Patient satisfaction and digital health in primary health care: a scoping review protocol.

Introduction: Using digital health in primary health care (PHC) contributes to reducing costs and travel time, achieving global development goals, improving access, quality and longitudinality of care, and managing health crises. Its evaluation must go beyond the technical-operational aspects to include patient satisfaction, a key element in assessing the quality of care. Objective: To identify and map patient satisfaction (expectations, desires, cultural values) about the adoption of digital health strategies and assess their impact on the quality of care in PHC. Methods: The review will follow the recommendations proposed by the Joanna's Briggs Institute (JBI) manual, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) and the methodology proposed by Arksey and O'Malley and Levac et al. and will be conducted in nine stages. The search will be conducted in health studies databases (MEDLINE via PubMed, EMBASE, CINAHL, Web of Science, and BVS), gray literature, and preprint repositories (Google Scholar and MedRxiv). Two reviewers will select the studies, and the third will analyze possible conflicts. The inclusion criteria comprise studies that have been made available in their entirety, whether they are primary studies or short communications, as well as the following materials extracted from the gray literature: preprints, manuals, government documents, books, guidelines, theses and dissertations. Exclusion criteria include literature reviews, abstracts, books, conference archives, letters to the editor, duplicates and opinion articles. Data will be analyzed by content analysis and inferential statistics. This protocol is registered on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/PUJDB. Results: The study aims to understand aspects related to the expectations, desires, and cultural values of patients from different countries, as well as the strengths and critical nodes of the use of digital health on the quality of care in PHC.

A Multi-Component Intervention to Improve Therapeutic Adherence in Uncontrolled Hypertensive Patients Within the Primary Care Level: A Before-and-After Study.

INTRODUCTION: Non-adherence to medication severely affects chronic disease control. AIM: To assess whether a multi-component intervention implemented at the public primary care level in Argentina improves adherence to antihypertensive medication and helps to reduce blood pressure (BP) levels in uncontrolled hypertensive patients. METHODS: A before-and-after study was conducted in five public primary care clinics located in the city of Almirante Brown, Argentina. One hundred and twenty-five uncontrolled hypertensive patients received a multi-component intervention based on the Chronic Care model and the 5As strategy (Ask, Advise, Agree, Assist, and Arrange). Medication possession ratio (MPR) and BP values were assessed before and after a 6-month period. RESULTS: The follow-up rate was 96.8%. Main baseline characteristics were as follows, male: 44.8%, mean age: 57.1 years (± 8.1), exclusive public healthcare coverage: 83.5%, primary school level or less: 68.8%, and mean systolic/diastolic BP: 157.4 (± 13.6)/97.7 (± 8.2) mmHg. After implementing the intervention, a significant increase in the proportion of adequate adherence (MPR ≥ 80%) was observed, from 16.8% at baseline to 47.2% (p < 0.001). A significant reduction of 16.4 mmHg (CI 95%: 19.6, 13.1) was observed for systolic blood pressure (SBP) and 12.0 mmHg (CI 95%: 14.2, 9.9) for diastolic blood pressure (DBP) (p < 0.001). At 6 months, 51.2% of the population achieved blood pressure control (SBP < 140 mmHg and DBP < 90 mmHg). CONCLUSIONS: The study intervention was associated with an increased adherence rate, achieving a significant reduction in BP values and reaching BP control in more than half of the population.

Integrating neuroscience and humanities in healthcare evolution: a multidisciplinary perspective / Integração das neurociências e das ciências humanas na evolução dos cuidados de saúde: uma perspetiva multidisciplinar

The trajectory of healthcare has evolved from ancient holistic practices to the present biomedical model, reflecting the dynamic interplay between scientific progress, technological advancements, and the integration of humanistic values. While biomedical advancements have revolutionized medical treatments, there is an emerging recognition of the importance of integrating neuroscience and humanities to foster holistic patient care and understanding. This paper aims to explore the historical development of medicine, emphasizing the convergence of neuroscience, psychiatry, and neurology within the biomedical framework. Additionally, it investigates the resurgence of humanities in healthcare and its role in promoting patientcentered care. Through a comprehensive review of literature, this study traces the historical roots of medicine and examines the interdisciplinary intersections of neuroscience, psychiatry, neurology, and medical humanities. The exploration reveals the significant contributions of interdisciplinary approaches in enhancing patient-centered care, fostering a comprehensive understanding of health and well-being, and shaping modern healthcare practices. The integration of neuroscience and humanities offers valuable insights into the complexities of human health, bridging legacy practices with innovative approaches. Embracing this interdisciplinary perspective is crucial for promoting holistic healthcare, emphasizing patient-centered care, and enriching the understanding of health and well-being in contemporary healthcare settings.

