What are the core elements of patient-centred care? A narrative review and synthesis of the literature from health policy, medicine and nursing

'The Second Arrow': A Collaborative Autoethnographic Exploration of What Can Be Learned From One Long COVID Journey

INTRODUCTION

Long COVID is a complex multisystem illness with multiple relapsing-remitting symptoms, which can vary in severity and impact people's daily lives. This study utilises the first author's experience of falling ill with and recovering from long COVID to investigate the lived experience of the illness. Learnings that could positively influence how people with long COVID, and health professionals, approach rehabilitation and recovery from the illness going forward are identified.

METHODS

Employing collaborative autoethnography, the first author investigated her personal experience of falling ill with, and rehabilitating from, long COVID, while soliciting input of the second author (an athletic therapist and physiotherapist, and researcher with expertise in chronic pain) for the purpose of analysis and interpretation. Reflexive thematic analysis was employed across a number of data sources available to the first author, including journal entries, text messages, emails, and pharmacy receipts.

RESULTS

Four themes were generated from the data, supported by a number of subthemes: (i) Psychosocial impact of long COVID, (ii) Invalidated, (iii) Validated, and (iv) Power and Ownership. The negative impact of a siloed and reductionist approach to care for long COVID is evident in the findings of this study. In addition, the need for healthcare environments that enhance autonomy and empowerment, and that implement patient-centred care, where the person living with chronic illness is supported to engage in management strategies that meet their needs, is underlined.

CONCLUSION

This study highlights the detrimental cost, both personally and financially, of the ongoing use of the biomedical model of care in the treatment of long COVID. Findings support the need for an interdisciplinary approach to care that considers the whole person and adopts a biopsychosocial approach to care. Furthermore, the need for healthcare professionals to actively listen to, respect, validate and support the person living with long COVID on their individualised recovery journey is evident.

PATIENT OR PUBLIC CONTRIBUTION

The first author was a long COVID patient, the context and extent of this is explained within the paper. As such, this paper is developed and written primarily from the perspective of a patient, as a first-hand narrative of the recovery journey from the illness, with the insights of a clinician (second author) providing context and the potential for a broader understanding of the journey. The goal of this work is, through the dissemination of the paper's findings, to improve pathways and outcomes for others living with long COVID.

Barriers and facilitators to the implementation of guidelines for venous thromboembolism prevention and management: A mixed-methods systematic review

Background

Evidence-based venous thromboembolism prevention and management is a priority for global health services. Low adoption of venous thromboembolism guidelines can result in compromised patient outcomes. Understanding clinicians' and patients' perceptions of barriers to and facilitators for guideline implementation and mapping identified barriers and facilitators to the Consolidated Framework for Implementation Research may inform theoretical interventions to improve guideline adoption rates.

Objective

To synthesize quantitative and qualitative evidence on both 1) perceptions and experiences of hospital clinicians and patients regarding venous thromboembolism practices and 2) barriers to and facilitators for guideline implementation.

Data source

English-language studies from MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane published between 2012 and 2023.

Methods

The included studies primarily focused on two aspects: firstly, elucidating the perceptions and experiences of healthcare providers and patients concerning venous thromboembolism management practices, and secondly, identifying the barriers and facilitators that influence the implementation of venous thromboembolism guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data were transformed into qualitized data and then thematically synthesized with qualitative data to compare the perspectives of clinicians and patients. Barriers and facilitators related to each topic were mapped to the Consolidated Framework for Implementation Research, and the barriers were entered into its implementation strategy matching tool to obtain implementation strategies.

Results

Of 8262 studies of varying quality, 26 (20 quantitative, five qualitative, and one mixed-methods) met the inclusion criteria. Four themes represented factors influencing guideline implementation: 1) healthcare-led multidisciplinary prevention and management, 2) feasibility of guideline implementation, 3) patient involvement in prevention and management, and 4) government and hospital environments and related systems. The majority of barriers identified by healthcare providers were related to the second and fourth themes, while for patients, there were multiple barriers under the third theme. Barriers were mainly mapped into four domains: intervention characteristics, outer setting, inner setting, and characteristics of individuals. Most facilitators mentioned by healthcare providers and patients were related to themes 1, 3, and 4 and mapped to three domains: outer setting, inner setting, and characteristics of individuals. Seven optimal implementation strategies were obtained through the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool.

Conclusions

We highlighted the most influential factors associated with implementing venous thromboembolism guidelines from the perspectives of both clinicians and patients, and mapping these factors to the Consolidated Framework for Implementation Research can help to develop stakeholder-appropriate implementation interventions.

Registration

This study's protocol has been registered at PROSPERO under the registration number CRD42024518184.

A novel child-centred core palliative care outcome measure for use in clinical practice and research: findings from a multinational validation study

BACKGROUND

Outcome measurement is pivotal to person-centred assessment, quality improvement and research. Children and young people with life-limiting and -threatening illness have high needs and service use, yet there is a lack of evidence for interventions and care models. Efforts to strengthen paediatric palliative care (PPC) services has been hampered by the lack of an appropriate outcome measure.

OBJECTIVE

To determine the validity, reliability, measurement invariance, responsiveness, acceptability, and interpretability properties of the novel Children's Palliative care Outcome Scale (C-POS).

METHODS

We recruited children (0-17 years) with life-limiting/life threatening conditions and their families in Kenya, Uganda and South Africa. Using C-POS repeated measurement using over four timepoints. We assessed: 1) construct validity (structural properties, discriminant validity, known groups validity, measurement invariance, differential item functioning by country), 2) reliability (internal consistency and test re-test), 3) responsiveness, 4) acceptability (time to complete) and 5) interpretability.

RESULTS

We recruited a cohort of 434 children (response rate 94%). Of these, 302 participated in the repeated measures component and 279 (92%) completed four datapoints. We found evidence for face and content validity as the C-POS items mapped on to themes developed from qualitative interviews, including: pain and other symptoms, pyscho-social well-being, and family wellbeing that matter to children and their families. We confirmed: 1) the two-factor structure (child and family subscales). We also confirmed discriminant and known groups validity, as well as construct equivalence for the child self-report and proxy versions. Controlling for age, we found no differential item functioning by country setting. 2)The sub-scale internal consistency was moderate, given the multi-dimensional nature of the C-POS self and proxy report versions omega scores (0.67 and 0.73, respectively). The test characteristic curve information confirmed the moderate internal subscale consistency scores between 0.3- 0.9 for the proxy version and 0.3-0.5 for the self-report version. Test-retest reliability was acceptable for all items, with weighted kappa range for scores: self-report (0.43-0.57) and proxy version (0.35-0.64) and family items (0.51-0.71). 3)Responsiveness was demonstrated, except for the feeding item. 4)Median completion time at the last visit was 10 min for both versions with minimal missing data. 5)The minimum important difference was 3 for the self and proxy report versions on a scale of 0-30 and 4 for the child and family scale on a scale of 0-55.

CONCLUSIONS AND RELEVANCE

The C-POS has good psychometric properties. To further improve the measure, we identified items for potential removal, conceptual gaps that should be addressed and domains for which developmental age-appropriate items are needed. C-POS has potential to evaluate and improve person-centred children's palliative care in research and routine clinical practice.

Willingness to engage in self-care impacts clinical outcomes at discharge in hospitalized pneumonia patients: a descriptive study

BACKGROUND

The objective of this study was to evaluate the association between willingness to engage in self-care and clinical outcomes in patients hospitalized with community-acquired pneumonia (CAP).

