Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa.

PURPOSE: Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers' perspective on factors influencing the optimal management of chronic pain. METHODS: Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model. RESULTS: The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal). CONCLUSION: Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Traumatic spinal cord injury chronic painChallenges to effective chronic pain management are multifold and include intrapersonal, interpersonal, organizational, and policy factors, in South Africa.The lack of guidance frameworks and contextualized guidelines inhibits optimal chronic pain management.Holistic assessment and management of chronic pain should be prioritized in the acute care setting in order to follow through to the rehabilitation and primary care settings.Mental health and its impact on chronic pain should be assessed and managed at all levels of care.

Perceived Barriers of Clinical Roles Towards Intensive Care Unit Mobility.

Background: There is overwhelming evidence of improved patient outcomes as a result of early mobilization in the intensive care unit (ICU). However, several barriers of ICU mobility remain understated with reference to clinical roles. The purpose of this study is to investigate the perceived barriers of early mobility of critically ill patients among ICU healthcare providers. Methods: In this cross-sectional study, the Mobilization Attitudes and Beliefs Survey (PMABS-ICU) was administered to ICU healthcare providers using an online survey. The study investigated barriers related to knowledge, attitudes, and behaviors regarding ICU mobility practices. These barriers were compared among different ICU clinical roles. Results: The survey yielded a total number of 214 healthcare providers with 41% female and 59% male. Respiratory therapists reported the highest perceived barriers to ICU mobility (M 39, IQR 36, 43) % compared to physical therapists (who reported the lowest barriers), occupational therapists, nurses, and physicians (p ≤ 0.05). ICU healthcare providers' behavior towards ICU mobility such as perceived benefits and safety is ranked as the primary barrier (M 49, IQR 42, 52) %. Professional experience did not significantly vary among all groups. Conclusion: Our findings highlight that ICU healthcare providers' perceptions, including both potential benefits and safety concerns regarding mobility, are significant barriers to implement mobility practices. ICU mobility barriers should be tackled by providing education and training. A focused effort to include RTs and nurses could advance interdisciplinary ICU mobility practice and reduce associated barriers.

Primary Healthcare Providers' Activities in Linking Patients With Chronic Diseases to Community Organizations: A Scoping Review.

CONTEXT: Aging and increasing comorbidities in the population are leading to more complex care for patients and primary healthcare providers. Community organizations (COs) may play a role in the services offered to support patients with chronic diseases (PCDs) but there are currently no clear guidelines to support primary healthcare providers in linking patients to COs. OBJECTIVES: The aim of this study was to describe the role of primary healthcare providers regarding linking PCDs to COs by: (1) describing linking activities; and (2) identifying the main facilitators and barriers associated with these activities. METHODS: This scoping review was based on the Arksey and O'Malley method, completed by Levac, Colquhoun, and O'Brien. Related keywords were used in 7 databases to search relevant studies. After the initial screening, 135 full texts were assessed for eligibility by 2 reviewers using inclusion/exclusion criteria. Empirical studies describing activities performed by primary healthcare providers in linking PCDs to COs or describing facilitators or barriers to linking activities were included. Studies describing activities linking to other services than COs or located in emergency departments were excluded. RESULTS: In total, 28 studies were included. Information reported in the studies was classified into 8 main linking activities: capacity development, patient identification, assessment, information, planning, referral, follow-up, and collaboration. Facilitators and barriers to these activities were related to intrapersonal characteristics of providers and patients, professional practice, work environment, relationships, and external influences. Healthcare providers' involvement was often adapted according to their field of practice. CONCLUSION: This scoping review details the role of primary healthcare providers when linking PCDs to COs in a collaborative and interdisciplinary context, which can be adapted to clinical practice by providers, experts, or stakeholders to support improvement in chronic care management.

The Importance of Patient Experience in Obtaining Mental Health Care at HRSA-Funded Health Centers.

