: To explore to what extent ReSPECT recommendations reflect individual preferences, as documented in the plan. Methods: ReSPECT plans of adults were collected from 11 General Practices in England. We adapted an evaluation tool used previously to analyse ReSPECT plans in acute settings. Free text sections for individual values/preferences and clinical recommendations were examined for clarity, consistency and congruency between them. Results: We retrieved 141 ReSPECT plans. Patients or those close to the patient were recorded as being consulted in most plans (94%). Individual preferences were completed in 57% of plans. Clinical recommendations reflected individual preferences by directly referencing the person and their preferences (31%), by being consistent with the documented preferences (30%), or by using the same wording as the preferences (6%). Conclusion: While many clinical recommendations reflect individual preferences, the preferences themselves are only recorded in just over half of ReSPECT plans. This is problematic, because the recording of individual preferences facilitates person-centred care, both directly by informing recommendations and indirectly when used to guide decision-making in situations not anticipated in the plan. Future training for clinicians should emphasize the need to document the personal values section of the plan.

Student radiographers' confidence of adapting practice for autistic patients: A qualitative survey on the role of placement experiences.

INTRODUCTION: Healthcare services can be inaccessible to autistic people without adaptions to clinical practice and the care provided. Therefore, understanding how radiographer education develops students' confidence in adapting care for autistic patients is crucial. This study aimed to explore how placement experience impacts student radiographer confidence in adapting care for autistic patients. METHODS: UK final-year student diagnostic and therapeutic radiographers were invited to complete a qualitative online survey. The survey asked for a description of placement experiences; of observing and/or performing the care of autistic patients and how this impacted confidence in caring for autistic patients. The data was thematically analysed. RESULTS: 43 responses (of 44 received) were included, from which 5 themes emerged. Those who felt placement experiences developed confidence described opportunities to apply theory learnt at university (theme 1) or drew attention to the benefit of prior (external) experience with autistic people (theme 3). However, the balance of power with the supervising radiographer (theme 2), witnessing autistic patients in distress (theme 4), and the heterogeneous nature of autism (theme 5) disrupted students' development of confidence. CONCLUSION: Several participants in this study found clinical placement developed confidence with autistic patients through applying knowledge and providing an opportunity for reflexive learning. However, various obstacles hindered this development, such as witnessing distressed patients, limited experiences with autistic patients and difficulty navigating relationships with radiographers. IMPLICATIONS FOR PRACTICE: To improve student radiographers' confidence of providing care for autistic patients, educators should consider methods, e.g., co-produced simulation, to fill potential gaps in their experience. There is also a pressing need for all radiographers to understand their responsibility in educating students and their impact on student wellbeing.

Environmentally sustainable person-centred care: Occupational therapy students' attitudes, perceptions and self-perceived preparedness for practice.

INTRODUCTION: Climate change threatens the environments in which person-centred occupational therapy occurs. Environmental sustainability is directly linked with the health and wellbeing of current and future generations, presenting occupational therapists with a unique advocacy and activist role. As practitioners of the future, there is an urgent need to understand students' attitudes, perceptions of, and self-perceived preparedness for, dealing with environmental determinants of health and intergenerational occupational and climate justice. METHODS: A cross-sectional exploratory descriptive survey collected United Kingdom (UK) based allied health professional students' attitudes, perceptions, and self-perceived preparedness for advocating for environmental sustainability in the context of person-centred care. The survey was distributed to 48 gatekeepers in UK institutions with approved allied health professional training programmes (44 offered occupational therapy); 62 occupational therapy students responded. Descriptive and non-parametric inferential statistics were used to analyse quantitative data. Text and short answers were analysed qualitatively via inductive content analysis. CONSUMER AND COMMUNITY INVOLVEMENT: The study was co-designed and implemented with MSc (pre-registration) occupational therapy students. RESULTS: Participants (94%) expressed concerns for climate change, with 84% feeling responsible for addressing environmental sustainability in health care. While 64.5% identified climate justice as a top priority, a perceived challenge emerged between person-centred care and sustainability, with only 18% of participants feeling prepared for environmental sustainability in occupational therapy practice. Participants requested education on personal and professional sustainability practices, as well as collective action. Sharing personal climate change experiences, advocating with family and friends, and facilitating connections for collective action were highlighted as potentially transformative educational tools in this area. CONCLUSION: Occupational therapy curricula should address environmental sustainability through pragmatic, critical, and ethical lenses to enhance students' preparedness for this advocacy and activist role. Reflection and continuous professional development for environmentally sustainable practices is recommended. PLAIN LANGUAGE SUMMARY: Occupational therapists believe that it is important to support people to participate in occupations that matter to them. However, the activities that some people choose to participate in may have negative effects on the environment and the planet. It is important to ensure that when occupational therapists support people in their choices of activities, this does not lead to unequal access to healthy and meaningful occupations of others, now or in the future. That is because occupational therapists also have a responsibility to prevent occupational injustice. Occupational therapy students are the professionals of the future, so it is important to include them in research about this topic. They need to develop skills that allow them to simultaneously make sure that they are delivering person-centred care, which is not environmentally detrimental and that does not lead to occupational injustice. Making sure that occupational therapists provide person-centred care while also managing risks of occupational injustice may be seen as a profession-specific dilemma. In this study, occupational therapy students in the UK completed a survey about their feelings, views, and readiness for managing this dilemma. Results showed that most respondents are concerned about climate change, but do not feel that their occupational therapy education sufficiently prepared them to practise in an environmentally sustainable way. They were asked to propose ideas for addressing this issue, and the article discusses how occupational therapy curricula might be changed in accordance.

