Measuring patients' medical treatment preferences in advance care planning: development and validation of the Treat-Me-ACP instrument - a secondary analysis of a cluster-randomized controlled trial.

BACKGROUND: Advance Care Planning interventions should be evaluated as broadly as possible to gain a holistic understanding of the Advance Care Planning process. However, validated early stage outcome instruments are lacking. Therefore, the Treatment-Preference-Measure-Advance Care Planning (Treat-Me-ACP) instrument was developed and validated as part of the cluster-randomized controlled trial STADPLAN (Study on Advance Care Planning in care-dependent community-dwelling older persons) to assess the effects of Advance Care Planning interventions on patients' medical treatment preferences. METHODS: The design of Treat-Me-ACP is based on the Emanuel Medical Directive and the Life Support Preferences Questionnaires. Using a multi-stage team approach a preliminary version of the Treat-Me-ACP was developed and pre-tested. The pre-tested instrument consists of one global medical care goal-item, five hypothetical scenarios with five hypothetical treatments, and one how would you feel-item within each scenario. A total of five scenario preference scores and five treatment preference scores can be formed. This version was subsequently applied to a subsample of the STADPLAN project (n = 80) to assess patient's preferences at baseline (T0) and at 12-month follow-up (T2). The further validation steps were based on this subsample and included: (1) acceptance by using completion rate and frequencies of missing data, (2) internal consistency by using Cronbach's α to test whether it was possible to create preference scores by scenario and treatment, (3) concurrent validation examining the association between the global medical care goal-item and the preference scores and the association between the how would you feel-items and the scenario preference scores, and (4) responsiveness of the instrument to changes in preferences for life-sustaining treatments by comparing preference scores from T0 to T2 between study groups. RESULTS: Acceptance of the instrument was high. Results of concurrent validation indicate that the five scenarios represent the global medical care goal well. The preference scores showed an average tendency for decreasing preferences for life-sustaining treatments across all scales for the intervention group during study follow-up. CONCLUSIONS: The Treat-Me-ACP can be used to evaluate the dynamics of patients' medical treatment preferences in Advance Care Planning. It has been validated for care-dependent community-dwelling older persons and can be used as an additional outcome measure in evaluating the effectiveness of ACP interventions. TRIAL REGISTRATION: German Clinical Trials Register: DRKS00016886 on 04/06/2019.

Pharmacists' perspectives on recommending herbal medicines for acute infections: a qualitative study.

BACKGROUND: Community pharmacists have an essential role in antimicrobial stewardship by providing self-care advice for self-limiting infections. AIM: To explore community pharmacists' perceptions and experiences of advising patients on management of acute respiratory tract infections (RTIs) and urinary tract infections (UTIs), and to explore issues regarding use of over-the-counter (OTC) medicines, including herbal medicines. DESIGN & SETTING: A qualitative study using semi-structured interviews with community pharmacists in England. METHOD: Qualitative interviews with community pharmacists were carried out face to face and by telephone between November 2019 and March 2020. Data were collected through in-depth, semi-structured interviews, recorded and transcribed. A reflexive thematic analysis was undertaken. RESULTS: In total, 18 community pharmacists were interviewed. Three main themes were identified. Theme 1 was self-management recommendations. Community pharmacists considered patients' preferences when recommending self-management strategies. Some believed that conventional OTC medications had quicker and stronger effects, while others preferred herbal OTCs as a more natural approach, particularly for less severe symptoms. Theme 2 was factors influencing pharmacists' recommendations for acute infections. This included pharmacists' perceptions of patient preferences, nature or severity of illness, research evidence, training, commercial pressures, and patient concerns about medication cost. Theme 3 was pharmacist-patient communication. Pharmacists sometimes experienced challenges with language barriers and patients' expectations of receiving antibiotics. Pharmacists emphasised the importance of being trusted by their patients. There was widespread acceptance of their role in self-management advice for acute illness and interest in the role of herbal medicines, but pharmacists did not feel confident in recommending these. CONCLUSION: Pharmacists are central to the management of self-limiting infections. There is a need to educate the public about appropriate use of antibiotics and provide training and support for pharmacists on self-management strategies including herbal medicine.

Efficacy and safety of community-based moxibustion for primary hypertension: A randomized controlled trial with patient preference arms.