A trajetória dos cuidados de saúde evoluiu das antigas práticas holísticas para o atual modelo biomédico, reflectindo a interação dinâmica entre o progresso científico, os avanços tecnológicos e a integração de valores humanísticos. Embora os avanços biomédicos tenham revolucionado os tratamentos médicos, há um reconhecimento emergente da importância de integrar as neurociências e as humanidades para promover a compreensão e os cuidados holísticos dos doentes. Este artigo tem como objetivo explorar o desenvolvimento histórico da medicina, salientando a convergência da neurociência, da psiquiatria e da neurologia no quadro biomédico. Além disso, investiga o ressurgimento das humanidades nos cuidados de saúde e o seu papel na promoção de cuidados centrados no doente. Através de uma revisão exaustiva da literatura, este estudo traça as raízes históricas da medicina e examina as intersecções interdisciplinares da neurociência, psiquiatria, neurologia e humanidades médicas. A exploração revela os contributos significativos das abordagens interdisciplinares para melhorar os cuidados centrados no doente, promover uma compreensão abrangente da saúde e do bem-estar e moldar as práticas modernas de cuidados de saúde. A integração das neurociências e das humanidades oferece conhecimentos valiosos sobre as complexidades da saúde humana, fazendo a ponte entre práticas antigas e abordagens inovadoras. A adoção desta perspetiva interdisciplinar é crucial para promover cuidados de saúde holísticos, enfatizando os cuidados centrados no doente e enriquecendo a compreensão da saúde e do bem-estar nos contextos de cuidados de saúde contemporâneos.

Espiritualidade e religiosidade como recurso de enfrentamento para pessoas com doença oncológica / Spirituality and religiosity as a coping resource for people with cancer / Espiritualidad y religiosidad como recurso de afrontamiento para las personas con câncer

Objetivo: O estudo visa analisar como a espiritualidade/religiosidade são importantes recursos de enfrentamento no processo de adoecimento e reabilitação em pessoas que recebem cuidados oncológicos. Visa-se descrever a percepção do papel desses recursos para as pessoas que recebem esses cuidados e investigar como ocorre a integração da fé na abordagem recebida por parte dos profissionais de saúde. Métodos: Trata-se de uma pesquisa de campo, descritiva e de cunho qualitativo, por meio de entrevistas com pessoas com doença oncológica assistidas pelo Instituto de prevenção do câncer Joel Magalhães-IJOMA nos meses de agosto/ setembro de 2021 e foram utilizados como instrumentos para a coleta de dados os questionários de caracterização e o questionário FICA. Resultados: Percebeu-se a importância de agregar a temática da espiritualidade/religiosidade no cuidado da pessoa com doença oncológica. Através das falas, identificou-se como a rede de apoio, os instrumentos para enfrentamento e a abordagem adequada do profissional são importantes recursos no decorrer do cuidado. Conclusão: É necessário ampliar a percepção dos profissionais de saúde acerca do cuidado holístico que abrange também a dimensão espiritual. Bem como propor uma intervenção consciente nos cuidados, ampliando os aspectos sociais e espirituais da pessoa, sem desprezar as práticas de Enfermagem e Ciência atuais. (AU)

Objective: The study aims to analyze how spirituality/religiosity are important coping resources in the process of illness and rehabilitation in people receiving cancer care. The aim is to describe the perception of the role of these resources for people who receive this care and investigate how the integration of faith in the approach received by health professionals occurs. Methods: This is a field research, descriptive and qualitative, through interviews with people with oncological disease assisted by the Joel Magalhães-IJOMA Cancer Prevention Institute in August/September 2021 and were used as instruments for data collection, the characterization questionnaires and the FICA questionnaire. Results: It was noticed the importance of adding the theme of religiosity/spirituality in the care of people with cancer. Through the speeches, it was identified as the support network, the coping instruments and the appropriate approach of the professional are important resources in the course of care. Conclusion: It is necessary to expand the perception of health professionals about holistic care that also encompasses the spiritual dimension. As well as proposing a conscious intervention in care, expanding the person's social and spiritual aspects, without neglecting current Nursing and Science practices. (AU)

Objetivo: El estudio tiene como objetivo analizar cómo la espiritualidad/religiosidad son importantes recursos de afrontamiento en el proceso de enfermedad y rehabilitación en personas que reciben atención oncológica. El objetivo es describir la percepción del papel de estos recursos para las personas que reciben este cuidado e investigar cómo se da la integración de la fe en el enfoque recibido por los profesionales de la salud. Métodos: Se trata de una investigación de campo, descriptiva y cualitativa, a través de entrevistas a personas con enfermedad oncológica asistidas por el Instituto de Prevención del Cáncer Joel Magalhães-IJOMA en agosto / septiembre de 2021 y se utilizaron como instrumentos para la recolección de datos, los cuestionarios de caracterización y el cuestionario FICA. Resultados: Se notó la importancia de incorporar el tema de la espiritualidad/religiosidad en la atención de las personas con cáncer. A través de los discursos, se identificó como la red de apoyo, los instrumentos de afrontamiento y el adecuado abordaje del profesional son recursos importantes en el curso de la atención. Conclusion: Es necesario ampliar la percepción de los profesionales de la salud sobre el cuidado holístico que englobe también la dimensión espiritual. Además de proponer una intervención consciente en el cuidado, ampliando los aspectos sociales y espirituales de la persona, sin descuidar las prácticas actuales de Enfermería y Ciencia. (AU)

How patients experience respect in healthcare: findings from a qualitative study among multicultural women living with HIV.