Timely mental health care prevents more complex and costly psychological problems, particularly for underserved individuals utilizing HRSA-funded health centers. Patient experience with care services and provider interactions may facilitate timely mental health care access. This study explored which elements of patient experience at health centers minimize delayed access to necessary mental health care. We used cross-sectional data on adult patients who needed mental health services from the 2022 Health Center Patient Survey (N = 1039). Multi-variable logistic regression analyses examined the influence of patient experience using measures drawn from the Consumer Assessment of Healthcare Providers and Systems on delayed mental health care, accounting for predisposing, enabling, and need factors. 82% of patients did not cite delayed mental health care. 60% or more of patients reported always or usually receiving responsive and coordinated care, with over 80% reporting always or usually receiving positive provider interactions. Lower odds of delayed mental health care was associated with always getting timely callback during business hours (adjusted odds ratio [aOR]: 0.26; 95% confidence interval [CI]: 0.09, 0.76), and that the provider always listened carefully (aOR: 0.33; CI: 0.14, 0.78), provided easy to understand recommendations (aOR: 0.31, CI: 0.12, 0.79), knew the patient's medical history (aOR: 0.33, CI: 0.15, 0.73), was respectful to the patient (aOR: 0.49, CI: 0.27, 0.90), or was easy to understand (aOR: 0.51, CI: 0.29, 0.88). Care responsiveness and positive provider communication are integral to facilitating timely mental health care access for vulnerable populations with mental health needs.

Exploring resilience among hospital workers: a Bayesian approach.

Background and importance: Healthcare professionals face significant workloads, as their roles are among the most demanding and stressful. Resilience serves as a crucial factor in helping them cope with the challenges encountered in their work environment and effectively manage stress. Assessing the level of resilience among healthcare workers and identifying potential variations across different groups is essential for effective public health management, preventing burnout, and ultimately enhancing patient care. Objective: To assess the resilience of various categories of workers operating within a tertiary care multisite hospital and understanding if there are any differences in resilience, based on their characteristics, the type of department they work in, and personality traits. Design setting and participants: This was a cross-sectional study conducted in January 2024 at EOC, a multi-site tertiary care hospital located in Southern Switzerland. 1,197 hospital workers answered an online survey which included: (1) an ad hoc questionnaire on personal and job characteristics, well-being-related activities, satisfaction level regarding communication, collaboration, support, and training opportunities in the workplace, (2) the Connor-Davidson Resilience Scale 10-Item on resilience, and (3) the Big Five Personality Inventory 10-item on personality traits. Outcome measures and analysis: Proportion of resilient and highly resilient individuals within the various categories of workers were analyzed with Bayesian approach and Bayesian robust regression. Main results: Being part of the hospitality staff, working as a doctor, and having a male sex were associated to the highest scores of resilience. Surgery and emergency departments had the highest proportion of highly resilient individuals. Male sex, older age, seniority, higher hierarchical rank, engagement in physical activities, relaxation or mindfulness practices, religiosity, perception of good collaboration, communication, support, and physical activity correlated with higher resilience skills. Conclusion: This cross-sectional study found that physicians and hospitality staff within our multi-site Swiss hospital are more resilient compared to other categories of hospital workers, and among departments, those working in surgery and Emergency Medicine. Enhancing our comprehension of resilience is crucial for more precise management of healthcare systems and the development of employment policies aimed at sustaining the capacity of healthcare systems to serve patients effectively, while also mitigating shortages of healthcare professionals.

The transition of patient care: Exploring the outcomes of prehospital to hospital patient handover practices and healthcare provider education.

Introduction: Inadequate patient handover is linked to numerous medical errors and lapses in communication between hospital healthcare providers and prehospital healthcare providers. Undergraduate healthcare curricula may limit programme-specific education on patient handover and shift learning to informal learning opportunities. This study aimed to investigate the outcomes of qualified healthcare provider (HCPs) educational programmes to determine the adequacy of handover practices, the source of their training, and their interprofessional acceptance of these practices. Methods: A multi-method study design was used - a document analysis of HCP programme outcomes and a two-section questionnaire. The questionnaire was sent to HCPs to determine the impact of patient handover practices on current healthcare systems and their opinion on whether the training on handovers is sufficient. Results: HCPs indicated little educational interaction regarding patient handover. Most participants felt handover education relied predominantly on informal training. With their existing knowledge, many HCPs revealed that they were comfortable in handing over a patient. Little interprofessional confidence regarding patient handover information indicates minimal interprofessional collaboration toward standardised approaches for patient handover. Conclusion: This study indicates a lack of standardised handover procedures, which leads to HCP self-interpretations. There is low trust between HCPs regarding information received. The study highlights the need for standardised handover training in healthcare curricula to improve patient safety and interprofessional collaboration.