Validation of the 40-Item and 24-Item Short Version of the Person-Centred Obesity Care Instrument for Patients Living with Obesity.

INTRODUCTION: Person-centred care (PCC) may hold promise for improved healthcare experiences and outcomes among patients living with obesity. A validated instrument to assess the delivery of PCC to patients living with obesity is, however, currently lacking. This study aimed to validate such an instrument. In this article, we describe the development and psychometric testing of the 40-item and 24-item short version of the Person-Centred Obesity Care (PCOC) instrument. METHODS: A total of 590 individuals living with obesity (BMI 33.4 ± 3.9) from a representative Dutch sample completed the 49-item PCOC instrument measuring the eight dimensions of PCC (patient preferences, physical comfort, coordination of care, emotional support, access to care, continuity and transition, information and education, and family and friends), and two measures of satisfaction with care. We performed confirmatory factor analyses to verify the factor structure of the instrument and examined its reliability and validity. RESULTS: Fit indicators of the first model with all 49 items showed that the model left room for improvement (comparative fit index [CFI] <0.90). A 40-item version was obtained with satisfactory-to-good fit (standardized root mean square residual [SRMR] = 0.05, root mean square error of approximation [RMSEA] = 0.06, CFI = 0.90). The instrument demonstrated good reliability, and the relationship between the PCOC and two indicators of satisfaction with care supported the validity of the scale. Shortening the instrument only further improved the fit indicators, resulting in the development of a 24-item short version (SRMR = 0.04, RMSEA = 0.05, CFI = 0.96), with similar results in terms of reliability and validity. CONCLUSION: The 40-item PCOC instrument and the 24-item short version showed to be reliable and valid instruments for the assessment of PCC among patients living with obesity. Based on the results, the 40 and 24-item PCOC are promising tools that can be used by clinicians and researchers to explore PCC delivery for patients living with obesity.

Structural validation of two person-centred practice inventories PCPI-S and PCPI-C - French version.

BACKGROUND: The shift towards person-centred care has become integral in achieving high-quality healthcare, focusing on individual patient needs, preferences, and values. However, existing instruments for measuring person-centred practice often lack theoretical underpinnings and comprehensive assessment. The Person-centred Practice Inventory - Staff (PCPI-S) and the Person-centred Practice Inventory - Care (PCPI-C) were developed in English to measure clinicians' and patients' experience of person-centred practice. The aim of this study was to investigate the psychometric properties of the French version of the PCPI-S and PCPI-C. METHODS: A multi-centred cross-sectional study was conducted in six hospitals in French-speaking Switzerland. Construct validity of the PCPI-S and the PCPI-C was evaluated by using confirmatory factor analysis and McDonald's Omega coefficient was used to determine the internal consistency. RESULTS: A sample of 558 healthcare professionals and 510 patients participated in the surveys. Psychometric analyses revealed positive item scores and acceptable factor loadings, demonstrating the meaningful contribution of each item to the measurement model. The Omega coefficient indicated acceptable to excellent internal consistency for the constructs. Model fit statistics demonstrated good model fit for the PCPI-S and PCPI-C. CONCLUSIONS: The findings support the construct validity and internal consistency of the PCPI-S and PCPI-C in assessing person-centred practice among healthcare professionals and patients in French-speaking Switzerland. This validation offers valuable tools for evaluating person-centred care in hospital settings.

Tools and Strategies to Integrate Multi-Domain Information for Personalized Decision-Making in Oncological Care Pathways: A Scoping Review.

