Students' interaction anxiety and social phobia in interprofessional education in Hong Kong: mapping a new research direction.

BACKGROUND: Interprofessional education (IPE) has been promoted as a breakthrough in healthcare because of the impact when professionals work as a team. However, despite its inception dating back to the 1960s, its science has taken a long time to advance. There is a need to theorize IPE to cultivate creative insights for a nuanced understanding of IPE. This study aims to propose a research agenda on social interaction by understanding the measurement scales used and guiding researchers to contribute to the discussion of social processes in IPE. METHOD: This quantitative research was undertaken in a cross-institutional IPE involving 925 healthcare students (Medicine, Nursing, Social Work, Chinese Medicine, Pharmacy, Speech Language Pathology, Clinical Psychology, Food and Nutritional Science and Physiotherapy) from two institutions in Hong Kong. Participants completed the Social Interaction Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6). We applied a construct validation approach: within-network and between-network validation. We performed confirmatory factors analysis, t-test, analysis of variance and regression analysis. RESULTS: CFA results indicated that current data fit the a priori model providing support to within-network validity [RMSEA=.08, NFI=.959, CFI=.965, IFI=.965, TLI=.955]. The criteria for acceptable fit were met. The scales were invariant between genders, across year levels and disciplines. Results indicated that social interaction anxiety and social phobia negatively predicted behavioural engagement (F = 25.093, p<.001, R2=.065) and positively predicted behavioural disaffection (F = 22.169, p<.001, R2=.057) to IPE, suggesting between-network validity. CONCLUSIONS: Our data provided support for the validity of the scales when used among healthcare students in Hong Kong. SIAS-6 and SPS-6 have sound psychometric properties based on students' data in Hong Kong. We identified quantitative, qualitative and mixed methods research designs to guide researchers in getting involved in the discussion of students' social interactions in IPE.Key MessagesThe Social Anxiety Scale (SIAS-6) and Social Phobia Scale (SPS-6) scales have sound psychometric properties based on the large-scale healthcare students' data in IPE in Hong Kong.Social interaction anxiety and social phobia negatively predicted students' behavioural engagement with IPE and positively predicted behavioural disaffection. The scales are invariant in terms of gender, year level and discipline.Quantitative, qualitative and mixed methods studies are proposed to aid researchers to contribute in healthcare education literature using the SIAS-6 and SPS-6.

The effects of advance care planning intervention on nursing home residents: A systematic review and meta-analysis of randomised controlled trials.

BACKGROUND: Advance care planning is a communication and decision-making process during which people express their wishes for future healthcare and treatment decisions. Advance care planning is particularly relevant to frail older adults. Recently, more advance care planning interventions have been implemented in nursing homes using randomised controlled trial approaches; however, no meta-analysis has been performed evaluating and synthesising the effect of advance care planning in nursing homes. OBJECTIVE: To determine the effect of advance care planning interventions on end-of-life outcomes in nursing home populations. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, EMBASE, Cochrane Library, Medical database, British Nursing Index, PsycInfo and CINAHL Plus from inception to March 2021. REVIEW METHODS: Randomised controlled trials or cluster randomised controlled trials implementing advance care planning interventions in nursing homes, and studies reporting end-of-life outcomes and published in English were included. Studies in which advance care planning was part of a more comprehensive intervention were excluded. The outcomes were evaluated using pooled odds ratios (ORs) or standardised mean differences (SMDs) with random-effects meta-analysis models. A meta-regression was performed to evaluate the heterogeneity of the included studies. The Cochrane Risk of Bias Tool 2.0 was used to assess the methodological quality of the included studies. RESULTS: Nine trials were identified with 2905 participants, with sample sizes ranging from 87 to 1292. The number of nursing homes involved ranged from 1 to 64. The types of advance care planning intervention differed, with most studies adopting formal education or training for nursing home staff, while the remainder adopted train-the-trainer approaches. The quality of the included studies varied, with two out of nine scoring low in overall risk of bias. Our comprehensive meta-analysis indicated with moderate heterogeneity that advance care planning interventions significantly increased the documentation of end-of-life care preferences (OR = 1.95, 95% CI: 1.64, 2.32), but not satisfaction with end-of-life care from families' perspectives (SMD = 0.08, 95% CI: -0.08, 0.23). The meta-regression did not identify any variables in advance care planning interventions to explain the heterogeneity. CONCLUSION: Advance care planning intervention yielded beneficial effects in nursing home residents by increasing the number of documented end-of-life care wishes but demonstrated no effect on satisfaction with end-of-life care from family caregivers' perspectives. This review highlights the need for more rigorously designed implementation studies to examine the effects of advance care planning interventions on healthcare outcomes among frail older adults in nursing homes.