Parents' experiences of waiting for their child's transplant: A focus on how healthcare providers can impact the waiting process.

Waiting for a child transplant is a form of suffering for parents, yet little research has explored how parents experience waiting and how healthcare providers can impact their waiting experiences. The purpose of this article is to investigate how parents experienced the process of waiting for their child's transplant with a specific focus on the impact of healthcare providers on parents' experience of waiting. Six parents from four different families participated in interviews and observations. Our narrative analysis suggested that parents had no narrative roadmap to navigate waiting and the importance of healthcare providers' tailoring the amount and type of medical information to a parents' needs. We discuss how waiting required parents to be hypervigilant and provide continuity of care for their child, and how this "managerial role" could lead to a loss of trust with their healthcare providers. Parents' accounts were replete with contradictions, and as an extension of this, waiting was full of contradictions. Findings contribute to conceptual, methodological, and practical work exploring how parents live in deep uncertainty about the future, and how healthcare providers can support parents in their child's transplantation and other life-threatening illness contexts.

Healthcare provider perceptions of support provision for people with stroke: a qualitative study.

PURPOSE: This study aimed to explore healthcare providers' perceptions of support provision for people who have experienced stroke. MATERIALS AND METHODS: A qualitative descriptive study was conducted. Snowball sampling was used to recruit Australian healthcare workers providing care to people with stroke. Semi-structured one-on-one interviews were audiotaped and transcribed. An inductive thematic analysis of all transcripts was undertaken by two authors. RESULTS: Fourteen participants who worked across the care continuum in three Australian states were interviewed. Responses fit into three overarching themes: (1) attitudes to supports; (2) availability and accessibility of supports; and (3) awareness of supports. These themes encompassed perceptions of the support options available for people with stroke and the factors affecting support provision decision making among healthcare providers. CONCLUSIONS: The healthcare providers in this study thought people with stroke would benefit from a greater range of available supports. Supports should take into account the diverse experiences and acute and long-term needs of people with stroke, as well as be accessible to people from all cultural, linguistic, and socioeconomic backgrounds. Healthcare providers and people who have experienced stroke may benefit from a roadmap for post-stroke support that clearly outlines where responsibility lies for support provision.

Healthcare providers across the care continuum feel that current post-stroke supports and services do not adequately serve the diversity of experiences and needs of stroke survivors.Stroke survivors who do not attend rehabilitation, including those with "mild" stroke or who do not fit within limb-focused rehabilitation services, may be missing out on key post-stroke information and support.The development of a roadmap for post stroke support that identifies minimum support provisions and where responsibility lies for provision could benefit healthcare providers, stroke survivors and their carers.

Provider Perspectives on Rapid Treatment Initiation Among People Newly Diagnosed With HIV: A New Message of "Urgency"?

BACKGROUND: Early initiation of antiretroviral therapy improves human immunodeficiency virus (HIV) outcomes. However, achieving earlier treatment initiation is challenging for many reasons including provider awareness and clinic barriers; this study sought to understand perceptions of an early initiation program. METHODS: We interviewed 10 providers from 3 HIV clinics in North Carolina (October-November 2020). We asked providers about overall perceptions of early initiation and the pilot program. We developed narrative summaries to understand individual contexts and conducted thematic analysis using NVivo. RESULTS: Providers believed earlier initiation would signal an "extra sense of urgency" about the importance of antiretroviral therapy-a message not currently reflected in standard of care. Safety was a consistent concern. Cited implementation barriers included transportation assistance, medication sustainability, and guidance to address increased staff time and appointment availability. CONCLUSION: Our qualitative findings highlight the need for training on the safety of early initiation and addressing staffing needs to accommodate quicker appointments.

Doctor and clinic staff perspectives on a program to immediately start HIV treatment among patients newly diagnosed with HIVTreating human immunodeficiency virus (HIV) is easier than ever. Starting newly diagnosed persons on HIV medication as soon as possible is a now recommended goal. However, starting patients right away can be challenging. This study interviewed doctors and clinic staff to better understand their perspectives prior to implementing a program that would provide newly diagnosed patients with HIV treatment immediately. Results showed that some doctors are worried patients will not return after receiving their medications. Providers want support for linking patients to the clinic and ensuring they will be able to receive their next dose of medication when they come in. Other providers saw the benefits of reducing HIV stigma if the program can more quickly start patients on treatment. Some providers explained that when you go to the doctor and are sick you receive medications immediately, yet for newly diagnosed patients living with HIV, patients can be told to come back a month later to start treatment. Some providers believe shifting this messaging may also help patients take their medications better. Most providers saw the need for clinics to have more same-day appointment availability to meet the needs of the new program. Overall, providers were excited about the opportunity to improve the HIV care by offering HIV medications to newly diagnosed patients immediately.