Moxibustion has been shown to have a potential antihypertensive effect, but its applicability for the primary care of hypertension is unclear. The authors conducted a multicenter randomized controlled trial (RCT) with patient preference arms to investigate the effect, safety, cost-effectiveness, and compliance of moxibustion in community patients with hypertension. Patients with primary hypertension were enrolled from seven communities randomly or nonrandomly assigned to receive self-administered moxibustion + the original hypertensive regimen or the original hypertensive regimen alone for 6 months. The authors mainly evaluated the effects of moxibustion on hypertensive outcomes and adverse events. As a result, a total of 160 and 240 patients were recruited into the randomized and nonrandomized arms, respectively, with 87.5% completing the follow-up. At month 6, there was a significantly greater reduction in systolic blood pressure (SBP) (difference: -10.57 mmHg), a higher proportion of responders (82.2% vs. 53.7%; odds ratio 4.00), and better improvements in hypertensive symptoms and quality of life (QoL) in the moxibustion group than in the control group in the randomized population, but there was no significant between-group difference in diastolic blood pressure (DBP). The nonrandomized findings showed the same effect direction for all outcomes, except for DBP. All moxibustion-related adverse events were mild. In conclusion, moxibustion can reduce SBP and improve hypertensive symptoms and QoL in community patients with hypertension, with good safety and low cost, although its effect on DBP remains uncertain. The findings suggest that moxibustion may be an appropriate technique for community primary care of hypertension.

Prevalence of Hemorrhoids and Their Risk Factors Among the Adult Population in Jazan, Saudi Arabia.

BACKGROUND: Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. They can be either internal, external, or internoexternal, according to their position in relation to the dentate line. They can cause significant financial burdens and personal discomfort. However, the typical symptoms of hemorrhoids include bleeding, pain, skin irritation, fecal leakage, prolapse, mucus secretion, and developing a thrombosed hernia. Nonetheless, research has shown that individuals with and without hemorrhoids equally report these symptoms. This study aims to investigate the prevalence of hemorrhoids and their risk factors among adult subjects in Jazan, Saudi Arabia. METHODS: This investigation was a cross-sectional study targeting adults diagnosed with hemorrhoids in the Jazan region. Data collection was performed via a self-administered questionnaire to measure sociodemographic data of the participants, lifestyle factors associated with hemorrhoids, clinical presentations of the disease, and Rome IV criteria for diagnosis of functional constipation. The chi-squared test was used to assess the frequency of hemorrhoid symptoms according to the participants' sociodemographic and lifestyle characteristics. RESULTS: In the current study, which recruited 361 participants, 59% (216 individuals) reported experiencing at least one symptom of hemorrhoids. The majority of the sample were females (60%), Saudis (96%), and living in urban areas (59%) and had a university education (77.3%). The most common risk factors identified were lack of regular physical activity (83%), prolonged sitting during office work (51%), and consuming food with saturated fat (50%). A total of 44% (159 participants) had a family history of hemorrhoids, and 40% reported suffering from constipation three times or more per week. Only 34% (123 participants) had been diagnosed with hemorrhoids by a physician. Interestingly, the majority of participants (57%) preferred using home remedies instead of seeking medical care from a healthcare professional. When assessing factors associated with experiencing a minimum of six hemorrhoid symptoms per month, age, lifestyle factors, family history of hemorrhoids, and defecation practices were found to be significantly correlated with a higher occurrence of symptoms (with a p-value of less than 0.05). CONCLUSION: The current study identified a high prevalence of hemorrhoid symptoms and their risk factors among the adult population in the Jazan region of Saudi Arabia. The findings suggest a need to increase the awareness of the public about hemorrhoids risk factors and the importance of seeking healthcare at an early stage of the disease.

Active surveillance versus treatment in low-risk DCIS: Women's preferences in the LORD-trial.