METHODS

An observational study in patients hospitalized with CAP was conducted. Patients were divided into two groups according to the willingness to engage in self-care, that was assessed with the Patient Activation Measure (PAM). Participants with scores ≤ 47.0 points were included in the unwillingness to engage in self-care group, and patients with PAM score > 47 points were included in the willingness to engage in self-care group. Main variables were assessed at hospital discharge and included clinical symptoms (cough, dyspnea, pain and fatigue), physical status, activity levels, psychological inflexibility and restrictions in daily life activities and social participation.

RESULTS

A total of 66 patients were included in the study (34 in the patients unwilling to engage and 32 in the patients willing to engage). Significant differences were found in clinical symptoms, psychological inflexibility, and restrictions in daily life activities and social participation in favor to patients' willingness to engage in self-care at hospital discharge.

CONCLUSIONS

Patients with CAP willing to engage in self-care showed improvements in clinical symptoms, psychological flexibility, and fewer limitations in daily activities and social participation at discharge.

Psychosocial screening, in-patient care, and disposition planning: Clinicians' perspectives

ObjectiveOur objective was to explore clinicians' views on the MyHEARTSMAP screening report; whether this report has impacted their patient care, and if so, how. MyHEARTSMAP is a psychosocial self-screening tool for youth to identify mental health concerns.MethodsWe conducted a cross-sectional study as a sub-study of the MyHEARTSMAP In-Patient randomized control trial. Eligible clinicians (nurses and physicians who have cared for patients in one of our partnered specialties and have seen a MyHEARTSMAP report in their patients' charts) provided their perceptions of the screening report through a survey.ResultsSixty-five clinicians were enrolled; 60 (92.3%; 95% CI 85.8-98.8%) believe psychosocial screening is beneficial, with many finding it helpful for building rapport with patients/families and providing additional mental health information. Thirty-seven clinicians (56.9%; 95% CI 44.9-69%) had previously read or used the MyHEARTSMAP report, and 31 (83.8%; 95% CI 71.9-95.7%) of these clinicians found the report helpful. Clinicians specifically found the report helpful for communicating with the patient, and guiding patient-centered care.ConclusionClinicians' perceptions towards the MyHEARTSMAP report were positive amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.

With and for the Patient: The Knowledges Embodied in Nurses' Practices-of-Work in Acute Care

While understanding of what nurses do is most commonly framed as using clinical decision-making in completing a range of tasks to meet the care needs of patients, other perspectives show nurses as experiential carers and/or utilising a body of professional knowledge to do this. Taking data from an ethnographic study framed in Bourdieu's theory of practice, this paper aims to extend understanding of how nurses in acute care accomplish nursing-in-practice by utilising reconnaissance, a conceptualisation of nursing practice knowledges, as a vocabulary to further analyse these data. In this new way of thinking about what nurses do, nursing-as-it-happens is shown to be not about nurses making decisions as such, but about how nurses use contextualised knowledge to activate practices that respond to what needs to be done for patient care in the context of each practice situation. Focusing attention on what nurses accomplish in their daily practices-of-work reveals nurse agency as working with and for the patient. This enables recognition of how nurses working with multiple patients on a shift can make adjustments to their practices in light of unfolding situations and, when necessary, bring each of those patients as persons to the centre of their practice.

Beyond technical proficiency: A scoping review of the role of soft skills in medical radiation science

INTRODUCTION

Soft skills, including communication, empathy, and teamwork, are essential in medical radiation science (MRS) for delivering comprehensive patient care. Despite the emphasis on technical skills, integrating soft skills is crucial for improving patient outcomes and fostering a collaborative healthcare environment. This scoping review investigates the role, significance, and teaching strategies of soft skills in MRS practice and education.

METHOD

A scoping review was conducted across Scopus, PubMed, Web of Science, Emcare and CINAHL for studies published from 1st January 2014 to 31st December 2023. Twenty-five studies employing various designs were included. Data extraction was performed double-blindly by four authors and validated by two additional reviewers. The review synthesized findings on soft skills such as communication, empathy, patient care, emotional intelligence, teamwork, and compassion.

RESULTS

Communication was the most frequently reported soft skill, noted in 17 articles, followed by empathy in ten studies. Twelve studies highlighted training strategies, including workshops, video demonstrations, and simulation-based training. These strategies were effective in enhancing soft skills.

CONCLUSION

Soft skills play a crucial role in delivering holistic patient care in MRS. Diverse training approaches can improve medical radiation practitioners' competencies and promote a supportive work environment.

IMPLICATIONS FOR PRACTICE

The review highlights studies that demonstrate good practices and measurable improvements in patient interactions, interdisciplinary collaboration, and overall care quality. These findings may support training institutions that may need to improve their curricula in relation to soft skills integration.

A "code-switching" model for healthcare communication

This article examines how technical terminology in public-facing communication creates epistemic barriers that undermine trust between experts and the public-especially in multilingual, multicultural healthcare systems. It argues that health leaders can foster trust by employing a "code-switching" model within institutions and in patient- or public-facing communications. Code-switching is a linguistic phenomenon in which individuals switch between languages, dialects, or language varieties based on the social context. Recognizing "public-speak" and "medical-speak" as distinct codes would facilitate patient understanding of information relevant to their care and promote trust. Health leaders play a crucial role in ensuring that complex medical information is translated into accessible language, bridging the gap between experts and the public.

My orthopedic brace inventory (MOBI): a new, reliable, and valid questionnaire to identify barriers to brace adherence in adolescent idiopathic scoliosis treatment

PURPOSE

Full-time wearing of an orthopedic brace has demonstrated effectiveness in limiting curve progression in adolescents with idiopathic scoliosis. However, treatment adherence is challenging, with an average wearing time of 13 h/day. Despite this issue, barriers to brace adherence have rarely been studied. The aim of this study was to develop and validate a new instrument tool to evaluate factors influencing brace adherence.

METHODS

Our study followed the COnsensus-based Standards for the selection of health Measurement INnstruments criteria (COSMIN). A conceptual framework was initially defined, and experts elaborated, reviewed, and selected candidate items. We also investigated the MOBI's factorial structure and its psychometric properties.

RESULTS

The MOBI initial version included 32 items related to four conceptual barriers to adherence, namely social/emotional, treatment, patient, and health system/professional. The factorial analysis led to an 18-item inventory with an internal consistency of 0.85 with four better-defined barriers (treatment social/emotional support structure, patient's self-image and perception, treatment adverse effects, and treatment acceptability. The MOBI-18f correlates with the SRS-22 domain treatment satisfaction and pain and the SF-12 mental health. Patients with poor brace wear time and more severe scoliosis will score higher on the MOBI-18f questionnaire.

CONCLUSION

The MOBI-18f is a reliable and valid measure of patients' adherence to brace treatment. This questionnaire can be used to develop interprofessional adherence support intervention in AIS patients undergoing brace treatment.