Uncovering communication strategies used in language-discordant consultations with people who are migrants: Qualitative interviews with healthcare providers.

BACKGROUND: Global migration has led to a sharp increase in the number of language-discordant consultations (LDCs) in healthcare. Evidence on how healthcare providers (HCPs) meet migrant patients' needs while mitigating language barriers is lacking. DESIGN: Using purposive and snowball sampling, we recruited twenty-seven Dutch HCPs (Mage = 45.07, SD = 11.46) and conducted semi-structured interviews to collect qualitative, open-ended data for identifying the communication strategies used with migrant patients in LDCs. We analysed the transcripts using deductive and inductive approaches (e.g., constant comparative method from Grounded Theory). Final pattern codes (i.e., key themes) were discussed among the research team until mutual agreement had been achieved. RESULTS: Five key themes emerged from the analyses: HCPs often 'got-by' with (1) instrumental and (2) affective communication strategies used in language-concordant consultations to start medical consultations. When some instrumental communication strategies were deemed ineffective (e.g., lingua franca, gesturing, etc.) to bridge language barriers, HCPs turned to (3) incorporating digital tools (e.g., Google Translate). When HCPs were unable to communicate with migrant patients at all, (4) informal, ad-hoc and professional interpreters were involved. Finally, HCPs often (5) involved additional support to engage migrant patients to engage in treatment-related behaviours. DISCUSSION AND CONCLUSIONS: Our results highlight the importance of raising awareness among HCPs about using various combinations of different strategies. The development of a guideline indicating the optimal combination of communication strategies for different medical consultation goals may be useful in reshaping the current communication behaviour of HCPs in LDCs. PATIENT OR PUBLIC CONTRIBUTION: HCPs were the study population involved in this qualitative study. Refugee health advisors, general practitioners and linguistic specialists (i.e., members of the Right2Health consortium) with experience with the Dutch healthcare system were involved throughout the development of this research. This includes a review of the research question, participant information sheet and interview topic guide as well as providing interpretations of the data and feedback to this manuscript.

Needs-Assessment for an Artificial Intelligence-Based Chatbot for Pharmacists in HIV Care: Results from a Knowledge-Attitudes-Practices Survey.

BACKGROUND: Pharmacists need up-to-date knowledge and decision-making support in HIV care. We aim to develop MARVIN-Pharma, an adapted artificial intelligence-based chatbot initially for people with HIV, to assist pharmacists in considering evidence-based needs. METHODS: From December 2022 to December 2023, an online needs-assessment survey evaluated Québec pharmacists' knowledge, attitudes, involvement, and barriers relative to HIV care, alongside perceptions relevant to the usability of MARVIN-Pharma. Recruitment involved convenience and snowball sampling, targeting National HIV and Hepatitis Mentoring Program affiliates. RESULTS: Forty-one pharmacists (28 community, 13 hospital-based) across 15 Québec municipalities participated. Participants perceived their HIV knowledge as moderate (M = 3.74/6). They held largely favorable attitudes towards providing HIV care (M = 4.02/6). They reported a "little" involvement in the delivery of HIV care services (M = 2.08/5), most often ART adherence counseling, refilling, and monitoring. The most common barriers reported to HIV care delivery were a lack of time, staff resources, clinical tools, and HIV information/training, with pharmacists at least somewhat agreeing that they experienced each (M ≥ 4.00/6). On average, MARVIN-Pharma's acceptability and compatibility were in the 'undecided' range (M = 4.34, M = 4.13/7, respectively), while pharmacists agreed to their self-efficacy to use online health services (M = 5.6/7). CONCLUSION: MARVIN-Pharma might help address pharmacists' knowledge gaps and barriers to HIV treatment and care, but pharmacist engagement in the chatbot's development seems vital for its future uptake and usability.