BACKGROUND: Respect is essential to providing high quality healthcare, particularly for groups that are historically marginalized and stigmatized. While ethical principles taught to health professionals focus on patient autonomy as the object of respect for persons, limited studies explore patients' views of respect. The purpose of this study was to explore the perspectives of a multiculturally diverse group of low-income women living with HIV (WLH) regarding their experience of respect from their medical physicians. METHODS: We analyzed 57 semi-structured interviews conducted at HIV case management sites in South Florida as part of a larger qualitative study that explored practices facilitating retention and adherence in care. Women were eligible to participate if they identified as African American (n = 28), Hispanic/Latina (n = 22), or Haitian (n = 7). They were asked to describe instances when they were treated with respect by their medical physicians. Interviews were conducted by a fluent research interviewer in either English, Spanish, or Haitian Creole, depending on participant's language preference. Transcripts were translated, back-translated and reviewed in entirety for any statements or comments about "respect." After independent coding by 3 investigators, we used a consensual thematic analysis approach to determine themes. RESULTS: Results from this study grouped into two overarching classifications: respect manifested in physicians' orientation towards the patient (i.e., interpersonal behaviors in interactions) and respect in medical professionalism (i.e., clinic procedures and practices). Four main themes emerged regarding respect in provider's orientation towards the patient: being treated as a person, treated as an equal, treated without blame or prejudice, and treated with concern/emotional support. Two main themes emerged regarding respect as evidenced in medical professionalism: physician availability and considerations of privacy. CONCLUSIONS: Findings suggest a more robust conception of what 'respect for persons' entails in medical ethics for a diverse group of low-income women living with HIV. Findings have implications for broadening areas of focus of future bioethics education, training, and research to include components of interpersonal relationship development, communication, and clinic procedures. We suggest these areas of training may increase respectful medical care experiences and potentially serve to influence persistent and known social and structural determinants of health through provider interactions and health care delivery.

User requirements for non-invasive and minimally invasive glucose self-monitoring devices in low-income and middle-income countries: a qualitative study in Kyrgyzstan, Mali, Peru and Tanzania.

AIMS: Development of non-invasive and minimally invasive glucose monitoring devices (NI-MI-GMDs) generally takes place in high-income countries (HICs), with HIC's attributes guiding product characteristics. However, people living with diabetes (PLWD) in low-income and middle-income countries (LMICs) encounter different challenges to those in HICs. This study aimed to define requirements for NI-MI-GMDs in LMICs to inform a target product profile to guide development and selection of suitable devices. METHODS: This was a multiple-methods, exploratory, qualitative study conducted in Kyrgyzstan, Mali, Peru and Tanzania. Interviews and group discussions/activities were conducted with healthcare workers (HCWs), adults living with type 1 (PLWD1) or type 2 diabetes (PLWD2), adolescents living with diabetes and caregivers. RESULTS: Among 383 informants (90 HCW, 100 PLWD1, 92 PLWD2, 24 adolescents, 77 caregivers), a range of differing user requirements were reported, including preferences for area of glucose measurement, device attachment, data display, alert type and temperature sensitivity. Willingness to pay varied across countries; common requirements included ease of use, a range of guiding functions, the possibility to attach to a body part of choice and a cost lower than or equal to current glucose self-monitoring. CONCLUSIONS: Ease-of-use and affordability were consistently prioritised, with broad functionality required for alarms, measurements and attachment possibilities. Perspectives of PLWD are crucial in developing a target product profile to inform characteristics of NI-MI-GMDs in LMICs. Stakeholders must consider these requirements to guide development and selection of NI-MI-GMDs at country level, so that devices are fit for purpose and encourage frequent glucose monitoring among PLWD in these settings.

Evaluation of Clinical Communication in Pharmacy Undergraduates in Brazil: A Multicentric Study.

OBJECTIVE: To assess the clinical communication characteristics of pharmacy undergraduates, estimate differences in this specific competency, and produce recommendations for further education and training. METHODS: Analysis of communication competence between 110 pharmacy students in the last graduation year from each of the 5 Brazilian regions and a simulated patient with complaints of mild allergic rhinitis passive of resolution with non-prescription medicines. The simulated appointment was recorded, and the video was analyzed using the 2 main elements: biomedical/task-focused and socio-emotional exchange of the Roter Interaction Analysis System. RESULTS: The total of utterances/speech from the pharmacist to the patient was 183.4; there was a statistically significant difference according to the Brazilian region. In the consultation, the frequency with which pharmacy students returned to the segment was evaluated, with a total mean clinical history segment 2 of mean 5.60; in segment 4, which is the counseling phase, an average of 4.80. In the task codes and the socio-emotional codes, there was a statistically significant difference between the codes when compared by region. We compare by sex because it is said that women talk more than men. There was a statistically significant difference in socio-emotional code and biomedical/focused and task being higher for women. CONCLUSION: The level of communication competence of students should be that desired for graduation, in all regions. There seems to be a difference between training and level of competence. Considering gender, although the consultation time is similar, it appears that the quality of communication is higher for women.

Empathic Care of Neonates: A Critical Literature Review.

Clinical empathy is a multidimensional ability to feel the patient's suffering, branched into components such as cognitive, emotional, and action, which results in benefits for patients, parents, health professionals, medical students, and others. The authors performed a critical review of the literature about empathy in neonatal care, in 2 databases, and analyzed the co-occurrence of keywords in the last 10 years. Nine articles were included in the qualitative synthesis. They highlight the interconnection between empathy, communication, ethics, and palliative care. Empathy was analyzed in situations that included pain, death, and suffering in the neonate, especially related to critically ill neonates. Strategies such as self-reflection and digital storytelling may help increase the clinical empathy education of health professionals. There are gaps in research considering the measurement of clinical empathy in neonatal care, and this measurement should be encouraged. To change care practices, education on empathy for health professionals, especially physicians, should be improved.