Men in Mental Health: A Scoping Review of Challenges, Contributions, and Future Possibilities of Recruiting into Nursing

Background/Objectives: Historically, male nurses were predominant in mental health settings due to their perceived physical strength and ability to manage violent patients. However, societal changes and the evolution of nursing education have led to a decline in male participation. This study aims to explore the characteristics, qualities, and attributes of male mental health nurses, while aiming to identify factors that attract and retain, as well as that deter, men in this field, to inform male recruitment and retention strategies to grow the mental health nursing workforce. Methods: A scoping review was conducted across six databases, including PubMed, MEDLINE, Web of Science, Scopus, CINAHL, PsycINFO, and ProQuest. The focus was on studies from 1970 to 2024. Screening and selection of studies were based on eligibility criteria. Narrative synthesis was conducted, and the study follows the PRISMA for Scoping Reviews checklist. Results: Limited research exists on male mental health nurses. The data highlight the unique contributions of male nurses, including their resilience, teamwork, and emotional competence. They also identify challenges such as workplace violence, stigma, and lack of career development opportunities. The literature suggests that targeted recruitment strategies and supportive work environments are essential to increase the number of male mental health nurses and address the nursing shortage in this specialty. Positive academic experiences and professional development opportunities are crucial for retaining male nurses. Conclusions: Addressing stigma associated with mental health nursing is needed, starting with a positive public health education campaign. Addressing workplace violence needs to stem from improved organisational procedures that promote the safety and wellbeing of nurses and clients, combined with de-escalation education and training; mentoring are vital to improving attraction, job satisfaction, and the retention of male nurses. By understanding these factors, health care organisations can better support male mental health nurses and enhance the overall quality of mental health care.

The effectiveness of family participation interventions for the prevention of delirium in intensive care units: A systematic review

AIM

To review the effect of family participation interventions in preventing delirium in Intensive Care Units (ICU).

METHODS

The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the "Synthesis Without Meta-analysis" guidelines. The search was performed using the MEDLINE, CINAHL, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases in April 2024. Eligibility criteria included patients admitted to Intensive Care Units, aged 18 or older exposed to risk factors for delirium, and with family members present; studies about family intervention to prevent delirium, that considered family as a partner in care and included interventions; studies that quantitatively assessed the effect of measures on the incidence and duration of delirium; interventional studies. Two authors independently applied these criteria using the Rayyan® application, assessing study quality with Critical Appraisal Skills Programme tools.

RESULTS

Fourteen studies were included, involving 33,232 patients. A meta-analysis was not feasible due to the highly heterogeneous results, but we concluded that the family participation interventions for delirium prevention were grouped into single-component and multi-component interventions. The single-component interventions, such as familiar voice messages, flexible visitation, and family presence, showed a favorable response in reducing delirium. The multicomponent interventions suggesting a positive effect included family visitation with professional-guided orientation; familiar voice messages for reorientation, newspaper reading, and nighttime eye patch use; sensory stimulation program; the ABCDEF bundle; the DyDel program; family education, emotional support, orientation training, cognitive stimulation, and ICU life care participation.

CONCLUSIONS

Several family participation interventions, both single-component and multicomponent, have shown positive effects on outcomes in preventing delirium in ICU patients, particularly in reducing its incidence and duration.

IMPLICATIONS FOR CLINICAL PRACTICE

Identifying the family participation interventions that can prevent delirium allows the development of measures to minimize its occurrence in ICU.

Meaningful contributions of rehabilitation for people with persistent pain; a reflexive thematic analysis

PURPOSE

This study aims to explore the meaningful contributions of rehabilitation for participants living with persistent pain.

MATERIALS AND METHODS

A phenomenological methodology was used. Thirteen purposefully selected participants, who self-identified as substantially improved from persistent pain due to rehabilitation, were interviewed in-depth. Data were analyzed using reflexive thematic analyses.

RESULTS

Participants included three men and ten women, age ranging from 22-69 years, pain duration was 2-30 years. Seven interconnected themes were developed: 1) indication of negative pain and health care experiences, 2) supporting working alliance with healthcare professionals, 3) Pain Dialogue, 4) improved self-awareness and self-regulation, 5) different view on pain, 6) autonomy and personal growth and 7) hope and new perspective. Integration of these themes provided a framework for understanding meaningful contributions of rehabilitation from the participants' perspective.

CONCLUSIONS

The study identified seven interconnected themes enhancing meaningful contributions of rehabilitation for participants who have substantially improved from persistent pain. These findings provide a novel conceptual understanding of how rehabilitation can foster recovery. The themes strongly support person-centred care, an understanding of Pain Dialogue and personal growth through the lens of the lived experience. The quality of the therapeutic relationship is considered a central vehicle for improved health outcomes.

Outcomes that Matter to Youth and Families in Behavioral Health Services

Patient-centered outcomes research helps youth and families using behavioral health services make informed decisions about treatments to help them achieve the outcomes most important to them. However, there are few efforts to identify the outcomes valued by youth and families systematically. This project aimed to support the development of behavioral health services that deliver outcomes valued by families by identifying the outcomes that youth and young adults with behavioral health needs and caregivers say matter most to them. We engaged 34 youth and young adults (YYA) with behavioral health needs, alongside 42 caregivers from six U.S. regions, in two rounds of one-hour virtual focus groups. The initial round involved participants identifying what they hoped to gain from using behavioral health services for personal, familial, and parental or child well-being and the attributes of positive service experiences. We coded responses using qualitative analytical software, culminating in synthesized reports. Subsequently, the second round entailed participants' review and refinement of initial findings. Across sessions, each group reported the top three outcomes deemed most important for children, YYA, parents, families, and their service experiences. YYA identified being understood by others, improving their interpersonal relationships, and feeling heard as the highest priority behavioral health service outcomes. Caregivers of children and youth with behavioral health needs identified having accessible services that meet their needs, having providers that collaborate effectively with parents and other service systems, and experiencing consistent and continuous behavioral health care for their child as the most important behavioral health service outcomes. Both YYA with behavioral health needs and caregivers of children and youth prioritized gaining the necessary knowledge, resources, and tools to support their or their child's behavioral health. Additionally, both participant groups emphasized the importance of effective communication with providers, within their families, and with peers. Minimizing judgment and stigma from society, providers, and other professionals also emerged as a critical outcome for these groups. It is essential for research and policy development to focus on and cater to the outcomes that are important and valued by YYA and their families to maximize family engagement in care.

Hospital personnel's experiences of using Easy Language in healthcare. A qualitative case study at a public hospital in Finland

BACKGROUND

The demand for simplified languages such as Easy Language has grown, also in healthcare. Despite this, very few studies have examined how healthcare personnel perceive Easy Language, or its effects on healthcare.

METHODS

This qualitative case study was conducted in a Finnish hospital. The data consisted of 14 interviews with hospital management and operational staff on their experiences of implementing and using Easy Language in patient communication.

RESULTS

According to the hospital personnel, the experiences of Easy Language use were mainly positive. The staff felt that patient instructions in Easy Language improved communication with customers. They were proud that the values of the hospital's strategy, especially customer orientation, were realized in practical work. However, operational-level personnel also reported certain challenges, especially regarding the adequacy of resources and training.

CONCLUSIONS

Considering its modest financial investment, we conclude that the Easy Language project had a positive impact. The hospital staff were satisfied and perceived that health communication in the hospital had improved. Their positive reputation due to their use of Easy Language brought added value to their work. Further studies are needed to measure the direct customer experience and financial effects of using Easy Language.

Person-centered workplace culture: insights from an inpatient department for older adults with chronic illnesses

Introduction

An aging population and the increasing prevalence of chronic conditions challenge healthcare systems in developed countries. In response, there is a growing emphasis on person-centered care, as advocated by the World Health Organization and integrated into national health strategies in countries such as the UK and Sweden. However, transitioning to person-centered care is a complex, long-term process shaped by organizational culture and care environments. These contextual factors play crucial roles in the development and sustainability of person-centered practice, significantly transforming the experiences of both older adults and staff.