Introduction: There is a growing interest in personalized decision-making in oncology. According to the Integrated Oncological Decision-Making Model (IODM), decisions should be based on information from three domains: (1) medical technical information, (2) patients' general health status and (3) patients' preferences and goals. Little is known about what kind of tool/strategy is used to collect the information, by whom this is collected (nurse, clinician) when this is collected (moment in the care pathway), and how this information should be collected and integrated within decision-making in oncological care pathways, and what its impact is. Methods: We searched PUBMED, Embase and Web of Science in October 2023 for studies looking at tools to collect and integrate information from the three domains of the IODM. We extracted data on the content and implementation of these tools, and on decision and patient outcomes. Results: The search yielded 2576 publications, of which only seven studies described collection of information from all three domains (inclusion criteria). In the seven included studies, information on the three domains was collected through dialogue, questionnaires, and assessments (what) by a nurse (2 out of 7 studies) or by other members of the Multi-Disciplinary Team (by whom) (5 out of 7 studies). Members of the Multi-Disciplinary Team subsequently integrated the information (5 out 7 studies) during their meeting (when), with patients and family attending this meeting in 2 studies (how). In terms of decision outcomes, 5 out of 7 studies compared the treatment recommendations before and after implementation of the tools, showing a modification of the treatment plan in 3% to 53% of cases. The limited data on patient outcomes suggest positive effects on well-being and fewer complications (3 out of 7 studies). Conclusion: The seven studies identified that integrated information from the three IODM domains into treatment decision-making lacked comprehensive information regarding the strategies, process, timing and individuals involved in implementing the tools. Nevertheless, the few studies that looked at patient outcomes showed promising findings.

Describing the status quo of person-centred dementia care in different types of care units in German nursing homes: A convergent mixed methods study.

Background: The policies and mission statements of nursing homes support the implementation of person-centred dementia care. The Dementia Policy Questionnaire assesses the content of person-centred dementia care in policies. To date, it is unknown whether these policies exist exclusively in dementia care units and whether the policies are consistent with the mission statements of nursing homes. Objective: We aimed to (1) investigate nursing home care unit types regarding the existence of policies measured by the Dementia Policy Questionnaire, (2) explore whether these policies are addressed in the mission statements of the nursing homes, and (3) integrate both results. Design: This is a convergent mixed methods study performed with a quantitative and qualitative dataset that was collected in the BeStaDem survey (2020). Setting: The BeStaDem survey included licensed nursing homes in Germany. Participants: A total of 134 nursing home administrators provided informed consent to participate in the BeStaDem survey. Methods: For quantitative data, we performed Fisher's exact test to identify differences in the Dementia Policy Questionnaire item distribution of several types of care units (aim 1). To support the results of Fisher's exact test, we additionally applied logistic regression analysis. For qualitative data, we analyzed the mission statements deductively with the qualitative content analysis method (aim 2). For integration, we used a convergent triangulation approach (aim 3). Results: The quantitative data collected from 134 German nursing homes show significant associations among person-centred dementia care policies, such as behavior assessment, and nursing homes with dementia care units. Regarding the qualitative data, of the 60 mission statements in total, eight mission statements of nursing homes with dementia care units exclusively address aspects such as dementia-specific interventions. The convergent triangulation approach shows that the answers given by the nursing homes in the quantitative survey are not always consistent with what they address in their mission statements. Conclusions: Nursing homes with dementia care units provide more person-centred dementia care policies than other care unit types do but mostly do not address these aspects in their mission statements. The implementation of person-centredness benefits from the existence of policies and mission statements if nursing homes clearly address what is meant by person-centred dementia care in their nursing home.

Patient buy-in to social prescribing through link workers as part of person-centred care: a realist evaluation.

Background: Social prescribing link workers have become part of primary health care in recent years. They help patients to recognise non-medical factors affecting their health and identify sources of support, often in the voluntary, community and social enterprise sector. They form part of wider work to strengthen person-centred care, which actively seeks to engage individuals in decision-making about their health, taking into account their medical, social, psychological, financial and spiritual circumstances. Objective: To understand how buy-in to social prescribing and the link worker role is established for a patient, and how this relates to person-centred care. Design: A realist evaluation. Setting: Patients engaging with link workers in seven different parts of England were involved. Methods: As part of data collection, we observed link workers interacting with 35 patients. We also interviewed 61 patients and re-interviewed 41 of them 9-12 months later. Data were coded and developed into context-mechanism-outcome configurations, which were used to produce a programme theory. Results: Data highlighted how patients might be uncertain about the link worker role but agree to a referral as they sought assistance with their non-medical issues. Patients talked about experiencing a sense of hope through the trust they developed in a link worker. This trust was established through the communication skills and knowledge demonstrated by a link worker, and by their ability to act as an anchor point when required - a reliable, consistent source of support to whom patients could offload. The link worker role also involved connecting patients to external support, which called for sensitivity around how ready someone was to move forward; this was shaped by a patient's motivation but also their capacity to make changes given other demands in their life. Connecting patients to external support could be affected by structural factors outside the link workers' control (e.g. housing options or employment opportunities). Limitations: We did not interview patients who had rejected the offer of social prescribing, and most had a positive view of meeting with a link worker. Conclusions: Person-centred care is engendered by link workers through their skills, knowledge and ability to respond to the individual readiness of patients to engage with external support. It can be curtailed by structural factors outside link workers' sphere of control, such as access to housing or caring responsibilities of patients. This can hinder patients' ability to 'connect to', leaving link workers to continue 'connecting with' patients as they act as an anchor point. Future work: Exploration is required of factors affecting patients who interact with a link worker but do not access external support. Longitudinal work with a cohort of patients, speaking to them on a regular basis, may provide further understanding in this respect. Funding: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130247.