Tuberculosis in adolescence: an integrative review focusing on patient-centered care / Tuberculose na adolescência: uma revisão integrativa com foco no cuidado centrado no paciente

ABSTRACT Objective: To identify how patient-centered care has been addressed in tuberculosis studies with adolescents. Data source: We searched for articles published in Portuguese, Spanish and English in the Virtual Health Library (LILACS), PubMed (MedLine), and Scopus (Elsevier) databases, from 2000 to 2020, using descriptors (DeCS, MeSH) in Portuguese and English. Data synthesis: 1,322 studies were identified, of which 18 were selected. The main themes found were related to adherence to tuberculosis treatment, knowledge, attitudes and practices, health education, and public policies. Conclusions: We observed that both the number of researchers dedicated to the topic and the presence of a truly person-centered view are still scarce elements in tuberculosis among adolescents research.

RESUMO Objetivo: Identificar, por meio de uma revisão integrativa, como o cuidado centrado no paciente tem sido abordado nos estudos de tuberculose com adolescentes. Fontes de dados: Buscamos artigos publicados em português, espanhol e inglês nas bases de dados da Biblioteca Virtual em Saúde - BVS (LILACS), PubMed (MedLine) e Scopus (Elsevier), de 2000 a 2020, utilizando descritores (DeCS, MeSH) em português e inglês. Síntese dos dados: Foram identificados 1.322 estudos, dos quais 18 foram selecionados. Os principais temas encontrados foram relacionados à adesão ao tratamento da tuberculose, conhecimentos, atitudes e práticas, educação em saúde e políticas públicas. Conclusões: Observamos que tanto o número de pesquisadores dedicados ao tema quanto a presença de uma visão verdadeiramente centrada na pessoa ainda são elementos escassos na pesquisa da tuberculose entre adolescentes.

As redes vivas na produção do cuidado com o usuário na centralidade do tratamento para tuberculose multidroga resistente / Las redes vivas en la producción del cuidado con el usuario en la centralidad del tratamiento para la tuberculosis multidrogo resistente / Live networks in care production with the user at the center of the treatment for multidrugresistant tuberculosis

Vivenciamos a trajetória de uma usuária-guia no tratamento para tuberculose multidroga resistente (TB-MDR). As narrativas das redes vivas na produção de cuidado apontam para os seguintes itens: 1) cuidar no ato de viver: suplantar os estigmas e cultivar vínculos que ajudem a superar os discursos fomentados pelo medo, preconceitos, exclusão e invisibilidade dos sujeitos; 2) redes vivas de cuidado: os entremeios da norma; e 3) as interfaces de atenção usuário-trabalhador da saúde: como desmistificar o julgamento dos trabalhadores da saúde, que, subordinados a protocolos limitantes, muitas vezes estigmatizam o usuário como "abandonador de tratamento"?. A usuária-guia vislumbrou que cuidar é se desterritorializar, é colocar os desejos como potência para transformação, saindo do modus operandi rumo à criatividade, tendo o usuário no centro do processo. (AU)

Presenciamos la trayectoria de una usuaria-guía en el tratamiento para tuberculosis multidrogo resistente (TB-MDR). Las narrativas de las Redes Vivas en la producción de cuidado señalan: 1) cuidar en el acto de vivir: suplantar los estigmas y cultivar vínculos que ayuden a superar los discursos fomentados por el miedo, prejuicios, exclusión e invisibilidad de los sujetos. 2) Redes Vivas de cuidado: los entresijos de la norma y 3) las interfaces de atención usuario-trabajador de la salud: ¿cómo desmistificar el juicio de los trabajadores de la salud quienes, subordinados a protocolos limitantes, muchas veces estigmatizan al usuario como "abandonador de tratamiento"? La usuaria-guía vislumbró que cuidar es desterritorializarse, es colocar los deseos como potencia para trasformación, saliendo del modus operandi rumbo a la creatividad, colocando al usuario en el centro del proceso. (AU)

We followed the trajectory of a guiding user undergoing treatment for multidrug-resistant tuberculosis (MDR-TB). The narratives of Live Networks in care production showed: 1) Caring in the act of living: Overcoming stigmas and cultivating bonds that help overcome discourses fostered by fear, prejudice, exclusion and invisibility of subjects; 2) Live Networks of care: The in-betweens of the norm; and 3) Interfaces of user-health worker care: How can we demystify the judgment of health workers who, subordinated to limiting protocols, often stigmatize the user as someone who "abandons the treatment"? The guiding user perceived that caring means deterritorializing oneself, expressing one's desires as power for transformation, and leaving the modus operandi towards creativity, with the user at the center of the process. (AU)

Evaluation of empathy in nursing students / Evaluación de la empatía en estudiantes de enfermería / Avaliação da empatia em estudantes de enfermagem

ABSTRACT Objective: to compare empathy levels among nursing students at different course stages considering gender and age. Method: this study was conducted at the Faculdade Israelita de Ciências da Saúde Albert Einstein, employing a quantitative, descriptive, comparative and cross-sectional approach. The sample included 169 four-year Nursing undergraduate students. A sociodemographic questionnaire was used to collect information from August 2020 to April 2022 and the Multidimensional Interpersonal Reactivity Scale was used to measure empathy. The relationships between empathy and independent variables were analyzed using linear models and presented with estimated means, confidence intervals and p-values, with a significance level of 5%. Results: the comparison of empathy levels in different course periods did not reveal significant relationships with the course year. However, the lowest score on the three subscales occurred in the fourth year. When analyzing the relationship between course years and gender, no subscale showed significant differences. A significant difference in the Empathic Consideration subscale emerged in the second year when separating by course year, with higher scores for females. Conclusion: the study highlights the continued importance of teaching empathy in nursing training. Therefore, the use of the Multidimensional Interpersonal Reactivity Scale proves to be valuable for evaluating interventions and offering support for adjustments in educational strategies. Commitment to improving empathy throughout professional training and practice is essential to ensure truly patient-centered healthcare.

