Advance care planning to patients with chronic kidney disease and their families: An intervention development study.

AIM: To develop an advance care planning intervention based on the needs of patients with chronic kidney disease, families and healthcare professionals. BACKGROUND: Patients with chronic kidney disease and their families request early advance care planning that continues throughout their illness trajectory. Healthcare professionals experience barriers to initiating advance care planning. Involvement of stakeholders in development of health interventions is important, to identify priorities, understand the problem and find solutions. METHOD: The development was inspired by the Medical Research Council's framework, and codesign was applied. One future workshop and one design workshop were conducted with the consumers. The process was iterative, and data were analysed using the action research spiral. The Guidance for reporting intervention development studies in healthcare (GUIDED) was used. RESULTS: Five areas were considered significant to an advance care planning intervention; a biopsychosocial approach, early palliative care, a family-focused approach, early and continuous advance care planning and a consumer-centred approach. Based on these, a conversation process with healthcare professionals was designed to give patients and families the opportunity to share values, preferences and wishes for treatment and their family and everyday life. CONCLUSION: Codesign facilitated a collaborative process that allowed the consumers to have a significant impact on the design of an advance care planning intervention. A conversation process concerning everyday life, illness and treatment was designed for patients and families. The intervention included an advance care planning tool to guide the healthcare professionals. PRACTICE IMPLICATIONS: The intervention has the intention to improve the communication between healthcare professionals, patients and families. The study provides important knowledge about the significance of giving the patients and their families support in sharing their values, preferences and wishes for treatment and everyday life, thus, to improve care and treatment in their illness trajectory. IMPACT: What problem did the study address Patients with chronic kidney disease and their families strongly request early initiation of advance care planning that continues throughout the illness trajectory. Healthcare professionals experience barriers to the initiation of the advance care planning and request a more systematic approach. What were the main findings Development of a conversation process about everyday life, illness and treatment for patients diagnosed with chronic kidney disease and families, including an advance care planning tool to guide the healthcare professionals. Where and on whom will the research have an impact The study contributes an advance care planning intervention to patients in the early stages of chronic kidney disease and their families. We believe that the intervention could be included during consultations with healthcare professionals in other stages of chronic kidney disease as well as other chronic disease. REPORTING METHOD: To strengthen the reporting of the development of the advance care planning intervention, we used the Guidance for reporting intervention development studies in healthcare (GUIDED). PATIENT OR PUBLIC CONTRIBUTION: The development of the intervention in this study was a collaborative process between patients, families, healthcare professionals and representatives from the Danish Kidney Association, the department's user council and the research team.

Experiences Regarding Use and Implementation of Artificial Intelligence-Supported Follow-Up of Atypical Moles at a Dermatological Outpatient Clinic: Qualitative Study.

BACKGROUND: Artificial intelligence (AI) is increasingly used in numerous medical fields. In dermatology, AI can be used in the form of computer-assisted diagnosis (CAD) systems when assessing and diagnosing skin lesions suspicious of melanoma, a potentially lethal skin cancer with rising incidence all over the world. In particular, CAD may be a valuable tool in the follow-up of patients with high risk of developing melanoma, such as patients with multiple atypical moles. One such CAD system, ATBM Master (FotoFinder), can execute total body dermoscopy (TBD). This process comprises automatically photographing a patient´s entire body and then neatly displaying moles on a computer screen, grouped according to their clinical relevance. Proprietary FotoFinder algorithms underlie this organized presentation of moles. In addition, ATBM Master's optional convoluted neural network (CNN)-based Moleanalyzer Pro software can be used to further assess moles and estimate their probability of malignancy. OBJECTIVE: Few qualitative studies have been conducted on the implementation of AI-supported procedures in dermatology. Therefore, the purpose of this study was to investigate how health care providers experience the use and implementation of a CAD system like ATBM Master, in particular its TBD module. In this way, the study aimed to elucidate potential barriers to the application of such new technology. METHODS: We conducted a thematic analysis based on 2 focus group interviews with 14 doctors and nurses regularly working in an outpatient pigmented lesions clinic. RESULTS: Surprisingly, the study revealed that only 3 participants had actual experience using the TBD module. Even so, all participants were able to provide many notions and anticipations about its use, resulting in 3 major themes emerging from the interviews. First, several organizational matters were revealed to be a barrier to consistent use of the ATBM Master's TBD module, namely lack of guidance, time pressure, and insufficient training. Second, the study found that the perceived benefits of TBD were the ability to objectively detect and monitor subtle lesion changes and unbiasedness of the procedure. Imprecise identification of moles, inability to photograph certain areas, and substandard technical aspects were the perceived weaknesses. Lastly, the study found that clinicians were open to use AI-powered technology and that the TBD module was considered a supplementary tool to aid the medical staff, rather than a replacement of the clinician. CONCLUSIONS: Demonstrated by how few of the participants had actual experience with the TBD module, this study showed that implementation of new technology does not occur automatically. It highlights the importance of having a strategy for implementation to ensure the optimized application of CAD tools. The study identified areas that could be improved when implementing AI-powered technology, as well as providing insight on how medical staff anticipated and experienced the use of a CAD device in dermatology.