Objective

To describe how workplace culture within an inpatient hospital department shapes person-centered care practices for older adults with chronic illnesses.

Methods

A qualitative, descriptive, exploratory-observational study was performed. Data were collected through participant observation guided by the Workplace Culture Critical Analysis Tool®. In a deductive thematic content analysis, data patterns of meaning were identified. The themes were generated underpinned by the Person-Centered Practice Framework dimensions of prerequisites, the practice environment, and person-centered processes and their respective constructs.

Results

Themes related to all person-centered practice dimensions were identified. Task demands during shifts create tension between routine-oriented work and the holistic, individualized approach required for person-centeredness. The absence of systematic multiprofessional team meetings further exacerbates this issue, limiting collaborative decision-making and personalized care planning. The contrasts in some subthemes may be related to discrepancies in the care provided by different professionals.

Conclusion

This study highlights the tension between routine-driven care and individualized approaches. Addressing identified challenges, such as formalizing multiprofessional meetings and enhancing reflective practices, is crucial for advancing person-centered care in this setting.

Physical therapist characteristics and therapeutic relationship process construct factors that improve patient health outcomes in physical therapy: a systematic review

BACKGROUND

It appears that the therapeutic relationship in physiotherapy practice facilitates the success of patient health outcomes, although the process by which it is carried out has been poorly studied.

OBJECTIVE

To explore the influence of the therapeutic relationship on any patient health outcomes in physical therapy settings.

METHODS

PubMed, Web of Science, Scopus, CINAHL, LILACS and Dialnet databases were systematically searched following PRISMA guidelines. The searches were completed in August 2024. Qualitative and quantitative studies measuring the therapeutic relationship and assessing its influence on health outcomes of patients treated with physical therapy were included.

RESULTS

The search yielded a total of 769 results. 13 studies ultimately retained for analysis. A total of 1555 individuals were studied who had suffered injuries such as low back pain; osteoarthritis; underwent cardiac surgery; hip fracture and elite athletes recovering from injuries. The results obtained were classified into three main themes: characteristics and skills of physical therapists (interpersonal, organizational, leadership and communication skills), therapeutic relationship factors (shared decision making, trusting relationships, motivating the patient and individualization of care) and patient health outcomes influenced by therapeutic relationship (functional outcomes, disability, pain intensity, outcome expectations, perceived global effect, adherence, self-efficacy, sports performance and lung function).

CONCLUSIONS

Through physical therapist's soft skills, therapeutic relationship factors are built under the paradigm of person-centered care and shared decision making, having a positive influence on certain patient health outcomes. Therefore, evidence support that therapeutic relationship contributes to improved patient health outcomes.

A qualitative study on general practitioners' perspectives on late-life depression in Singapore-part II: system- and physician-related factors

Background

Little is known about the practices and resources employed by general practitioners (GPs) in Singapore to manage late-life depression. As the country is stepping up its efforts to promote collaborative care across community mental health and geriatric care, understanding GPs' current practices when managing late-life depression appears timely.

Methods

This qualitative descriptive study explored the perspectives on late-life depression of 28 private GPs practicing in Singapore through online semi-structured group and individual interviews. GPs were purposively sampled across age, gender, and ethnicity. Analysis followed a reflexive thematic approach and focused on physician- and system-related factors.

Findings

Clinical instinct, experience, and knowledge of appropriate resources for specific patients played an important role for GPs during late-life depression care. GPs paid particular attention to communicating with patients tactfully during initial assessments and diagnosis, although some GPs chose to be upfront with patients with whom they had already established rapport. Using non-English languages when communicating about depression could mitigate stigma in some cases but added confusion in others. GPs relied primarily on their own professional support network to manage late-life depression. Although GPs acknowledged the usefulness of public care services, they felt that collaborative care was hindered by a lack of efficient communication channels between providers and appropriate financial coverage to coordinate the frequently complex care of depressed older adults.

Interpretation

Current resources and practices to manage late-life depression vary greatly between private GPs in Singapore. This needs to be considered during ongoing reforms to achieve effective collaborative care.

Funding

This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project "Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients' Voice in Primary Care" [NUHSRO/2022/049/NUSMed/DFM].

Cost-effectiveness of integrated maternal HIV, syphilis, and hepatitis B screening opt-out strategies in Nepal: a modelling study

Background

The World Health Organisation (WHO) developed a comprehensive framework encouraging an integrated approach to achieve triple elimination of vertical transmission of HIV, syphilis, and hepatitis B in Asia. Current screening practices in Nepal show significantly lower coverage for syphilis and hepatitis B compared to HIV suggesting potential for integration. In this study, we aimed to model the cost-effectiveness of triple screening during antenatal care in Nepal.

Methods

We modelled maternal HIV, hepatitis B, and syphilis cascade of care and their corresponding disease states using disease-specific Markov models over a 20-year horizon with a cycle length of one year. We compared dual integrated screening for HIV and syphilis and triple integrated screening for HIV, syphilis, and hepatitis B with HIV screening only. Costs were estimated from a provider's perspective. Results were presented as incremental cost-effectiveness ratios (ICERs). Univariable and probabilistic sensitivity analyses were conducted.

Findings

Our modelling analysis showed that dual-integrated screening for HIV and syphilis was highly cost-effective when compared to current strategy of screening for HIV only (ICERs of US$18). Triple-integrated antenatal screening for HIV, syphilis, and hepatitis B was highly cost-effective compared with dual-integrated strategy with an ICER of US$114. Moreover, 100% and 98% of the probabilistic sensitivity analysis estimates for dual- and triple-integrated screening were proven cost-effective, compared to HIV-only screening.

Interpretation

Our results support WHO recommendations for implementing integrated triple antenatal screening in Nepal and Asia more broadly, aiming to reduce maternal and neonatal morbidity through early detection and intervention.

Funding

No funding was reported.

Translation, Cultural Adaptation, and Validation of the Spanish Version of the Person-Centred Practice Inventory-Staff (PCPI-S)

Background: Person-centredness, a global movement in healthcare, is consistent with international developments in healthcare policy. It is important to have instruments to measure person-centred care. The Person-Centred Practice Inventory-Staff (PCPI-S) is an internationally recognized instrument that aims to measure how healthcare staff experience person-centred practice. Aim: To perform the cultural adaptation and psychometric testing of a Spanish version of the PCPI-S (PCPI-S (Sp)). Method: A two-stage research design was implemented as follows: (1) the translation and cultural adaptation of the PCPI-S from English to Spanish using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice"; (2) a quantitative cross-sectional survey for the psychometric evaluation of the PCPI-S. Test-retest reliability was evaluated using the Kendall tau concordance coefficient, internal reliability was assessed through the ordinal theta (OT) coefficient, and confirmatory factor analysis was performed to examine the theoretical measurement model. Results: A Spanish version of the PCPI-S was obtained. There were no significant difficulties in the translation process or the consulting sessions. A sample of 287 healthcare professionals participated in the study at least once. All the items showed at least a fair level of test-retest reliability. The OT scores were adequate (>0.69). The model showed good to adequate levels of fit: CFI = 0.89, SRMR = 0.068; RMSEA = 0.060 with CI90% (0.056-0.063). Conclusions: The Spanish translation of the PCPI-S was psychometrically valid when tested with Spanish healthcare professionals. This instrument will help identify professionals' perceptions of person-centred practice, track the evolution of this practice over time, and assess interventions aimed at improving person-centred practice.