RESUMEN Objetivo: comparar los niveles de empatía entre estudiantes de enfermería en diferentes etapas de graduación, considerando género y edad. Método: estudio realizado en la Facultad Israelita de Ciências da Saúde Albert Einstein, con enfoque cuantitativo, descriptivo, comparativo y transversal. La muestra estuvo compuesta por 169 estudiantes de pregrado en Enfermería de cuatro años. Se utilizó un cuestionario sociodemográfico para recolectar información de agosto de 2020 a abril de 2022 y la Escala de Reactividad Interpersonal Multidimensional para medir la empatía. Las relaciones entre empatía y variables independientes se analizaron mediante modelos lineales y se presentaron con medias estimadas, intervalos de confianza y valores p, con un nivel de significancia del 5%. Resultados: la comparación de los niveles de empatía en diferentes períodos de graduación no reveló relaciones significativas con el año de graduación. Sin embargo, la puntuación más baja en las tres subescalas se produjo en el cuarto año. Al analizar la relación entre años de graduación y género, ninguna subescala mostró diferencias significativas. Al separar por año de graduación, la diferencia significativa en la subescala de Consideración Empática surgió en el segundo año, con puntuaciones más altas para las mujeres. Conclusión: el estudio destaca la importancia continua de enseñar la empatía en la formación de enfermería. Por lo tanto, el uso de la Escala Multidimensional de Reactividad Interpersonal resulta valiosa para evaluar intervenciones y ofrecer apoyo para ajustes en las estrategias educativas. El compromiso de mejorar la empatía a lo largo de la formación y la práctica profesional es esencial para garantizar una atención sanitaria verdaderamente centrada en el paciente.

RESUMO Objetivo: comparar os níveis de empatia entre estudantes de enfermagem em diferentes estágios da graduação, considerando gênero e idade. Método: estudo conduzido na Faculdade Israelita de Ciências da Saúde Albert Einstein, com abordagem quantitativa, descritiva, comparativa e transversal. A amostra incluiu 169 alunos dos quatro anos de graduação em Enfermagem. Utilizou-se um questionário sociodemográfico para coletar informações no período de agosto de 2020 a abril de 2022 e a Escala Multidimensional de Reatividade Interpessoal para mensurar empatia. As relações entre empatia e variáveis independentes foram analisadas, utilizando modelos lineares e apresentados com médias estimadas, intervalos de confiança e valores-p, com nível de significância de 5%. Resultados: a comparação dos níveis de empatia em diferentes períodos da graduação não revelou relações significativas com o ano de graduação. No entanto, o menor escore nas três subescalas ocorreu no quarto ano. Ao analisar a relação entre anos de graduação e gênero, nenhuma subescala apresentou diferenças significativas. Ao separar por ano de graduação, a diferença significativa na subescala Consideração Empática surgiu no segundo ano, com escores mais altos para o gênero feminino. Conclusão: o estudo destaca a importância contínua do ensino de empatia na formação em enfermagem. Assim, a utilização da Escala Multidimensional de Reatividade Interpessoal se mostra valiosa para avaliar intervenções e oferecer subsídios para ajustes nas estratégias educacionais. O compromisso com o aprimoramento da empatia ao longo da formação e prática profissional é essencial para garantir uma assistência de saúde verdadeiramente centrada no paciente.

Dimensions of suffering and the need for palliative care: experiences and expectations of patients living with cancer and diabetes and their caregivers in Mexico - a qualitative study.

OBJECTIVES: Over 40 million people in low-income and middle-income countries (LMICs) experience serious health-related suffering (SHS) annually and require palliative care. Patient and caregiver experiences of SHS in LMICs are understudied despite their importance in guiding palliative care provision. Diabetes and cancer are the second-leading and third-leading causes of death in Mexico, causing a significant SHS burden on patients, families and health systems. This study examines SHS and palliative care from the point of view of patients with cancer and diabetes and their caregivers. DESIGN: A qualitative descriptive study based on in-depth telephone interviews was conducted between August 2021 and February 2022. Data were analysed through inductive thematic analysis. PARTICIPANTS: Overall, 20 patients with end-stage cancer, 13 patients with diabetes and 35 family caregivers were interviewed individually. SETTING: Participants were recruited from two family medicine clinics and a pain clinic in Mexico City. RESULTS: Seven themes emerged: (1) suffering as a multifaceted phenomenon, (2) diversity in perceptions of suffering, (3) different coping strategies, (4) need and perceived importance of relief from suffering, (5) barriers to accessing services to relieve suffering, (6) demand for the health sector's active and humane role in addressing suffering and (7) preferences and need for comprehensive care for relief from suffering. The primary coping strategies included family companionship, protective buffering and faith-based support. Participants lacked knowledge of palliative care. They expressed the importance of relief from suffering, viewing it as the health sector's responsibility and requesting more humane, personalised care and access to medicines and pain clinics. CONCLUSIONS: The multifaceted nature of SHS highlights the health system's responsibility to provide high-quality palliative care. Policies to enhance access to palliative care should integrate it into primary care, redesigning services towards patient and caregiver biopsychosocial and spiritual needs and ensuring access to medicines and competent health personnel.