BACKGROUND: Ductal carcinoma in situ (DCIS) can progress to invasive breast cancer (IBC), but most DCIS lesions remain indolent. However, guidelines recommend surgery, often supplemented by radiotherapy. This implies overtreatment of indolent DCIS. The non-randomised patient preference LORD-trial tests whether active surveillance (AS) for low-risk DCIS is safe, by giving women with low-risk DCIS a choice between AS and conventional treatment (CT). Here, we aim to describe how participants are distributed among both trial arms, identify their motives for their preference, and assess factors associated with their choice. METHODS: Data were extracted from baseline questionnaires. Descriptive statistics were used to assess the distribution and characteristics of participants; thematic analyses to extract self-reported reasons for the choice of trial arm, and multivariable logistic regression analyses to investigate associations between patient characteristics and chosen trial arm. RESULTS: Of 377 women included, 76% chose AS and 24% CT. Most frequently cited reasons for AS were "treatment is not (yet) necessary" (59%) and trust in the AS-plan (39%). Reasons for CT were cancer worry (51%) and perceived certainty (29%). Women opting for AS more often had lower educational levels (OR 0.45; 95% confidence interval [CI], 0.22-0.93) and more often reported experiencing shared decision making (OR 2.71; 95% CI, 1.37-5.37) than women choosing CT. CONCLUSION: The LORD-trial is the first to offer women with low-risk DCIS a choice between CT and AS. Most women opted for AS and reported high levels of trust in the safety of AS. Their preferences highlight the necessity to establish the safety of AS for low-risk DCIS.

Patient preferences and shared decision making for the traditional Chinese medicine treatment of lung cancer: A discrete choice experiment study.

Background: Traditional Chinese Medicine (TCM), integrating patient preferences into decision-making process, has been widely used in the multimodality therapy of lung cancer. This study aimed to estimate patient preferences for treatment and shared decision-making (SDM) modes concerning inpatient TCM treatment of lung cancer in Shanghai in order to provide a basis for clinical decision-making process on TCM therapy for lung cancer. Methods: This study was conducted among patients (n = 347) from nine tertiary hospitals in Shanghai by discrete-choice experiment (DCE) survey and Shared Decision-Making Questionnaire-patient version (SDM-Q-9) survey. The DCE was developed with the inclusion of the most relevant attributes at appropriate levels for the TCM treatment of lung cancer. The empirical data analyses of patients were performed using mixed logit models. Additionally, subgroup analysis was conducted. Results: In total, 347 respondents completed the questionnaire. All attributes' coefficients were statistically significant for patients' preferences. Patients showed strong preferences for increasing disease control rate, relieving nausea and vomiting, reducing the risk of side effects, and were concerned about monthly out-of-pocket costs. Subgroup analysis indicated that patients with a lower SDM-Q-9 score and those who were satisfied with medical services emphasized more importance of higher disease control rate. Furthermore, most of the patients (90.20%) self-reported a high willingness to use SDM during the decision-making process. Conclusion: In Shanghai, patients mainly preferred SDM and considered disease control rate as the most essential attribute in the TCM treatment of lung cancer. The study findings could underscore the importance of considering patients' preferences and promote SDM.

Balancing benefits and risks in lung cancer therapies: patient preferences for lung cancer treatment alternatives.

Background: In the treatment of Non-Small Cell Lung Cancer (NSCLC) the combination of Immuno- Oncotherapy (IO) and chemotherapy (CT) has been found to be superior to IO or CT alone for patients' survival. Patients and clinicians are confronted with a preference sensitive choice between a more aggressive treatment with a greater negative effect on quality of life versus alternatives that are less effective but have fewer side effects. Objectives: The aims of this study were to: (a) quantify patients' preferences for relevant attributes related to Immuno-Oncotherapy treatment alternatives, and (b) evaluate the maximum acceptable risk (MAR)/Minimum acceptable benefit (MAB) that patients would accept for treatment alternatives. Methods: An online preference survey using discrete-choice experiment (DCE) was completed by NSCLC patients from two hospitals in Italy and Belgium. The survey asked patients' preferences for five patient- relevant treatment attributes. The DCE was developed using a Bayesian D-efficient design. DCE analyses were performed using mixed logit models. Information regarding patient demographics, health literacy, locus of control, and quality of life was also collected. Results: 307 patients (158 Italian, 149 Belgian), stage I to IV, completed the survey. Patients preferred treatments with a higher 5-year survival chance as the most important attribute over all the other attributes. Preference heterogeneity for the attribute weights depended on health literacy, patients' age and locus of control. Patients were willing to accept a substantially increased risks of developing side effects in exchange for the slightest increase (1%) in the chance of surviving at least 5 years from the diagnosis of cancer. Similarly, patients were willing to accept a switch in the mode of administration or complete loss of hair to obtain an increase in survival. Conclusion: In this study, the proportion of respondents who systematically preferred survival over all other treatment attributes was particularly high. Age, objective health literacy and locus of control accounted for heterogeneity in patients' preferences. Evidence on how NSCLC patients trade between survival and other NSCLC attributes can support regulators and other stakeholders on assessing clinical trial evidence and protocols, based on patients' conditions and socio-demographic parameters.