People's health and well-being can be affected by non-medical issues (e.g. loneliness, money worries, housing problems). Social prescribing helps people with these issues by connecting them to support, often in the voluntary-community sector. Link workers are key to social prescribing. They listen to people talk about non-medical issues affecting how they feel physically and/or psychologically. They also connect people to external support ­ such as a befriending service, volunteering opportunities, organisations that give advice on money/housing, or other community groups. It is an important role, but we need to know more about how link workers work best, which our study set out to do. In our study, we collected data around seven link workers in different areas of England. As part of data collection, we interviewed 61 patients and re-interviewed 41 of them 9­12 months later. We also watched 35 patients meeting with a link worker. We found that patients were often unsure about what to expect when a doctor referred them to a link worker. However, they hoped this person could help them with their non-medical issues. When link workers were warm, non-judgmental and listened, patients were more likely to trust them. This trust was increased when link workers shared knowledge of and directed patients towards options in the community that could support their non-medical issues. Patients thought it was important for link workers to be a consistent source of support, who did not push them to do things they were not ready to try. Our research provides an insight into how link workers can provide a person-centred approach when supporting patients. This means that the needs, values and individual situation of patients take priority. It calls for an equal partnership to be created between a patient and link worker in deciding how to address the former's non-medical issues.

The Baro-Adrenal Axis.

The adrenal gland is a player in the Ominous Octet of obesity, which lists eight endocrine contributors to the development of obesity. Baro-adrenal axis describes the bidirectional, multifaceted link between weight homoeostasis and adrenal function, in health and disease. This communication lists the various ways in which adrenal function influences, and is impacted by, obesity.

Evaluation of a Digital Previsit Tool for Identifying Stroke-Related Health Problems Before a Follow-Up Visit (Part 1): Survey Study.

BACKGROUND: Stroke may lead to various disabilities, and a structured follow-up visit is strongly recommended within a few months after an event. To facilitate this visit, the digital previsit tool "Strokehealth" was developed for patients to fill out in advance. The concept Strokehälsa (or Strokehealth) was initially developed in-house as a Windows application, later incorporated in 1177.se. OBJECTIVE: The study's primary objective was to use a patient satisfaction survey to evaluate the digital previsit tool Strokehealth when used before a follow-up visit, with a focus on feasibility and relevance from the perspective of people with stroke. Our secondary objective was to explore the extent to which the previsit tool identified stroke-related health problems. METHODS: Between November 2020 and June 2021, a web-based survey was sent to patients who were scheduled for a follow-up visit after discharge from a stroke unit and had recently filled in the previsit tool. The survey covered demographic characteristics, internet habits, and satisfaction rated using 5 response options. Descriptive statistics were used to present data from both the previsit tool and the survey. We also compared the characteristics of those who completed the previsit tool and those who did not, using nonparametric statistics. Free-text responses were thematically analyzed. RESULTS: All patients filling out the previsit tool (80/171; age: median 67, range 32-91 years) were community-dwelling. Most had experienced a mild stroke and reported a median of 2 stroke-related health problems (range 0-8), and they were significantly younger than nonresponders (P<.001). The survey evaluating the previsit tool was completed by 73% (58/80; 39 men). The majority (48/58, 83%) reported using the internet daily. Most respondents (56/58, 97%) were either satisfied (n=15) or very satisfied (n=41) with how well the previsit tool captured their health problems. The highest level of dissatisfaction was related to the response options in Strokehealth (n=5). Based on the free-text answers to the survey, we developed 4 themes. First, Strokehealth was perceived to provide a structure that ensured that issues would be emphasized and considered. Second, user-friendliness and accessibility were viewed as acceptable, although respondents suggested improvements. Third, participants raised awareness about being approached digitally for communication and highlighted the importance of how to be approached. Fourth, their experiences with Strokehealth were influenced by their perceptions of the explanatory texts, the response options, and the possibility of elaborating on their answers in free text. CONCLUSIONS: People with stroke considered the freely available previsit tool Strokehealth feasible for preparing in advance for a follow-up visit. Despite high satisfaction with how well the tool captured their health problems, participants indicated that additional free-text responses and revised information could enhance usability. Improvements need to be considered in parallel with qualitative data to ensure that the tool meets patient needs. TRIAL REGISTRATION: Researchweb 275135; https://www.researchweb.org/is/vgr/project/275135.