Transición del cuidado de pacientes con enfermedades crónicas y su relación con las características clínicas y sociodemográficas / Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics / Transição do cuidado de pacientes com doenças crônicas e sua relação com as características clínicas e sociodemográficas

Objetivo: evaluar la transición del cuidado desde la perspectiva de las personas que viven con enfermedades crónicas e identificar su relación con las características clínicas y sociodemográficas. Método: estudio transversal, con 487 pacientes dados de alta de un hospital. Se utilizaron los instrumentos de caracterización clínica, sociodemográfica y Care Transitions Measure-15, que mide los factores Preparación para el automanejo, Preferencias aseguradas, Comprensión sobre medicamentos y Plan de cuidados. Análisis estadístico descriptivo e inferencial. Resultados: la transición del cuidado fue satisfactoria (76,8±10,4). Media de factores: Preparación para el automanejo (82,2±10,8), Preferencias aseguradas (84,7±14,3), Comprensión sobre medicamentos (75,7±13,7) y Plan de Cuidados (64,5±13,2). Pacientes del sexo femenino presentaron mayor promedio en el factor comprensión sobre medicamentos. Los blancos y los residentes en áreas urbanas calificaron mejor el Plan de cuidados. La media más alta se observó para el factor Preferencias aseguradas (84,7±14,3) y la más baja para el factor Plan de cuidados (64,5±13,2). En todos los factores se encontraron diferencias significativas en las variables (paciente quirúrgico, tener artefactos clínicos y no estar hospitalizado por COVID-19). Los pacientes internados hasta cinco días presentaron diferencia estadística en los factores Preparación para el automanejo y Comprensión sobre medicamentos. En los pacientes que no reingresaron dentro de los 30 días posteriores al alta, la preparación para el automanejo fue mejor. Cuanto mejor sea la preparación para el automanejo, menores serán las tasas de reingreso a los 30 días. Conclusión: en pacientes que viven con enfermedades crónicas, variables sociodemográficas y clínicas están asociadas a la transición del cuidado. Los pacientes que evaluaron mejor la preparación para el automanejo tuvieron menos reingresos dentro de los 30 días.

Objective: evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. Method: cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. Results: the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. Conclusion: in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days.

Objetivo: avaliar a transição do cuidado na perspectiva de pessoas que vivem com doenças crônicas e identificar sua relação com as características clínicas e sociodemográficas. Método: estudo transversal, com 487 pacientes que receberam alta de um hospital. Foram utilizados instrumentos de caracterização clínica, sociodemográfica e Care Transitions Measure-15, que mensura os fatores Preparo para o autogerenciamento, Preferências asseguradas, Entendimento das medicações e Plano de cuidados. Análise estatística descritiva e inferencial. Resultados: a transição do cuidado foi satisfatória (76,8±10,4). Média dos fatores: preparo para o autogerenciamento (82,2±10,8), Preferências asseguradas (84,7±14,3), Entendimento das medicações (75,7±13,7) e Plano de Cuidados (64,5±13,2). Pacientes do sexo feminino apresentaram média superior no fator entendimento sobre medicações. Brancos e residentes na zona urbana avaliaram melhor o Plano de cuidados. Observou-se a maior média no fator Preferências asseguradas (84,7±14,3) e a menor no fator Plano de cuidados (64,5±13,2). Em todos os fatores, foram encontradas diferenças significativas nas variáveis (paciente cirúrgico, portar artefatos clínicos e não estar internado por COVID-19). Pacientes internados até cinco dias apresentaram diferença estatística nos fatores Preparação para o autogerenciamento e Entendimento das medicações. Em pacientes que não apresentaram reinternação em 30 dias após a alta, o Preparo para o autogerenciamento foi melhor. Quanto melhor o Preparo para o autogerenciamento, menores são os índices de reinternação em 30 dias. Conclusão: em pacientes que vivem com doenças crônicas, variáveis sociodemográficas e clínicas estão associadas à transição do cuidado. Pacientes que avaliaram melhor o preparo para autogerenciamento tiveram menos reinternações em 30 dias.

Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial.

INTRODUCTION: Nearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for increasing patient-centred care and reducing unmet needs. No such ePRO interventions have been implemented in Mexico. This paper presents the study protocol for designing and evaluating an ePRO digital health application combined with proactive follow-up by nurses. METHODS AND ANALYSIS: We designed a two-component intervention for women receiving breast cancer treatment: a responsive web application for monitoring ePROs and clinical algorithms guiding proactive follow-up by nurses. We will conduct a pilot test of the intervention with 50 patients with breast cancer for 6 weeks to assess feasibility and adjust the application. We will conduct a parallel arm randomised controlled trial assigning 205 patients each to intervention and control in one of Mexico's largest public oncology hospitals. The intervention will be provided for 6 months, with additional 3 months of post-intervention observation. The control group will receive usual healthcare and a list of breast cancer information sources. Women diagnosed with stages I, II or III breast cancer who initiate chemotherapy and/or radiotherapy will be invited to participate. The primary study outcome will be supportive care needs; secondary outcomes include global quality of life and breast symptoms. Information on the outcomes will be obtained through web-based self-administered questionnaires collected at baseline, 1, 3, 6 and 9 months. ETHICS AND DISSEMINATION: The National Research and Ethics Committees of the Mexican Institute of Social Security approved the study (R-2021-785-059). Participants will sign an informed consent form prior to their inclusion. Findings will be disseminated through a policy brief to the local authorities, a webinar for patients, publications in peer-reviewed journals and presentations at national and international conferences. TRIAL REGISTRATION NUMBER: NCT05925257.