Why Are Healthcare Providers Leaving Their Jobs? A Convergent Mixed-Methods Investigation of Turnover Intention among Canadian Healthcare Providers during the COVID-19 Pandemic.

BACKGROUND: Staffing shortages across the healthcare sector pose a threat to the continuity of the Canadian healthcare system in the post-COVID-19 pandemic era. We sought to understand factors associated with turnover intention as well as Canadian healthcare providers' (HCPs) perspectives and experiences with turnover intention as related to both organizational and professional turnover. METHOD: A convergent questionnaire mixed-methods design was employed. Descriptive statistics and ordinal logistic regressions were used to analyze quantitative data and ascertain factors associated with turnover intention. Thematic analysis was used to analyze qualitative open-field textbox data and understand HCPs' perspectives and experiences with turnover intention. RESULTS: Quantitative analyses revealed that 78.6% of HCPs surveyed (N = 398) reported at least a 25% turnover likelihood regarding their organization, with 67.5% reporting at least a 25% turnover likelihood regarding their profession. Whereas regression models revealed the significant impact of years worked, burnout, and organizational support on turnover likelihood for organizations, age, sex, burnout, and organizational support contributed to the likelihood of leaving a profession. Patterns of meaning drawn from participants' qualitative responses were organized according to the following four themes: (1) Content to stay, (2) Drowning and no one cares, (3) Moral stressors, and (4) Wrestling with the costs and benefits. CONCLUSIONS: Many HCPs described weighing the costs and benefits of leaving their organization or profession during the COVID-19 pandemic. Although challenging working conditions, moral stressors, and burnout may play a significant role in HCPs' experiences of turnover intention, there is ample room to intervene with organizational support.

From vaccine hesitancy to vaccine motivation: A motivational interviewing based approach to vaccine counselling.

The COVID-19 pandemic highlighted Vaccine Hesitancy (VH) as an accelerating global phenomenon that must be addressed. According to the WHO, thirty to fifty percent of the world's population are VH. Motivational Interviewing (MI) is an evidence-based communication style demonstrated to significantly reduce VH. MI guides people toward change through the expression of empathy and by respecting an individual's autonomy. Healthcare providers (HCPs) are the primary implementors of vaccine policies and the most trusted advisors and influencers of vaccination intention at the individual patient level. Training HCPs in MI is one of the most effective strategies to overcome VH. Many countries are currently implementing HCP training programs and population-based MI interventions to improve vaccine uptake. MI conversations are 'the heart' of vaccine decision-making processes. Understanding individual patient-level drivers of hesitancy allows clinicians to efficiently provide tailored, accurate information that reinforces a person's own motivation and confidence in their own decision. This paper describes a 4-step practical framework designed to support HCPs in their dialogue with vaccine-hesitant patients. (1) Engaging to establish a trustful relationship and safety to freely express opinions, beliefs, and knowledge gaps; (2) Understanding what matters most to the individual; (3) Offering Information to co-build accurate knowledge in order to guide the individual toward vaccine intention (4) Clarifying and Accepting to validate an individual's decision-making autonomy. We believe that our pragmatic approach can contribute to greater acceptability of COVID-19 and other vaccines, and enable rapid deployment of practical MI skills across care systems.

Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis.

BACKGROUND: This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. METHODS: Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees. RESULTS: Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities. CONCLUSION: Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

Artificial intelligence and job performance of healthcare providers in China.

Introduction: This study explores the influence of artificial intelligence (A.I.) applications on the job performance of healthcare providers, based on data from standardised-trained residents in the First People's Hospital of Yunnan Province in China. Methods: The ordinary least squares model is employed to examine the relationship between A.I. applications and job performance. To address potential endogeneity and missing variables, we utilise the propensity score matching method and alternative regression models. Results: The findings indicate that the job performance of standardised-trained residents positively correlates with A.I. applications. This relationship remains robust after addressing endogenous and missing variables. Further discussion reveals that patients' support mediates the relationship between A.I. and job performance. Under identical conditions, the job performance of female residents empowered by A.I. is found to be significantly better than that of their male counterparts. Conversely, no heterogeneity is observed regarding the impact of A.I. on the job performance of medical practitioners and clinical medical technicians. Discussion: This study underscores the positive role of A.I. applications in enhancing the job performance of standardised-trained residents. The results highlight the mediating role of patient support and suggest gender-based differences in the efficacy of A.I. empowerment.

