Understanding Indigenous peoples experiences to inform recommendations for improving cultural safety and care in radiation therapy centres in Alberta, Canada.

BACKGROUND: Worldwide there has been a shift in the ideology within healthcare systems that focuses on 'people' rather than the 'patients'. A patient should not only be perceived by their condition but rather viewed holistically as a person. Within a South African (SA) context, the constitution has been amended to state that all South African citizens have the right to healthcare that is caring, free from harm, and effective. Hence, it can be rationalized that patient-centered care (PCC) is a necessary and vital approach in South African healthcare as well. A study conducted by Hyde and Hardy in the United Kingdom (UK) explored measures of PCC from radiography patients, radiographers, radiography managers, radiography educators, and radiography students' perspectives. This study was duplicated to define informed measures of PCC from a South African perspective. Therefore, this study aimed to gain perspectives on PCC measures in diagnostic radiography within a sample of the South African community. This paper focuses on the perspectives of the clinical radiographer and patient respondents. METHOD: This study was conducted using a quantitative approach with the use of an online survey. The Qualtrics software was utilized to design the survey. The survey consisted of three PCC themes; use of technology, comfort and emotional support, and control over the environment. Recruitment of the subgroups was via advertisement in social media, email networks, and word of mouth. RESULTS: There were 28 radiographer responses and 14 patient responses. The data were analyzed using SPSS software version 28. Patient care while explaining the use of technology in radiography, received positive responses from both respondent groups. Patient care measures that explored comfort and emotional support received varied responses from patients and radiographers. Important PCC concepts, such as asking the patient about their care needs and health problems, were lacking. Patients indicated that radiographers do not include their family members in the discussion of the care needs even though family involvement is a PCC element. CONCLUSION: The perceptions of PCC measures differed between the two groups which indicated that there are still some gaps in clinical practice. Patient involvement in their care and individualized care should be prioritized. There is a need for family involvement during radiography procedures to be better highlighted within clinical practice. It is also recommended that more importance be placed on PCC during undergraduate training. While service delivery is important, radiographers must not disregard their PCC responsibilities towards the patient.

Narratives in the Journal of Medical Imaging and Radiation Sciences: Publishing stories in an academic journal.

Healthcare narratives can be used for education to elicit an emotional or affective response, develop critical thinking, and gain perspective on individuals' experiences with life and illness to cultivate person-centered care. This editorial describes the recent experience of the Journal of Medical Imaging and Radiation Sciences (JMIRS) in developing a new narrative submission format. The processes of engaging and supporting patient authors as well as creating a more accessible submission and review process are presented. Finally, the paper discusses the emerging impact of published narratives and the benefit of working with patients as experts and authors.

Unintended consequences of patient online access to health records: a qualitative study in UK primary care.

BACKGROUND: Health systems are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care worldwide. The NHS Long Term Plan created the right for patients to access 'digital first' primary care by 2023-2024, including online patient access to full medical records. AIM: To identify and understand the unintended consequences of online patient access to medical records. DESIGN AND SETTING: Qualitative interview study in 10 general practices in South West and North West England. METHOD: Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records. RESULTS: Online access generated unintended consequences that negatively impacted patients' understanding of their health care, with patients finding surprising or difficult to interpret information. Online access impacted GPs' documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care. In other cases, this negatively impacted the quality of the records and patient safety when GPs avoided documenting speculations or concerns. Contrary to assumptions that workload would be reduced, online access introduced extra work, such as managing and monitoring access, and taking measures to prevent possible harm to patients. CONCLUSION: The unintended consequences described by both staff and patients show that, to achieve the intended consequences set out in NHS policy, additional work is necessary to prepare records for sharing and to prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access, now that it is the default position. A table of potential unintended consequences and mitigation measures is provided to aid practice managers and clinicians implementing online access.

Unintended consequences of online consultations: a qualitative study in UK primary care.

BACKGROUND: Health services are increasingly using digital tools to deliver care, and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care. AIM: To identify and understand the unintended consequences of online consultations in primary care. DESIGN AND SETTING: Qualitative interview study in eight general practices using online consultation tools in South West and North West England between February 2019 and January 2020. METHOD: Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff. RESULTS: Consequences of online consultations were identified that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with, and whether practices used online consultations as their preferred method for patients to contact the practice. Consequences were identified that limited increases in practice efficiency by creating additional work, isolation, and dissatisfaction for some staff. CONCLUSION: Unintended consequences often present operational challenges that are foreseeable and partly preventable. However, these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Process changes tailored to local circumstances are critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated information exchange that leads to diffuse relationships and a more transactional style of medicine.

Power, paradox and pessimism: On the unintended consequences of digital health technologies in primary care.

We consider what might be learned from the unintended, apparently unanticipated, consequences of the use of digital health (including alternatives to face to face consultations, electronic medical records, use of apps and online monitoring) in primary care. We chose a conceptual literature review method, to seek a higher order understanding of the nuanced patterning of unintended consequences of digital health technologies (for people, relationships, organisations and ways of working) which are rarely simply positive or negative. The approach is informed by realist review, which recognises that experiences and outcomes of interventions work (or fail) in different ways in particular contexts. We present three higher order themes to illuminate underpinning mechanisms for unintended consequences in digital health technologies in primary care. These themes are illustrated by case examples, with particular focus on those that have been little discussed in the literature. Following Merton's (1936) differentiation between consequences for the actor(s) and others, which are mediated through the culture and social structure, we discuss consequences that i) disrupt power relations between patients and health professionals or between different groups of health professions, ii) contribute to paradoxical outcomes and iii) result in a potentially corrosive sub-culture of pessimism about digital health. We conclude that when implementing or evaluating digital technologies in primary care, it is wise to consider the 'dark logic' of the intervention (Bonell et al., 2015). Attention to issues of power relations, the potential for paradoxical outcomes, and impacts on the expectations of staff in relation to digital innovation are particularly salient in relation to the dramatic changes in primary care delivery initiated during the Covid-19 pandemic. Fostering a sense of ownership and interest in monitoring the effects that matter to the organisation will likely help counter pessimism and renew interest in deploying those digital innovations that show promise.

Latinos with obsessive-compulsive disorder: Mental healthcare utilization and inclusion in clinical trials.

Previous research has documented that ethnic minorities, particularly Latinos, obtain fewer mental health services than Caucasians (Kearney, Draper, & Baron 2005; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Conceivably, this may be due to a wide array of cultural issues (e.g., negative stigma attached to mental health, and language, socio-economic, and acculturation barriers), symptom disparities across Caucasian and Latino groups, or lack of effective outreach methods by clinicians and researchers. However, research is limited. As a result, Latinos may be insufficiently represented in clinical studies for OCD, making it unclear whether evidence-based treatments demonstrate the same efficacy and effectiveness for Latinos as has been demonstrated for Caucasians. The current study takes an in-depth analysis of 98 efficacy and effectiveness studies for OCD from across the Western hemisphere and reports the rates of Latino inclusion from each sample. Ninety clinical studies in the US and Canada, as well as eight clinical studies in Mexico and Central America were reviewed. Findings showed that only 11 (24%) US and Canadian studies included Latino participants, illustrating an overwhelming underrepresentation of Latinos in clinical studies for OCD. Further explanation of the results and their implications are discussed, along with suggestions for effectively improving access to mental health research and appropriate treatments.