What factors facilitate interprofessional collaboration outcomes in interprofessional education? A multi-level perspective.

OBJECTIVES: Interprofessional education (IPE) harnesses the power of teams to facilitate collaborative learning across disciplines. However, prior research has not paid sufficient attention to the role of team-level factors on IPE outcomes, posing a major theoretical and methodological limitation. In response to this, using social interdependence theory (SIT), this study aimed to delineate the independent contributions of both team-level and student-level interprofessional attitudes (teamwork, roles, and responsibilities; patient-centeredness; and community-centeredness) in predicting IPE collaboration outcomes (goal achievement, team effectiveness, and team performance) employing multi-level analysis. METHODS: To test whether interprofessional attitudes at the team and student levels predict IPE collaboration outcomes, conducted multilevel modeling. We used the pretest and posttest data from 323 healthcare students in Hong Kong from Chinese medicine, medicine, nursing, pharmacy, and social work programmes enrolled in the IPE Cancer module. RESULTS: Among the interprofessional attitudes, "teamwork, roles, and responsibilities" was found to be the best predictor of IPE outcomes, both at the student and team levels. Students who recognized the benefits of shared learning had better goal achievement and team effectiveness. Furthermore, teams that emphasized shared learning also had better overall team performance. CONCLUSIONS: Students' attitudes towards teamwork, roles, and responsibilities in interprofessional collaborative practice, both at the student and team levels, are important to attaining positive student- and team-level outcomes. The study contributes to the expansion of existing knowledge in medical education, theoretically, by adopting SIT as a lens through which collaborative learning in healthcare teams can be understood, and methodologically, by applying multi-level approaches and delineating important student- and team-level predictors of IPE outcomes.

A pilot randomized controlled trial using Baduanjin qigong to reverse frailty status among post-treatment older cancer survivors.

OBJECTIVES: To evaluate the feasibility and potential effects of qigong Baduanjin for reversing frailty status among older cancer survivors. MATERIALS AND METHODS: Twenty-eight older cancer survivors screened as pre-frail or frail were recruited. They were randomly assigned (1:1) to receive a sixteen-week Baduanjin intervention or an active control condition (light flexibility exercise). Frailty status (primary outcome) and secondary outcomes (physical performance, activities of daily living performance, psychological well-being, and health-related quality of life) were measured by physical performance tests and questionnaires. Qualitative interviews were conducted to explore participants' perspectives on the intervention. RESULTS: Twenty-one participants (75%) completed the study, with reasons of withdrawal mainly relating to the COVID-19 pandemic. Attendance at Baduanjin sessions and adherence to self-practice were satisfactory, with all retained participants attending all sessions and 81.8% practicing Baduanjin for more than 90 min per week. Qualitative findings demonstrated that participants accepted Baduanjin. The proportion of improvement in frailty status at post-intervention appeared to be higher in the intervention group (26.7%; 95% confidence interval [CI], 10.1% to 54.0%) than the control group (15.4%; 95% CI, 3.7% to 46.0%); yet the difference was not statistically significant (p = 0.461). CONCLUSIONS: Baduanjin qigong appears to be feasible and acceptable among older cancer survivors. To confirm the intervention effect, an adequately powered trial is warranted. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04694066. Retrospectively registered 5 January 2021, https://clinicaltrials.gov/ct2/show/NCT04694066.

Effect of qigong for sleep disturbance-related symptom clusters in cancer: a systematic review and meta-analysis.

OBJECTIVES: To examine the effects of qigong interventions on sleep disturbance-related symptom clusters for cancer patients and to explore the possible mediating role of fatigue and depression in affecting sleep. METHODS: In this systematic review and meta-analysis, a systematic search was conducted through October 2020 by searching multiple English and Chinese databases. Inclusion was limited to randomized controlled trials that measured the effect of qigong on sleep and fatigue/depressive symptoms in cancer patients. Eleven studies involving 907 cancer patients were included in the systematic review, whereas the meta-analysis included ten studies with 851 cancer patients. RESULTS: The most commonly investigated form of qigong was Taichi, and the intervention length ranged from 10 days to 6 months. All studies employed self-reported measurements. Overall, qigong significantly improved sleep (SMD = -1.28, 95% CI: -2.01, -0.55) and fatigue (SMD = -0.89, 95% CI: -1.59, -0.19) in cancer patients post-intervention, but not depressive symptoms (SMD = -0.69, 95% CI: -1.81, 0.42). Notably, the benefits on sleep and fatigue became non-significant after 3 months. Qigong's effect on sleep was significantly mediated by its effect on fatigue (ß = 1.27, SE = 0.24, p = 0.002), but not depressive symptoms (ß = 0.53, SE = 0.26, p = 0.106). CONCLUSIONS: Qigong can be recommended for improving sleep disturbance-fatigue symptom clusters in the cancer population, while qigong's benefit on sleep is likely based on its effect on reducing fatigue. Future qigong studies should adopt more rigorous design and employ strategies to maintain longevity of intervention benefits.