Same patient but different worlds: A state-of-the-art review translating best practice psychosocial care from musculoskeletal care to the orthopaedic context

BACKGROUND

Individuals with chronic musculoskeletal conditions experience persistent pain and disability that has deleterious impacts on physical function, psychological health, social engagement, relationships, and work participation. This impact is greater in people with psychosocial risk factors, and best practice musculoskeletal care recommends a biopsychosocial approach to management. Orthopaedic surgery is often an effective management approach for chronic musculoskeletal conditions, but research has only recently explored the links between differing patient outcomes after orthopaedic surgery and psychosocial risk factors. Implementing biopsychosocial approaches to musculoskeletal care has taken great strides in the primary care setting however, implementation of the biopsychosocial approach in orthopaedic surgery brings complexity as the context changes from primary care to hospital based secondary care. The aim of this review therefore is to explore implementation of psychosocial care in the elective orthopaedic surgery context, informed by evidence in musculoskeletal care.

ASSESSMENT AND MANAGEMENT OF PSYCHOSOCIAL FACTORS

Several composite screening tools for psychosocial factors or 'yellow flags' are recommended for use in primary care for musculoskeletal conditions alongside a comprehensive patient interview. However, in the orthopaedic surgery context, composite measures have focused on discharge destination, and there is not a universal approach to comprehensive patient interview incorporating a biopsychosocial approach. A range of biopsychosocial approaches to musculoskeletal conditions have been developed for the primary care setting, yet few have been explored in the context of orthopaedic surgery.

IMPLEMENTATION OF PSYCHOSOCIAL CARE

Implementing best practice psychosocial care into the orthopaedic context has enormous potential for all stakeholders, but several barriers exist at the level of the individual patient and practitioner, workforce, health service and society. We have discussed key considerations for implementation including workforce composition, patient-centred care and shared decision making, health literacy, continuity of care, and consideration of preferences for women and culturally diverse communities.

CONCLUSION

This review considers current literature exploring implementation of psychosocial care into the orthopaedic surgery context, informed by current research in musculoskeletal care. This presents a critical opportunity for orthopaedic surgery to provide optimised, equitable, high-value, patient-centred care.

The effectiveness of Function Focused Care among patients acutely admitted to hospital: A stepped wedge cluster trial

BACKGROUND

During acute hospital admission, patients often experience loss of functional status. A low level of physical activity is associated with higher levels of loss of functional status. Stimulating physical activity to maintain functional status is considered essential nursing care. Function Focused Care is a promising approach stimulating physical activity. In a previous study, Function Focused Care in Hospital was deemed feasible.

OBJECTIVE

To determine the effectiveness of Function Focused Care in Hospital compared with usual care on the functional status of hospitalized stroke and geriatric patients.

DESIGN

A multicenter stepped wedge cluster trial.

METHODS

A neurological and a geriatric ward of an academic hospital and a general hospital in the Netherlands participated in this study; each was considered a cluster in the trial. The primary outcome was patients' functional status over time, measured with the Barthel Index and Elderly Mobility Scale. Secondary outcomes were the patients' length of stay, fear of falling, self-efficacy, motivation, resilience, and outcome expectations for functional and exercise activities. Data was collected at hospital admission (baseline), day of discharge, and three and six months after discharge via patient files and questionnaires and analyzed with generalized linear mixed models.

RESULTS

In total, we included 892 patients, of which 427 received Function Focused Care in Hospital and 465 received usual care. Although we did not find significant differences in the Barthel Index and Elderly Mobility Scale at discharge or follow-up, we found a significant decrease in the mean length of stay (-3.3 days, 95 % CI -5.3 to -1.1) in favor of the Function Focused Care in Hospital group. In addition, in the Function Focused Care in Hospital group, a larger proportion of patients were discharged to home compared to the control group (38.2 % vs. 29.0 %, p = 0.017), who were discharged more often to a care facility.

CONCLUSION

The length of hospital stay was substantially decreased, and discharge to home was more common in the group receiving Function Focused Care in Hospital with equal levels of independence in Activities of Daily Living and mobility in both groups upon discharge. Although significant differences in the Barthel Index and Elderly Mobility Scale were not found, we observed that neurological and geriatric patients were discharged significantly earlier compared to the control group.

REGISTRATION

https://onderzoekmetmensen.nl/en/trial/24287 (date of first recruitment: 05-02-2016).

TWEETABLE ABSTRACT

Patients receiving Function Focused Care in Hospital were discharged from the hospital 3.3 days earlier and discharged home more often than the group of patients receiving care as usual. @umcutrecht @hogeschoolutrecht.

Attitudes Towards Non-directiveness Among Medical Geneticists in Germany and Switzerland

The principle of non-directiveness remains an important tenet in genetics. However, the concept has encountered growing criticism over the last two decades. There is an ongoing discussion about its appropriateness for specific situations in genetics, especially in light of recent significant advancements in genetic medicine. Despite the debate surrounding non-directiveness, there is a notable lack of up-to-date international research empirically investigating the issue from the perspective of those who actually do genetic counselling. Addressing this gap, our article delves into the viewpoints and experiences of medical geneticists in Germany and Switzerland. Twenty qualitative interviews were analysed employing reflexive thematic analysis. Participants' responses revealed substantial uncertainties and divergences in their understanding and application of the concept. It seems to cause distress since many geneticists stated that the principle was difficult to put into clinical practice and was no longer ethically justified given the increasing likelihood of therapeutic implications resulting from genomic testing outcomes. The insights provided by our qualitative empirical study accord with the ongoing theoretical debate regarding the definition, legitimacy, and feasibility of the principle. An adequately nuanced understanding and application of non-directiveness seems crucial to circumvent the risks inherent in the principle, while promoting patient autonomy and beneficence.

Aphasia disrupts usual care: "I'm not mad, I'm not deaf" - the experiences of individuals with aphasia and family members in hospital

PURPOSE

Communication difficulties are highly prevalent in the stroke population, with implications for patient experience, safety and outcomes. This study explores the experiences of people with aphasia and family members regarding healthcare communication in acute and subacute stroke settings.

METHODS AND MATERIALS

A phenomenological approach was used to understand participants' experiences. Participants took part in a focus group and data were analysed using an inductive thematic approach.

RESULTS

For individuals with aphasia (n = 4) and family members (n = 2), five themes were generated: "aphasia makes it hard to communicate," "hospital staff focus on the patient's medical status only," "people with aphasia do not get the help they need to improve," "staff lack the skills to communicate with people with aphasia," and "staff are crucial to improving healthcare communication."

CONCLUSIONS

The stroke team has expertise in the medical management of stroke but struggle to communicate with patients with aphasia. Patients' experience of healthcare communication is often one-way and limited to following instructions, with missed opportunities to discuss core topics such as prognosis, rehabilitation, and person-specific needs. Patients and families assert that all members of the stroke healthcare team should be able to adapt communication to accommodate patients.

Clinical outcomes of nurse-coordinated interventions for frail older adults discharged from hospital: A systematic review and meta-analysis

AIM

To determine the effects of nurse-coordinated interventions in improving readmissions, cumulative hospital stay, mortality, functional ability and quality of life for frail older adults discharged from hospital.

DESIGN

Systematic review with meta-analysis.

METHODS

A systematic search using key search terms of 'frailty', 'geriatric', 'hospital' and 'nurse'. Covidence was used to screen individual studies. Studies were included that addressed frail older adults, incorporated a significant nursing role in the intervention and were implemented during hospital admission with a focus on transition from hospital to home.