Provider perspectives on adolescent access to contraception in South Africa.

BACKGROUND:  Poor access to contraception influences adolescent health outcomes and may lead to sexual and reproductive health challenges. Unmet sexual and reproductive health should contribute to unplanned adolescent pregnancies, sexually transmitted infections, and other conditions. Therefore, it is crucial to enable adolescents to access appropriate contraceptive methods easily. AIM:  This study explored factors influencing adolescents' access to contraceptive methods from the perspective of primary healthcare providers in South Africa. SETTING:  This study was conducted in two health districts of the Western Cape province in South Africa: the City of Cape Town Metropolitan Municipality and the West Coast district. METHODS:  Using a qualitative research design, in-depth semi-structured interviews were conducted with 24 healthcare providers who work in primary healthcare clinics. Subsequently, the interviews were transcribed and verified for errors. Braun and Clarke's thematic analysis model guided the data analysis using ATLAS.ti software (version 22). The study adhered to the consolidated criteria for reporting qualitative studies checklist for qualitative research. RESULTS:  Four themes emerged through the data analysis: (1) personal influences, (2) community-level influences, (3) health system influences, and (4) policy-level influences. Representative quotations were used to illustrate the themes and sub-themes. CONCLUSION:  Adolescence is shaped by various influences that affect adolescents' ability to access contraception. These factors include their awareness of contraception, social environment, provider biases and school policies. Understanding these influences is crucial for addressing unintended pregnancies and promoting sexual and reproductive health among this age group.Contribution: This study highlights strategies that facilitate and hinder adolescents' access to contraception.

Genetics healthcare providers' experiences counseling patients with results from consumer genomic testing.

BACKGROUND: Consumer genomic testing (CGT), including direct-to-consumer and consumer-initiated testing, is increasingly widespread yet has limited regulatory oversight. To assess the current state, we surveyed genetics healthcare providers' experiences with CGT. METHODS: A retrospective survey about experiences counseling on CGT results was completed by 139 respondents recruited from the National Society of Genetic Counselors, Clinical Cancer Genomics Community of Practice, and genetics professional societies. RESULTS: Among respondents, 41% disagreed with the statement that potential benefits of CGT outweigh harms, 21% agreed, and 38% were undecided. A total of 94% encountered ≥1 challenge counseling CGT patients, including adverse psychosocial events (76%), incorrect variant interpretation (68%), and unconfirmed results (69%); unconfirmed results were more common among oncology providers (p = 0.03). Providers reporting higher total challenge scores (p = 0.004) or more psychosocial or interpretation challenges (p ≤ 0.01) were more likely to indicate CGT harms outweigh benefits. Those with higher CGT clinical volume were more likely to indicate benefits outweigh harms (p = 0.003). Additional CGT challenges included patient understanding and communication of results, false negatives, incorrect testing/care, and financial costs; seven respondents (6%) documented positive outcomes. CONCLUSION: Providers counseling CGT patients encounter psychosocial and medical challenges. Collaborations between regulators, CGT laboratories, providers, and consumers may help mitigate risks.

Acceptance of Virtual Reality Simulation Training for Stoma Care by Healthcare Providers: A Pilot Questionnaire Study After Viewing Prototype Imagings.

OBJECTIVES:  Educational simulation systems using virtual reality (VR) with head-mounted devices are spreading into the medical field. We developed an innovative training system whereby experienced ostomates can share their proficient stoma self-care techniques with novice ostomates through VR simulations, enabling anytime, anywhere learning. We examined the questionnaire study to assess the acceptance of VR simulation training for stoma care by healthcare providers. METHODS: This study was conducted for the participants, nurses, and doctors, at the 39th Kyushu Stoma Rehabilitation Research Meeting with the organizer's permission. We created two VR simulation prototypes from the perspective of ostomates and caregivers using modeled stomas. We conducted a qualitative study through a questionnaire with healthcare professionals regarding their experiences of viewing VR videos. RESULTS: The study included 20 (52.6%) nurses certified in wound, ostomy, and continence (WOC) care, 16 (42.1%) non-WOC nurses, and two (5.3%) medical doctors. Over 90% of participants showed a positive inclination towards the practical application of the system in clinical settings for both scenarios. A significantly higher number of nurses in the non-WOC nurse group expressed a definite interest in using the imaging from the ostomate's perspective versus that in the WOC nurse group (81.3% vs. 40%, P=0.013). CONCLUSIONS: From this survey, we concluded that the respondents felt a VR training system was a positive experience, to say it is acceptable means that it was as good as the standard of care. ​​​​​​Particularly, non-WOC nurses, with fewer opportunities in stoma care compared to WOC nurses, showed stronger interest in practically implementing this innovative training system.