Exercise levels and preferences on exercise counselling and programming among older cancer survivors: A mixed-methods study.

OBJECTIVES: To assess exercise levels and exercise counselling /programming preferences among older cancer survivors. MATERIALS AND METHODS: A mixed-methods study design was employed. Quantitative instruments on exercise levels, exercise counselling and programming preferences, frailty status, and cancer-related symptoms were administered to 290 post-treatment older cancer survivors aged ≥65. Twelve participants with different exercise levels and different views on exercise counselling and programming were purposively selected to participate in semi-structured interviews. RESULTS: Overall, 58.3% of participants did not meet the recommended exercise guidelines, and 44.1% were not engaging in any vigorous or moderate exercise. Frail survivors were less likely to meet the guidelines (aOR = 0.194, 95%CI = 0.053, 0.712) compared to their robust counterparts. However, 66.9% and 62.8% of participants expressed a definite or possible interest in receiving exercise counselling and participating in an exercise program, respectively. Particularly, survivors who are male, did not receive chemotherapy, are less educated, and have higher symptom burden were less likely to show interest. Most preferred low-intensity exercise (59.8%) and wanted to start the exercise program after treatment (68.2%), which differs from the literature on general adult survivors. The major trigger to initiate and maintain exercise behaviors was the benefits of exercise and a common barrier to exercising was lack of time. CONCLUSION: Most older cancer survivors did not meet the recommended exercise guidelines, but they were open to exercise counselling and programming. Reviewing education on the benefits of exercise is especially important after treatment completion to promote healthy lifestyles.

Effects of a Home-Based Palliative Heart Failure Program on Quality of Life, Symptom Burden, Satisfaction and Caregiver Burden: A Randomized Controlled Trial.

CONTEXT: Provision of home-based palliative care (PC) for seriously ill patients is important, yet few home-based PC services specifically or exclusively focus on end-stage heart failure (ESHF) patients. OBJECTIVES: This study aimed to examine the effect of a home-based palliative heart failure (HPHF) program on quality of life (QOL), symptoms burden, functional status, patient satisfaction, and caregiver burden among patients with ESHF. METHODS: This study was a two-group randomized controlled trial undertaken in three hospitals. We recruited a total of 84 hospitalized ESHF patients who were referred to PC. They were randomized to the intervention or control group. The intervention group received a 12-week structured program with regular home visits/telephone calls provided by the nurse case managers. Data were collected at baseline (T1) and at four (T2) and 12 weeks (T3) after discharge. RESULTS: A statistically significant between-group effect was found, with the HPHF group having significantly higher McGill QOL total score than the control group (P = 0.016) and there was significant group × time interaction effect (P = 0.032). There was no significant between-group effects detected for the measures of symptom distress or functional status at 12 weeks. The intervention group had higher satisfaction (P = 0.001) and lower caregiver burden (P = 0.024) than the control group at 12 weeks. CONCLUSION: The HPHF program is effective in enhancing the QOL of ESHF patients, satisfaction with care, and caregiver burden. The program has potential to reduce distress for some of the symptoms.

Cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure.

BACKGROUND: Studies have shown positive clinical outcomes of specialist palliative care for end-stage heart failure patients, but cost-effectiveness evaluation is lacking. AIM: To examine the cost-effectiveness of a transitional home-based palliative care program for patients with end-stage heart failure patients as compared to the customary palliative care service. DESIGN: A cost-effectiveness analysis was conducted alongside a randomized controlled trial (Trial number: NCT02086305). The costs included pre-program training, intervention, and hospital use. Quality of life was measured using SF-6D. SETTING/PARTICIPANTS: The study took place in three hospitals in Hong Kong. The inclusion criteria were meeting clinical indicators for end-stage heart failure patients including clinician-judged last year of life, discharged to home within the service area, and palliative care referral accepted. A total of 84 subjects (study = 43, control = 41) were recruited. RESULTS: When the study group was compared to the control group, the net incremental quality-adjusted life years gain was 0.0012 (28 days)/0.0077 (84 days) and the net incremental costs per case was -HK$7935 (28 days)/-HK$26,084 (84 days). The probability of being cost-effective was 85% (28 days)/100% (84 days) based on the cost-effectiveness thresholds recommended both by National Institute for Health and Clinical Excellence (£20,000/quality-adjusted life years) and World Health Organization (Hong Kong gross domestic product/capita in 2015, HK$328117). CONCLUSION: Results suggest that a transitional home-based palliative care program is more cost-effective than customary palliative care service. Limitations of the study include small sample size, study confined to one city, clinic consultation costs, and societal costs including patient costs and unpaid care-giving costs were not included.