DATA SOURCES

This review searched MEDLINE (Ovid), CINAHL (EBSCO), PubMed (EBSCO), Scopus, Embase (Ovid) and Cochrane library for studies published between 2000 and September 2023.

RESULTS

Of 7945 abstracts screened, a total 16 randomised controlled trials were identified. The 16 randomised controlled trials had a total of 8795 participants, included in analysis. Due to the heterogeneity of the outcome measures used meta-analysis could only be completed on readmission (n = 13) and mortality (n = 9). All other remaining outcome measures were reported through narrative synthesis. A total of 59 different outcome measure assessments and tools were used between studies. Meta-analysis found statistically significant intervention effect at 1-month readmission only. No other statistically significant effects were found on any other time point or outcome.

CONCLUSION

Nurse-coordinated interventions have a significant effect on 1-month readmissions for frail older adults discharged from hospital. The positive effect of interventions on other health outcomes within studies were mixed and indistinct, this is attributed to the large heterogeneity between studies and outcome measures.

RELEVANCE TO CLINICAL PRACTICE

This review should inform policy around transitional care recommendations at local, national and international levels. Nurses, who constitute half of the global health workforce, are ideally situated to provide transitional care interventions. Nurse-coordinated models of care, which identify patient needs and facilitate the continuation of care into the community improve patient outcomes.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Review findings will be useful for key stakeholders, clinicians and researchers to learn more about the essential elements of nurse-coordinated transitional care interventions that are best targeted to meet the needs of frail older adults.

IMPACT

When frail older adults experience transitions in care, for example discharging from hospital to home, there is an increased risk of adverse events, such as institutionalisation, hospitalisation, disability and death. Nurse-coordinated transitional care models have shown to be a potential solution to support adults with specific chronic diseases, but there is more to be known about the effectiveness of interventions in frail older adults. This review demonstrated the positive impact of nurse-coordinated interventions in improving readmissions for up to 1 month post-discharge, helping to inform future transitional care interventions to better support the needs of frail older adults.

REPORTING METHOD

This systematic review was reported in accordance with the Referred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Participation in medication safety of older-adult patients with chronic disease during the transition from hospital to home: a descriptive qualitative study

BACKGROUND

Medication safety issues occur frequently among older-adult patients with chronic diseases during the transition from the hospital to their homes. Patient participation in medication safety has been found to be an effective measure for improving patient safety. However, few studies have been conducted on the safety of older-adult patients with chronic disease during the hospital to family transition period. This study aimed to understand the experiences and perceptions of such patients regarding participation in medication safety during the hospital to family transition period and to explore the actual situation and obstacles during this period in the Chinese context.

METHODS

A descriptive, qualitative research approach was adopted using purposive sampling. Eighteen patients with chronic disease (aged 61-84 years) participated, all of whom were in the period of transition from hospital to home. Data were collected through semi-structured face-to-face interviews and analysed using directed qualitative content analysis.

RESULTS

Four themes and 12 sub-themes were identified in this study. The four themes were participation in medication decision-making, participation in medication self-management, participation support, and barriers to patient participation.

CONCLUSIONS

Patient participation is important in ensuring medication safety during the hospital to family transition period. This study highlights that older-adult patients' participation in medication safety includes three aspects: participation in medication decision-making, participation in medication self-management, and participation support. Health literacy, medical communication, and family care support are the key factors affecting patient participation in medication safety. Effective intervention strategies for this patient group during the transition period would target improving patients' cognition, health literacy, doctor-prescription communication, and family care support to encourage patients to be more actively involved in the process of drug treatment.

Involvement in medication safety behaviors among older people with chronic diseases: systematic review of intervention studies

BACKGROUND

This study aimed to systematically evaluate interventions and effects that promote involvement in medication safety among older people with chronic diseases and to provide new ideas and references for developing standardized and effective intervention strategies to improve patient involvement in medication safety.

METHODS

A comprehensive literature search across twelve databases was conducted using both computerized and manual methods. The search was limited to studies designated as randomized controlled trials or quasi-experimental studies and was conducted from the time of each database's inception until September 2023. Two researchers independently carried out qualitative analyses, which included screening the literature, extracting the data, and assessing the quality of the selected studies.

RESULTS

This study included five studies involving a total of 388 participants, with interventions aimed at enhancing patient involvement in medication safety, including interactive health education, motivational interviewing, and medication reconciliation. However, direct evidence confirming the positive impact of these interventions in promoting medication safety behaviors among older people with chronic diseases is still lacking.

CONCLUSIONS

Patient involvement in medication safety behaviors is essential for promoting healthy aging. Medication education, motivational interviewing, and medication reconciliation may improve the willingness and ability of older people to participate. However, limitations in the methodological quality of current studies prevent drawing definitive conclusions, highlighting the urgent need for more high-quality research.

TRIAL REGISTRATION

PROSPERO number CRD42023494924.

Considerations across multiple stakeholder groups when implementing fall prevention programs in the acute hospital setting: a qualitative study

BACKGROUND

Falls in hospital remain a common and costly patient safety issue internationally. There is evidence that falls in hospitals can be prevented by multifactorial programs and by education for patients and staff, but these are often not routinely or effectively implemented in practice. Perspectives of multiple key stakeholder groups could inform implementation of fall prevention strategies.

METHODS

Clinicians of different disciplines, patients and their families were recruited from wards at two acute public hospitals. Semi-structured interviews and focus groups were conducted to gain a broad understanding of participants' perspectives about implementing fall prevention programs. Data were analysed using an inductive thematic approach.

RESULTS

Data from 50 participants revealed three key themes across the stakeholder groups shaping implementation of acute hospital fall prevention programs: (i) 'Fall prevention is a priority, but whose?' where participants agreed falls in hospital should be addressed but did not necessarily see themselves as responsible for this; (ii) 'Disempowered stakeholders' where participants expressed feeling frustrated and powerless with fall prevention in acute hospital settings; and (iii) 'Shared responsibility may be a solution' where participants were optimistic about the positive impact of collective action on effectively implementing fall prevention strategies.

CONCLUSION

Key stakeholder groups agree that hospital fall prevention is a priority, however, challenges related to role perception, competing priorities, workforce pressure and disempowerment mean fall prevention may often be neglected in practice. Improving shared responsibility for fall prevention implementation across disciplines, organisational levels and patients, family and staff may help overcome this.

A qualitative study on general practitioners' perspectives on late-life depression in Singapore-part I: patient presentations and behaviours

Background

Detection and management of late-life depression largely relies on primary care. Yet in Singapore, older adults are unlikely to seek help for their mental health from their primary care providers. This qualitative descriptive study explores how late-life depression manifests to general practitioners (GPs) in the Singaporean primary care setting.

Methods

Twenty-eight private GPs practicing in Singapore were asked about their clinical experience with late-life depression during semi-structured group and individual discussions conducted online. Participants were purposively sampled across age, gender, and ethnicity (Chinese, Malay, Indian). Transcripts were analysed with reflexive thematic analysis.

Findings

To GPs, depression in older patients often manifests through somatic symptoms or subtle behavioural changes, only detectable through follow-ups or collateral history. GPs reported that older patients attribute depressive symptoms to normal ageing or do not mention them, particularly within an Asian culture encouraging stoic endurance. GPs perceived late-life depression as reactions to ageing-related stressors, with male, low-income, or institutionalised patients being at particular risk of insidious, severe depression. GPs noted ethnic differences regarding families' involvement in care, which they described as helpful, but sometimes stress-provoking for patients. Fear of burdensomeness or loss of autonomy/social role could prompt rejection of diagnosis and treatment in patients. GPs considered good patient-doctor rapport as a facilitator at every step of the care process, noting more favourable prognosis in care-concordant patients.