Telenursing practice in the care of surgical cancer patients: a scoping review protocol.

INTRODUCTION: Telenursing is a component of telehealth that occurs when nurses use information and communication technologies to provide care and nursing services remotely. To understand how telenursing services in surgical oncology patients can be better implemented, it is important that the success models are collected and studied. Therefore, the general objective is to develop the scoping review protocol for the survey of existing evidence on the practice of oncological perioperative telenursing. METHODS AND ANALYSIS: The scoping review will be conducted following the scoping review directions of the Joanna Briggs Institute with the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews checklist for the review report. The databases that will be used for these searches will be: MEDLINE (PubMed), EMBASE, CINAHL, SCOPUS, Web of Science and Virtual Health Library. To search for grey literature, Google Scholar, WorldWideScience and Global ETD Search will be used. Primary studies, observational or experimental, published in any year or language will be considered. For the selection and extraction of data, two independent reviewers will read the title, summary and full text using the Rayyan software and a form prepared by the authors. The data to be extracted are related to the characterisation of the study (study design, country and year of publication) and details of the telenursing programme (surgery or surgical specialty, perioperative period, tools used, organisation and operation, outcome indicators and treatment methods and content in telenursing). Among others, the difficulties and potentialities for the development or implementation of telenursing will also be extracted, as the main result of the study. ETHICS AND DISSEMINATION: The study does not require ethical approval as it will use previously published research data. The results will be shared in journals and scientific events and may be used for the development and implementation of oncological perioperative telenursing programmes.

Portuguese translation, cultural adaptation, and validation of the Person-Centred Practice Inventory - Staff (PCPI-S) / Tradução, adaptação cultural e validação do Inventário da Prática Centrada na Pessoa, profissionais de saúde (PCPI-S)

Abstract Aiming to translate, culturally adapt, and psychometrically evaluate the Person-centred Practice Inventory - Staff (PCPI-S) for Portuguese healthcare professionals, this methodological study was conducted sequentially in two phases. Phase I followed the 10-steps recommendations from the ISPOR taskforce for translation and cultural adaptation of patient reported outcome measures. Phase II comprised a quantitative cross-sectional virtual survey of the translated PCPI-S with healthcare professionals, who were reached through snowball sampling from both primary and specialized care settings. The psychometric properties of the PCPI-S were determined by assessing reliability and construct validity. A sample of 304 healthcare professionals participated in Phase II. Ceiling effects were found. The overall internal consistency was excellent (> 0.9). The confirmatory factor analysis showed a good model fit after minor modifications, revealing construct validity, and supporting the theoretical framework. In conclusion, the three-factorial model of PCPI-S adjusted to the studied sample is a valid and reliable instrument to assess the perceptions of healthcare professionals on person-centred practice in various Portuguese clinical contexts. Considering the ceiling effects, the effect of social desirability should be explored.

Resumo Com o objetivo de traduzir, adaptar culturalmente e avaliar psicometricamente o Inventário para a Prática Centrada na Pessoa para profissionais de saúde (PCPI-S) em diversos contextos de prestação de cuidados, este estudo metodológico realizou-se em duas fases sequenciais. A Fase I seguiu as recomendações de dez etapas da taskforce da ISPOR para tradução e adaptação cultural de medidas de resultados auto reportados. A Fase II incluiu um estudo cross-sectional do PCPI-S traduzido com profissionais de saúde, que foram alcançados por meio de amostragem snowball em contextos de cuidados primários e diferenciados. A psicometria do PCPI-S foi analisada pela avaliação da confiabilidade e validade de construto. Uma amostra de 304 profissionais de saúde participou da Fase II. Efeitos de teto foram encontrados. A consistência interna geral foi excelente (> 0,9). A análise fatorial confirmatória mostrou um bom ajuste do modelo e validade de construto, refletindo o referencial teórico. Concluindo, o modelo tri-fatorial do PCPI-S ajustado à amostra estudada é um instrumento válido e fiável para avaliar as percepções dos profissionais de saúde sobre a prática centrada na pessoa em vários contextos de cuidados portugueses. Considerando os efeitos teto, a desejabilidade social deve ser explorada.

Physical therapists' perspectives of patient values and their place in clinical practice: a qualitative study.

BACKGROUND: In physical therapy practice patients and therapists exchange their perspectives on musculoskeletal health problems and their meaning for both of them. However, literature indicates that physical therapists find it difficult to enquire about the patients' values during clinical encounters. OBJECTIVES: The aim of this study was to gain deeper insight into the perspectives of physical therapists about patient values. DESIGN: Explorative qualitative focus group study. METHOD: Twenty-three physical therapists were interviewed in the Netherlands from March to May 2021. Two researchers analyzed the interviews and derived relevant codes. After an iterative process of comparing, analyzing, conceptualizing and discussing the codes, themes were identified through a thematic framework, illustrated with meaningful quotes. RESULTS: Three major themes were identified: Humane, Tacit, and Responsive. It appeared that patient values play unconsciously a major role in daily practice and are associated with humanity, not technical or procedural aspects of the encounter. Responsive denotes that all values require interaction in which aligning with the individual patient forms the basis of treatment. Barriers for being responsive are identified as subthemes: Choices, Trust, Diverseness, and Boundaries. CONCLUSION: The concept of patient values appeared to be implicit. The professional intuitively attunes as a fellow human being to values and expectations of the individual patient. This study contributes to finding a balance and mutual reinforcement of implicit and explicit knowledge. With all found experiences and insights the concept of patient values became more explicit in physical therapy to create a framework for education and research in the future.