Effects of a transitional palliative care model on patients with end-stage heart failure: study protocol for a randomized controlled trial.

BACKGROUND: Heart failure (HF) is characterized by high rates of readmission after hospitalization, and readmission is a major contributor to healthcare costs. The transitional care model has proven efficacy in reducing the readmission rate and economic outcomes, and increasing satisfaction with care. However, the effectiveness of the transitional care model has not been evaluated in patients with end-stage HF. This study was designed to compare the customary hospital-based care and a comprehensive transitional care model, namely the Home-based Palliative HF Program (HPHP), in terms of readmission rate, quality of life, and satisfaction with care among end-stage HF patients under palliative care. METHODS/DESIGN: This is a randomized controlled trial taking place in hospitals in Hong Kong. We have been recruiting patients with end-stage HF who are identified as appropriate for palliative care during hospitalization, on referral by their physicians. A set of questionnaires is collected from each participant upon discharge. Participants are randomized to receive usual care (customary hospital-based care) or the intervention (HPHP). The HPHP will be implemented for up to 12 months. Outcome measures will be performed at 1, 3, 6, and 12 months post-discharge. The primary outcome of this study is quality of life measured by the Chronic Heart Failure Questionnaire - Chinese version; secondary outcomes include readmission rate, symptom intensity, functional status, and satisfaction with care. DISCUSSION: This study is original and will provide important information for service development in the area of palliative care. The introduction of palliative care to end-stage organ failure patients is new and has received increasing attention worldwide in the last decade. This study adopts the randomized controlled trial, a vigorous research design, to establish scientific evidence in exploring the best model for end-stage HF patients receiving palliative care. TRIAL REGISTRATION: This trial was registered as NCT02086305 on 7 March 2014 in the United States Clinical Trials Registration, and in the Clinical Trials Registry, Hong Kong University with the trial number UW12202.

Effects of a transitional palliative care model on patients with end-stage heart failure: a randomised controlled trial.

OBJECTIVE: To examine the effects of home-based transitional palliative care for patients with end-stage heart failure (ESHF) after hospital discharge. METHODS: This was a randomised controlled trial conducted in three hospitals in Hong Kong. The recruited subjects were patients with ESHF who had been discharged home from hospitals and referred for palliative service, and who met the specified inclusion criteria. The interventions consisted of weekly home visits/telephone calls in the first 4 weeks then monthly follow-up, provided by a nurse case manager supported by a multidisciplinary team. The primary outcome measures were any readmission and count of readmissions within 4 and 12 weeks after index discharge, compared using χ(2) tests and Poisson regression, respectively. Secondarily, change in symptoms over time between control and intervention groups were evaluated using generalised estimating equation analyses of data collected using the Edmonton Symptom Assessment Scale (ESAS). RESULTS: The intervention group (n=43) had a significantly lower readmission rate than the control group (n=41) at 12 weeks (intervention 33.6% vs control 61.0% χ(2)=6.8, p=0.009). The mean number (SE) of readmissions for the intervention and control groups was, respectively, 0.42 (0.10) and 1.10 (0.16) and the difference was significant (p=0.001). The relative risk (CI) for 12-week readmissions for the intervention group was 0.55 (0.35 to 0.88). There was no significant difference in readmissions between groups at 4 weeks. However, when compared with the control group, the intervention group experienced significantly higher clinical improvement in depression (45.9% vs 16.1%, p<0.05), dyspnoea (62.2% vs 29.0%, p<0.05) and total ESAS score (73.0% vs 41.4%, p<0.05) at 4 weeks. There were significant differences between groups in changes over time in quality of life (QOL) measured by McGill QOL (p<0.05) and chronic HF (p<0.01) questionnaires. CONCLUSIONS: This study provides evidence of the effectiveness of a postdischarge transitional care palliative programme in reducing readmissions and improving symptom control among patients with ESHF. TRIAL REGISTRATION NUMBER: HKCTR-1562; Results.