Interpretation

Depression in older adults in Singapore can be covert, with favourable outcomes relying on GPs' ability to pick up on subtle changes, assess patients holistically, and build rapport with patients and families.

Funding

This work was funded by the Division of Family Medicine Research Capabilities Building Budget under the project "Technology and Compassion: Improving Patient Outcomes Through Data Analytics and Patients' Voice in Primary Care" [NUHSRO/2022/049/NUSMed/DFM].

Patients' perception of the quality of psychiatric inpatient care in the Faroe Islands

PURPOSE

Evaluating the quality of psychiatric care from the patient's perspective is crucial to measure the effectiveness of the provided care. This study aimed to translate the original Swedish Quality in Psychiatric Care - Inpatient (QPC-IP) instrument into Faroese, adapting it to the specific context of psychiatric inpatient care in the Faroe Islands, conducting a detailed evaluation of its psychometric properties, and to describe patients' perception of quality of psychiatric care.

MATERIALS AND METHODS

Following a thorough translation and back-translation, the content validity of the Faroese QPC-IP was confirmed by a group of Faroese patients. Subsequently, the instrument was completed by 61 psychiatric inpatients.

RESULTS

Item total correlations revealed that most items strongly correlated with their intended dimensions, mirroring the original Swedish version. However, a noteworthy exception was found in the discharge dimension, leading to the exclusion of an item related to helping find an occupation; this task was not performed by the ward. While the internal consistency of the overall scale was excellent, specific dimensions exhibited lower consistency.

CONCLUSIONS

The translation and cultural adaptation of the Faroese QPC-IP proved satisfactory. The psychometric evaluation affirmed a shared understanding of the quality of psychiatric care in both Faroese and Swedish cultural contexts. As a result, the Faroese QPC-IP emerges as a valuable instrument for assessing the quality of psychiatric care in the Faroe Islands. Its utility extends to quality assurance initiatives and contributes to cross-cultural research examining the quality of psychiatric care from the patient's perspective.

It Is Time to Take Complaints Seriously? An Exploratory Analysis of Communications Sent by Users to a Public Healthcare Agency before, during and after the COVID-19 Pandemic

Taking due account of users' perspectives is crucial for improving the quality of healthcare services. This study aimed to analyse the representations and evaluation criteria that users of a public health agency express towards care and treatment services and to explore whether and how the content and meaning of their communications varied according to pre-pandemic, pandemic or post-pandemic periods. A total of 501 communications sent to the public relations office of an Italian health agency were collected. An automatic content analysis procedure was applied to the textual corpus. Four main thematic cores were identified concerning the request for care and respect, the value of the doctor-patient relationship and the difficulties in contacting services and accessing care. Two main latent dimensions of meaning were identified, which capture the dialectic between the demand for relationships and the demand for access to care, and between attention to the relational competence of health workers and attention to the needs and rights of users. Communications collected during the pre-pandemic and post-pandemic periods mainly concern the difficulty of access to care; those collected during the pandemic period mainly concern the doctor-patient relationship. Interpersonal aspects and timely access to care appear to be crucial in users' assessment of the quality of care.

Exploring the implicit meanings of 'cultural diversity': a critical conceptual analysis of commonly used approaches in medical education

Existing approaches to cultural diversity in medical education may be implicitly based on different conceptualisations of culture. Research has demonstrated that such interpretations matter to practices and people concerned. We therefore sought to identify the different conceptualisations espoused by these approaches and investigated their implications for education. We critically reviewed 52 articles from eight top medical education journals and subjected these to a conceptual analysis. Via open coding, we looked for references to approaches, their objectives, implicit notions of culture, and to implementation practices. We iteratively developed themes from the collected findings. We identified several approaches to cultural diversity teaching that used four different ways to conceptualise cultural diversity: culture as 'fixed patient characteristic', as 'multiple fixed characteristics', as 'dynamic outcome impacting social interactions', and as 'power dynamics'. We discussed the assumptions underlying these different notions, and reflected upon limitations and implications for educational practice. The notion of 'cultural diversity' challenges learners' communication skills, touches upon inherent inequalities and impacts how the field constructs knowledge. This study adds insights into how inherent inequalities in biomedical knowledge construction are rooted in methodological, ontological, and epistemological principles. Although these insights carry laborious implications for educational implementation, educators can learn from first initiatives, such as: standardly include information on patients' multiple identities and lived experiences in case descriptions, stimulate more reflection on teachers' and students' own values and hierarchical position, acknowledge Western epistemological hegemony, explicitly include literature from diverse sources, and monitor diversity-integrated topics in the curriculum.

Death From COVID-19, Muslim Death Rituals and Disenfranchised Grief - A Patient-Centered Care Perspective

In Islam, religious directives regarding death are derived from the Quran and Islamic tradition, but there is a variety of death rituals and practices, lived by Muslims across contexts and geographies. This narrative study explored the dynamics of death and bereavement resulting from COVID-19 death among religious Muslims in Israel. Narrative interviews were conducted with 32 religious Muslims ages 73-85. Findings suggest several absent death rituals in COVID-19 deaths (i.e., the physical and spiritual purification of the body, the shrouding of the body, the funeral, and the will). Theoretically, this study linked death from COVID-19 with patient-centered care, highlighting disenfranchised grief due to the clash of health authority guidelines with religious death practices. Methodologically, this narrative study voices the perspectives of elder religious Muslims in Israel. Practically, this study suggests ways to implement the cultural perspective in COVID-19 deaths and enable a healthy bereavement process.

Patient participation in surgical wound care in acute care settings: An integrative review

BACKGROUND

Surgical site infections can significantly impact postoperative recovery. Patient participation, which involves patients actively engaging in wound care, has been linked to improved healing and reduced wound complications. However, there is limited synthesis of the literature that explores the patient's role and participation in the context of surgical wound care.

OBJECTIVE

To explore patients' perceptions of how they participate in surgical wound care, within 30 days post-operation.

DESIGN

An integrative review guided by Whittemore and Knafl's methodology. This review was registered with PROSPERO (CRD42022363669).

DATA SOURCES

Searches were conducted in Medline (Ovid), CINAHL (Complete), and EMBASE (Elsevier) databases in October 2023, supplemented by forward and backward citation searching.

REVIEW METHODS

Based on a priori eligibility criteria, two authors independently screened articles to select relevant studies. The quality of the included research articles was critically appraised using the Mixed Methods Appraisal Tool. A descriptive and thematic synthesis was used to synthesise the findings.

RESULTS

Of the 4701 records screened for titles and abstracts, 25 studies using qualitative, quantitative, and mixed-methods designs were included. Three key themes were identified. In theme 1, 'I am healing: how my wound shapes me and my journey,' physical symptoms, psychological factors and previous experiences significantly influenced patients' engagement in wound care. Theme 2, 'Taking charge of my healing: my active engagement in wound care' described how patient participation in surgical wound care goes beyond clinical procedures and can include the use of technology and holistic self-care. Finally, theme 3, 'Navigating the path to recovery: How others shape my experience' showed that effective communication is crucial for promoting participation, yet issues like inadequate information can leave patients unprepared for wound management.