Patient preference for deferasirox film-coated versus dispersible tablet formulation: a sequential-design phase 2 study in patients with thalassemia.

Iron chelation therapy (ICT) is the mainstay of treatment in patients with thalassemia requiring blood transfusions. This phase 2 JUPITER study evaluated patient preference between film-coated tablet (FCT) and dispersible tablet (DT) in transfusion-dependent thalassemia (TDT) or non-TDT (NTDT) patients treated with both formulations in a sequential manner. The primary endpoint was patient-reported preference for FCT over DT, while secondary outcomes included patient reported outcomes (PROs) evaluated by overall preference, and by age, thalassemia transfusion status, and previous ICT status. Out of 183 patients screened, 140 and 136 patients completed the treatment periods 1 and 2 of the core study, respectively. At week 48, the majority of patients preferred FCT over DT (90.3 vs. 7.5%; difference of percentage: 0.83 [95% confidence interval (CI), 0.75-0.89; P < 0.0001]). FCT scored better on secondary PROs and showed less severe gastrointestinal symptoms than DT, except in the change of modified Satisfaction with Iron Chelation Therapy (mSICT) preference scores, which were similar for both the formulations. Patients with TDT had stable ferritin levels, while it showed a downward trend up to week 48 in patients with NTDT on deferasirox treatment. Overall, 89.9% of patients reported ≥ 1 adverse event (AE), of which 20.3% experienced ≥ 1 serious AE. The most common treatment-emergent AEs were proteinuria, pyrexia, urine protein/creatinine ratio increase, diarrhea, upper respiratory tract infections, transaminase increase, and pharyngitis. Overall, this study reinforced the observations from the previous study by showing a distinct patient preference for FCT over DT formulation and further supported the potential benefits of life-long compliance with ICT.

Hospital-based spiritual care: what matters to patients?

Demographic changes in Australia have led to an increase in both religious diversity and the number of people who do not nominate a faith affiliation at hospital admission. Models of chaplaincy have shifted from clerical and largely male to an increasingly skilled and diverse spiritual care workforce appointed directly by health services. This study uses survey and in-depth interview methods at an inner-city Australian hospital to examine patient preferences for hospital chaplaincy provided by faith communities, and the importance of faith affiliation compared to other spiritual care provider characteristics. Survey results indicate that of 110 respondents, a high proportion (74%) prefer spiritual care to be provided by a person of the same faith. However, when considered relative to other characteristics, faith affiliation was not as important as kindness, listening skills and a non-judgmental attitude. Our findings have implications for workforce planning and educating. Further research in different settings and with different populations will make the findings more generalizable.

Sacral neuromodulation: Rechargeable versus non-rechargeable device. What would the patient preferences be in France?

AIMS: Sacral neuromodulation (SNM) is a minimally invasive technique that provides effective treatment for the management of refractory overactive bladder (OAB), non-obstructive urinary retention (NOUR), and fecal incontinence (FI). This study assessed patient preferences between the currently available non-rechargeable SNM device and a new, full-body magnetic resonance imaging (MRI)-safe, smaller, rechargeable device. METHODS: An online cross-sectional survey was conducted among French OAB, NOUR, FI patients, recruited via a market research vendor. To assess their preferences, patients were asked to indicate their level of agreement with 10 statements regarding the size of the device, its rechargeability, and the role of MRI using a 6-item Likert scale. A descriptive statistical analysis was performed. RESULTS: In all, 95 patients (68% women), mean age 50 years, were included in the study: 51% were treated for OAB; 44% received an oral treatment and 28% had SNM. Overall, 71% of the 95 patients indicated a preference for the new device; 75% considered that recharging the device would not impact their lifestyle; 74% believed that the smaller size of the rechargeable device would facilitate their choice to be treated with SNM; 80% found full-body MRI compatibility important. CONCLUSIONS: Most patients may prefer the new rechargeable SNM device over the current "standard". Compatibility with full-body MRI and the smaller device size seemed the key features of the newer device that would influence their choice of being treated with SNM. Future national and international recommendations should consider a shared decision-making process between the physician and the patient.