Are primary care consultations in Trinidad patient-centered? A cross-sectional study of patients with non-communicable diseases.

BACKGROUND: The aim of this study was to measure the patient's perception of patient centeredness in their consultations for non-communicable diseases (NCDs). We also measured consultation length and patient enablement. METHOD: A cross-sectional study was conducted over 2 months at four primary care clinics at the St. Joseph cluster of the North Central Regional Health Authority (NCRHA) in Trinidad and Tobago. Interviewers timed the consultation and completed post-consultation questionnaires using the Patient Perception of Patient-Centeredness (PPPC) questionnaire and the Patient Enablement Index (PEI). The PPPC is a 14-item (each scored 1-4) Likert-scaled instrument. The total score is averaged and a PPPC score of 4 is the maximum. The PEI measures the ability of the patient to cope with life and their disease. The PEI consists of 6 questions scored 0-2, with a maximum score of 12. RESULTS: There were 180 respondents (response rate = 82.5%). Participants were female (75.6%), aged over 65 years (50.6%), married (51.1%), Indo-Trinidadian (52.2%), and Christian (60.6%). Half achieved a primary school education, and 37.2% secondary. The consultation length ranged between 1.32 and 31.22 min. The average, median and mode of the consultation length were 8.5, 7.74 and 10 min, respectively. The average, median and mode of the measures of patient-centeredness were PPPC (3.67, 3.86 and 4) and PEI score (5.93, 6 and 6). The PPPC average was lower in patients with a stroke (p = 0.022), and higher among those with more than 2 consultation interruptions (p = 0.015) and those who knew the doctor very well (p = 0.015). The PEI score was lower in patients with heart disease (p = 0.022). The consultation length was longer in those with tertiary education (p = 0.044) and those with two consultation interruptions (p = 0.032). PPPC Average and PEI Score correlated well (ρ = 0.408, p < 0.001). The consultation length correlated with the PPPC Average (ρ = 0.168,p = 0.025). CONCLUSION: Primary Care consultations in this cluster of health centres in NCRHA in Trinidad were often patient centered. The consultation length, patient-centeredness, measured with the PPPC instrument, and patient enablement scores, measured with the PEI instrument, in consultations for NCDs in Trinidad compare favourably with international reports.

Perspectives on Sedation Among Interdisciplinary Team Members in ICU: A Survey Study.

OBJECTIVE: To explore the interdisciplinary team members' beliefs and attitudes about sedation when caring for mechanically ventilated patients in the ICU. DESIGN: Cross-sectional survey. SETTING: A 17-bed cardiothoracic ICU at a tertiary care academic hospital in Colorado. SUBJECTS: All nurses, physicians, advanced practice providers (APPs), respiratory therapists, physical therapists (PTs), and occupational therapists (OTs) who work in the cardiothoracic ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We modified a validated survey instrument to evaluate perspectives on sedation across members of the interdisciplinary ICU team. Survey responses were collected anonymously from 111 members (81% response rate). Respondents were predominantly female (70 [63%]). Most respondents across disciplines (94%) believed that their sedation practice made a difference in patients' outcomes. More nurses (48%), APPs (62%), and respiratory therapists (50%) believed that sedation could help alleviate the psychologic stress that patients experience on the ventilator than physicians (19%) and PTs/OTs (0%) (p = 0.008). The proportion of respondents who preferred to be sedated if they were mechanically ventilated themselves varied widely by discipline: respiratory therapists (88%), nurses (83%), APPs (54%), PTs/OTs (38%), and physicians (19%) (p < 0.001). In our exploratory analysis, listeners of an educational podcast had beliefs and attitudes more aligned with best evidence-based practices than nonlisteners. CONCLUSIONS: We discovered significant interdisciplinary differences in the beliefs and attitudes regarding sedation use in the ICU. Since all ICU team members are involved in managing mechanically ventilated patients in the ICU, aligning the mental models of sedation may be essential to enhance interprofessional collaboration and promote sedation best practices.

Requirements for Brazilian Outpatient Centers of Excellence in Hidradenitis Suppurativa: Consensus Co-Creative Study.

Background: Hidradenitis suppurativa (HS) is a chronic skin condition. Its complexity and impact on patients highlight the need for multidisciplinary care that can address the physical, psychological, and social aspects. Centers of excellence can ideally provide the necessary infrastructure, resources, and expertise to effectively treat HS. However, there are still no consolidated models of centers of excellence in HS, and establishing their foundations is an intricate research challenge. Purposely, design and co-creation as innovation techniques are helpful approaches to this type of research. Methods: In this study, we conducted a co-creation with consensus among HS specialists to propose the criteria and requirements to establish outpatient centers of excellence of HS in Brazil. We followed a linear process with mixed methods in 6 stages. Results: The process resulted in 10 categories for establishing outpatient centers, including their respective requirements, rationale, and classification. The categories include onboarding and welcoming; infrastructure and procedures; infusion therapy; flows and referrals; staffing; disease management; metrics during diagnosis; metrics during treatment; awareness and advocacy; research and education. Discussion: The idealized outpatient centers can play a role in the complete multidisciplinary treatment for HS and advancing the science of healthcare services by providing a focus for research, training, and translation of findings into practice.