Knowledge, attitudes, and practice of physicians and pharmacists regarding the prevention and treatment of cardiovascular toxicity associated with cancer treatment.

This study aimed to explore physicians' and pharmacists' knowledge, attitudes, and practice (KAP) regarding the prevention and treatment of cardiovascular toxicity associated with cancer treatment. A multicenter cross-sectional study included physicians and pharmacists between April 2023 and June 2023. The study included 918 participants (514 physicians and 404 pharmacists). The average scores of knowledge, attitudes, and practice were 11.6 ± 3.39, 24.7 ± 2.6, and 26.3 ± 6.8 points. Sufficient knowledge was significantly associated with age ≥ 41 years (odds ratio (OR) = 2.745, 95% confidence interval (CI) 1.086-6.941, P = 0.033), male (OR = 2.745, 95% CI 1.150-2.223, P = 0.005), bachelor's degree (OR = 0.084, 95% CI 0.013-0.533, P = 0.009), master's degree and above (OR = 0.096, 95% CI 0.015-0.609, P = 0.013), physician occupation (OR = 7.601, 95% CI 1.337-43.207, P = 0.022), pharmacy department (OR = 18.858, 95% CI 3.245-109.57, P = 0.001), oncology department (OR = 4.304, 95% CI 2.426-7.634, P < 0.001), cardiology department (OR = 3.001, 95% CI 1.387-6.492, P = 0.005), hospitals located in Eastern China (OR = 1.957, 95% CI 1.120-3.418, P = 0.018), and hospitals located in Western China (OR = 3.137, 95% CI 1.783-5.518, P < 0.001). Positive attitudes were significantly associated with a senior professional title (OR = 2.989, 95% CI 1.124-7.954, P = 0.028) and hospitals located in Eastern China (OR = 0.424, 95% CI 0.257-0.698, P = 0.001), Western China (OR = 0.231, 95% CI 0.136-0.394, P < 0.001), and Southern China (OR = 0.341, 95% CI 0.198-0.587, P < 0.001). Proactive practice was significantly associated with male (OR = 1.414, 95% CI 1.029-1.943, P = 0.033), senior professional title (OR = 3.838, 95% CI 1.176-12.524, P = 0.026), oncology department (OR = 3.827, 95% CI 2.336-6.272, P < 0.001), and cardiology department (OR = 2.428, 95% CI 1.263-4.669, P = 0.008). Both physicians and pharmacists had positive attitudes toward the prevention and treatment of cardiovascular toxicity associated with cancer treatment, while their knowledge and practice were not as proactive.

Effects of open and hidden administration of treatment-related information; a multi-experiment study.

BACKGROUND: Two experiments (E1 and E2; N = 44 and N = 52, respectively) investigated the effect of positive (PI) and neutral information (NI) about a dental procedure, and if the delivery of the information by the treatment team (open administration) or unbeknownst to the treatment team (hidden administration), affected pain. METHODS: Using a mixed design, patients undergoing drilling in a molar were randomized to the NI or PI groups. Before, during, and after treatment, patients reported their pain and stress levels. In E1 the treatment team delivered the information. In E2, an assistant not engaged in the treatment delivered the information. RESULTS: In the PI group in E1, pain was reduced by 50 % compared to the NI group, and the effects of stress on pain were mitigated. These effects were abolished in E2. The dentist reported having displayed positive nonverbal behaviours (e.g. smiling and longer eye contact) in the PI group in E1, but not in E2. DISCUSSION: Positive information reduced pain only when administrated openly. There was no effect of positive information administrated hidden from the treatment team. As information was similar in both experiments, factors other than the information most likely reduced pain in the PI group in E1. CONCLUSION: Delivering positive information by the treatment team may generate behavioural cues which generate placebo effects.