Patient preferences for the treatment of type 2 diabetes in Australia: a discrete choice experiment.

Background: Australia has a high proportion of migrants, with an increasing migration rate from India. Type 2 diabetes is a chronic condition common amongst the Indian population. The decision to initiate and continue medication therapy (conventional or ayurvedic medicine) is complex and is influenced by a wide range of factors. Objective: To determine preferences for conventional vs. ayurvedic medicines in Indian migrants with diabetes, and to identify the factors that may influence their preferences. Methods: A discrete choice experiment was conducted with participants in Australia who were migrants from India with type 2 diabetes (n=141). Each respondent evaluated eight choice tasks consisting of eight attributes describing medicines and outcomes of medication taking; and were asked to choose 'conventional', or 'ayurvedic' medicine. A mixed multinomial logit model was used to estimate preferences. Results: Overall, respondents' preference to initiate a medicine was negative for both conventional (ß=-2.33164, p<0.001) and ayurvedic medicines (ß=-3.12181, p<0.001); however, significant heterogenicity was noted in participants' preferences (SD: 2.33122, p<0.001). Six significant attributes were identified to influence preferences. In decreasing rank order: occurrence of hypoglycaemic events (relative importance, RI=24.33%), weight change (RI=20.00%), effectiveness of medicine (RI=17.91%), instructions to take with food (RI=17.05%), side effects (RI=13.20%) and formulation (RI=7.49%). Respondents preferred to initiate a medicine despite potential side effects. Conclusions: There was a greater preference for conventional medicine, though neither were preferred. Medicine attributes and medication-taking outcomes influenced people's preferences for an antidiabetic medicine. It is important to identify individual preferences during healthcare consultations to ensure optimal medication-taking.

Jet injection needle-free dental anaesthesia: Initial findings.

OBJECTIVES: We evaluated patient preference and reported levels of anxiety and discomfort of participants treated with a new needle-free electric motor-driven device vs. conventional local anaesthetic for dental extractions in a proof-of-principle study. Healing and response of gingival tissues to injection were also evaluated at 1, 3- and 7-days post-procedure. METHODS: After informed consent, eight participants who required bilateral maxillary extractions were included in the trial. The side and order of placement for the needle-free and conventional anaesthetic were randomized. The same operator delivered anaesthesia and ensured teeth were anaesthetized on both sides. Another operator, unaware of order and type of anaesthesia placed, performed the extractions. RESULTS: Participant's average discomfort scores were low for both techniques, and lower for the needle-free injection at all timepoints. Needle-free local anaesthesia was the preferred technique by most participants at most timepoints. The average volume of anaesthetic dispensed was similar between techniques. Successful anaesthesia with the needle-free device was achieved in 6 out of 8 participants. Healing of the extraction sockets and adjacent oral mucosa progressed normally for all participants, with no evidence of infection, trauma or hematoma in the injection sites of the test and conventional sides. CONCLUSIONS: The needle-free local anaesthetic technique investigated achieved sufficient anaesthesia for tooth extractions in the maxilla in 75% of the subjects. A larger clinical trial is needed to further validate the technique tested and to investigate whether needle-free local anaesthesia can be successfully applied to the provision of restorative therapy. CLINICAL SIGNIFICANCE: The results of this study can be used by clinicians treating patients who suffer from dental anxiety and needle-phobia.

Patient Attitudes Toward Acupuncture in the Perioperative Setting.

Introduction: Acupuncture is a potential treatment option for pain, nausea, vomiting, anxiety, and agitation in the perioperative period. Patient preference for participating in acupuncture in the perioperative period is not well understood. The aim of this study was to quantify patient interest in perioperative acupuncture, explore the relationship between acupuncture interest, insurance coverage and patient cost, and identify clinical factors associated with patient interest in acupuncture. Materials and Methods: Adult patients evaluated in the Preoperative Evaluation Clinic at the Mayo Clinic in Phoenix, AZ, between June 2019 and July 2019, received a voluntary survey to assess their attitudes toward receiving acupuncture in the perioperative period. Patient interest in acupuncture to help treat pain, anxiety, and postoperative nausea and vomiting, as well as their willingness to pay for such services, were assessed. Demographic data, American Society of Anesthesiologists (ASA) physical class, scheduled procedure, and insurance coverage were extracted from the medical record. Univariate analysis was performed to estimate interest in acupuncture. Results: Three hundred and seven respondents were included in this study with a response rate of 60.4%. A total of 68.4% of study participants were interested in receiving perioperative acupuncture. Of those interested in acupuncture, 86.7% were interested if acupuncture was offered at no cost (either free or fully covered by insurance). A total of 47.1% of those patients interested in acupuncture would be interested if the cost of acupuncture was between 20 and 50 U.S. dollars. A total of 8.6% would be interested in acupuncture if patients were expected to pay the full cost of treatment (estimated 175 U.S. dollars). Age, sex, ASA status, type of surgery, risk of procedure, and Medicare/Medicaid coverage were not statistically associated with interest in acupuncture. Conclusions: When there is little to no direct cost to the patient, the majority of patients are interested in acupuncture in the perioperative period.

Palliative Care Needs Assessment in the Population Living in Mayotte: SPMAYOTTE, a Qualitative Study Conducted with 62 Patients, Caregivers and Healthcare Professionals.

BACKGROUND/AIM: Mayotte is a French island in the Indian Ocean. There is no palliative care structure in this territory. The island and its population have specific characteristics: insularity, poverty, coexistence of modern and traditional medicine, importance of religion (Islam) and the presence of many foreigners without health insurance. The aim of this study is to determine the palliative care needs of the Mayotte population and propose the establishment of an appropriate service. METHODS: A qualitative study was conducted in Mayotte using interviews with patients and their caregivers, and focus groups were conducted with healthcare professionals involved in their care. Patients requiring palliative care were identified and recruited from the hospital or the patient's home by healthcare professionals. RESULTS: A total of 62 people participated in the study between May and June 2019. The needs expressed were analysed and then grouped into categories: access to medical care (especially at home), management of physical symptoms (analgesia) and psychological symptoms, organisation of care (coordination between healthcare professionals) and training of healthcare professionals (pain management, palliative care, interculturality and translation), taking into account cultural and religious aspects. Regarding the foreign population, the categories were: improving access to healthcare, access to the social protection system and daily living conditions (transport, food and accommodation). CONCLUSIONS: The specific needs of the population, assessed through the study, have led to an original proposal, which differs from the usual structures of palliative care in France.

Travel Time for Dental Care Services Based on Patient Preference in South Korea.

This study analyzed patient preferences using travel time from residence to dental institution when selecting dental care services. We used data from the Korean Health Panel from 2008 to 2017 and analyzed each dental service episode. Since the distribution of travel time was skewed to the left, median travel time was analyzed. The association of travel time with services was analyzed via the population-averaged generalized estimating equation (GEE) with the Poisson family. The median of the average travel time per episode was longer for non-National Health Insurance (NHI)-covered services and shorter for NHI-covered services. The first quintile of low-income subjects traveled the longest for all services and utilized dental care the most. In the GEE analysis, travel time was approximately three times longer for implant treatment and gold inlay/resin fillings and >2 times longer for orthodontic care than for NHI-covered services. Patients residing in rural counties traveled for longer than residents of large cities. Income was statistically significant; however, the coefficient was close to zero. Travel time was related to the type of service and reflected patient preference. This was more prominent for expensive non-NHI-covered services than for NHI-covered services. The findings suggest patients' subjective preferences for dental clinic selection are expressed as rational deliberation considering each individual's situation.

[Technical recommendation for pragmatic randomized controlled trial of heat-sensitive moxibustion in community (â ): randomization with consideration of patient preference].

Heat-sensitive moxibustion is the appropriate technique of the external treatment in traditional Chinese medicine and it is widely used in community because of its "easy learning, simple operation and clear curative effect". Pragmatic randomized controlled trial is a main intervention design in the real world study, which provides a high-level evidence for the effectiveness assessment of heat-sensitive moxibustion in community management. Focusing on the key links of randomization, e.g. block randomization, stratified randomization, cluster randomization, sample size allocation, allocation concealment and blinding, the paper elaborates the advantages, disadvantages and technical details of two-stage randomization with consideration of patient preference in pragmatic randomized controlled trials of heat-sensitive moxibustion in community. It facilitates improving the quality of evidence, reproducibility and methodological homogeneity among different trials.

Understanding the role of patient preference in the treatment algorithm for chronic low back pain: results from a survey-based study.

Aims: Interventional pain treatments range from injections to established radiofrequency ablation techniques and finally neuromodulation. In addition to safety, efficacy and cost dominance, patient preference for type of treatment is important. Methods: Chronic pain patients (n = 129) completed a preference scale to determine which interventional pain management procedures they would prefer from among radiofrequency ablation, temporary (60-day) peripheral nerve stimulation (PNS), conventional PNS and spinal cord stimulation/dorsal root ganglion stimulation. A second survey (n = 347) specific to assessing the preference for radiofrequency ablation or temporary PNS treatment was completed by patients with low back pain. Results: On the basis of mean rank, temporary PNS percutaneously implanted for up to 60 days was the most preferred treatment compared with the other options presented (p = 0.002). Conclusions: Patient preference should be unbiased and considered as an independent variable for physician discussion in treatment options and future research.

Patient preference is an important variable for physicians to consider when discussing treatment options for low back pain. A consumer survey study was completed discussing patient preference among various invasive treatments for low back pain. When given scenarios discussing risks and benefits of each procedure (temporary peripheral nerve stimulation for 60 days, heat ablation of small back nerves and permanently implanted back pain devices) temporary peripheral nerve stimulation was considered the preferred option.

Accessibility of information on patients' and family members' end-of-life wishes in advance care planning.

AIM: To describe healthcare professionals' accessibility and transfer of patients' and family members' end-of-life wishes in ACP to the palliative care unit. DESIGN: The study used a qualitative descriptive study design. METHODS: Purposive sampling was used. The data (N = 33) were collected through interviews with physicians, registered nurses, practical nurses and social workers. The data were analysed by inductive content analysis. RESULTS: Two main categories emerged. Patients' and family members' end-of-life wishes documentation in relation to changing information needs was described in relation to patients' condition and care context. Transfer of patients' and family members' end-of-life wishes to palliative care unit included written and verbal communication. Results showed lack of implementation of ACP early, lack of implementation about the holistic interpretation of ACP into medical notes and lack of transferability of ACP into documenting systems impacting on accessibility and realization for the patient and family members at the end-of-life.

The delivery of patient centred dietetic care in subacute rehabilitation units: A scoping review.

BACKGROUND: Patient centred care (PCC) positively influences individual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC because effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. METHODS: PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through individual consultations with adult patients undertaking subacute rehabilitation. RESULTS: Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, 'individualised care', 'tailored advice', 'follow-up' and 'team collaboration'. CONCLUSIONS: This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that the delivery of care which is truly patient centred is far more comprehensive than individualising interventions or organising ongoing services. This raises the question: is the delivery of nutrition care in subacute rehabilitation unit's patient centred?

Technical recommendation for pragmatic randomized controlled trial of heat-sensitive moxibustion in community (Ⅰ): randomization with consideration of patient preference / 中国针灸

Heat-sensitive moxibustion is the appropriate technique of the external treatment in traditional Chinese medicine and it is widely used in community because of its "easy learning, simple operation and clear curative effect". Pragmatic randomized controlled trial is a main intervention design in the real world study, which provides a high-level evidence for the effectiveness assessment of heat-sensitive moxibustion in community management. Focusing on the key links of randomization, e.g. block randomization, stratified randomization, cluster randomization, sample size allocation, allocation concealment and blinding, the paper elaborates the advantages, disadvantages and technical details of two-stage randomization with consideration of patient preference in pragmatic randomized controlled trials of heat-sensitive moxibustion in community. It facilitates improving the quality of evidence, reproducibility and methodological homogeneity among different trials.