CONCLUSIONS

This review highlights opportunities to personalise and prioritise a patient-oriented approach to surgical wound care. Clinicians and educators should adopt an individualised approach by tailoring patient participation based on patient factors (i.e. physical symptoms) and adopt patient-centred communication approaches. Researchers should focus on exploring approaches to self-care and technology, as these approaches may enhance patient participation in wound care.

Foundations for a Personalized Psycho-Oncology: The State of the Art

Personalized psycho-oncology represents a major challenge for the holistic care of cancer patients. It focuses on individualized psychotherapeutic and psychiatric interventions to address specific psychological needs. This narrative review summarizes the current literature on personalized psycho-oncology and highlights the prevalence and impact of psychiatric/psychological disorders in cancer patients. Personalized approaches, including tailored interventions and interdisciplinary collaboration, have been shown to be effective in improving mental health and overall quality of life. The integration of inflammatory biomarkers into treatment plans is a promising but challenging way to alleviate mental health problems. In addition, there is a need for specific diagnostic tools and treatment guidelines that take into account the specific psychological impact of different types of cancer. Future research should aim to refine these personalized strategies, improve diagnostic accuracy, and evaluate the cost-effectiveness of these interventions to improve both the psychological well-being and treatment outcomes of cancer patients.

Person-centered care for common mental disorders in Ontario's primary care patient-centered medical homes: a qualitative study of provider perspectives

BACKGROUND

For more than a decade, the Patient-Centered Medical Home model has been a guiding vision for the modernization of primary care systems. In Canada, Ontario's Family Health Teams (FHTs) were designed in the mid-2000s with the medical home model in mind. These primary care clinics aim to provide accessible, comprehensive, and person-centered primary care services to communities across Ontario. Their services typically include mental health care for people experiencing common mental disorders, such as depression and anxiety disorders. It remains unclear, however, whether the mental health care delivered within FHTs is consistent with person-centered care approaches. In the current study, we aimed to explore the perspectives of FHT providers on the care delivered to people with common mental disorders to determine whether, and to what extent, they believed this care was person-centered.

METHODS

We conducted a qualitative grounded theory study involving interviews with 65 health professionals and administrators from 18 FHTs across Ontario. Transcripts were coded using a three-step process of initial, focused, and axial coding that mixed inductive and deductive approaches informed by sensitizing concepts on person-centeredness.

RESULTS

Practices and challenges associated with the delivery of mental health care in a person-centered way were captured by several themes regrouped into five domains: (1) patient as unique person, (2) patient-provider relationship, (3) sharing power and responsibility, (4) connecting to family and community, and (5) creating person-centered care environments. FHT providers perceived that they delivered person-centered care by delivering mental health care that was responsive, flexible, and consistent with biopsychosocial approaches. They emphasized the importance of creating long-lasting relationships with patients grounded in empathy and trust. Their challenges included being able to ensure continuity of care, adequately prioritizing patients' mental health issues, and meaningfully engaging patients and families as partners in care.

CONCLUSIONS

Our findings suggest that FHT providers have adopted a range of person-centered practices for people with common mental disorders. However, greater attention to practices such as shared decision making, supporting self-management, and involving families in care would strengthen person-centeredness and bring teams closer to the Patient-Centered Medical Home vision.

Being in a meaningful context. Nature and animal-assisted activities as perceived by adults with autism

INTRODUCTION

Animal-assisted and nature-based interventions in psychosocial treatment for various groups of clients have been studied internationally. However, there is little knowledge about how young adults with autism experience participation in such types of interventions. This clinical study aimed to describe the feasibility of animal-assisted and nature-based activities on a farm as a complementary intervention for young adults with autism and social withdrawal.

METHODS

The participants were aged 18-30 years, diagnosed with autism and social withdrawal, with no organised occupation during the previous year. Eleven of 13 participants completed a 12-week intervention in small groups. They took part in interviews before and after, which focused on their current life situation and expectations about, and experiences of the intervention. The feasibility was described in terms of participants' characteristics, attendance, and their experiences of participating in the activity. Data were analysed with descriptive statistics and qualitative content analysis.

CONSUMER AND COMMUNITY INVOLVEMENT

The intervention was formed in collaboration with participating supervisors, ordinary clinical staff, and a young woman with a user perspective.

FINDINGS

The level of feasibility was found to be high. The mean participation rate during the activity days was 75% and varied from 50 to 100%. The analysis of the participants' experiences from the activity generated three categories, "Being in a meaningful context", "Creating a comfort zone" and "Developing structure in everyday life", and each of these included sub-categories.

CONCLUSION

The main categories revealed a dynamic process based in meaningfulness, comfort and structure in everyday life. The positive experiences of undemanding activities, emotional relationships and non-verbal communication with the horses were prominent and might facilitate the development of social interaction. However, the intervention's timeframe of 12 weeks was experienced as too short for long-lasting change.

Patient-centered care in diabetes care-concepts, relationships and practice

We still do not have comprehensive knowledge of which framework of patient-centered care (PCC) is appropriate for diabetes care, which elements of PCC are evidence-based, and the mechanism by which PCC elements are associated with outcomes through mediators. In this review, we elaborate on these issues. We found that for diabetes care, PCC elements such as autonomy support (patient individuality), cooperation and collaboration (system-level approach), com-munication and education (behavior change techniques), emotional support (biopsychosocial approach), and family/other involvement and support are critically important. All of these factors are directly associated with different patient outcomes and indirectly associated with outcomes through patient activation. We present the practical implications of these PCC elements.

Identifying Components of a Person-Centered Augmentative and Alternative Communication Intervention for People With Dementia: Opinions of an International Expert Panel

PURPOSE

Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia.

METHOD

A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis.

RESULTS

Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes.

CONCLUSION

This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia.

Experiences and perspectives of adults on using opioids for pain management in the postoperative period: A scoping review

BACKGROUND

Opioids play an important role in peri-operative pain management. However, opioid use is challenging for healthcare practitioners and patients because of concerns related to opioid crises, addiction and side effects.

OBJECTIVE

This review aimed to identify and synthesise the existing evidence related to adults' experiences of opioid use in postoperative pain management.

DESIGN

Systematic scoping review of qualitative studies. Inductive content analysis and the Theoretical Domains Framework (TDF) were applied to analyse and report the findings and to identify unexplored gaps in the literature.

DATA SOURCES

Ovid MEDLINE, PsycInfo, Embase, CINAHL (EBSCO), Cochrane Library and Google Scholar.

ELIGIBILITY CRITERIA

All qualitative and mixed-method studies, in English, that not only used a qualitative approach that explored adults' opinions or concerns about opioids and/or opioid reduction, and adults' experience related to opioid use for postoperative pain control, including satisfaction, but also aspects of overall quality of a person's life (physical, mental and social well being).

RESULTS

Ten studies were included; nine were qualitative ( n  = 9) and one used mixed methods. The studies were primarily conducted in Europe and North America. Concerns about opioid dependence, adverse effects, stigmatisation, gender roles, trust and shared decision-making between clinicians and patients appeared repeatedly throughout the studies. The TDF analysis showed that many peri-operative factors formed people's perceptions and experiences of opioids, driven by the following eight domains: Knowledge, Emotion, Beliefs about consequences, Beliefs about capabilities, Self-confidence, Environmental Context and Resources, Social influences and Decision Processes/Goals. Adults have diverse pain management goals, which can be categorised as proactive and positive goals, such as individualised pain management care, as well as avoidance goals, aimed at sidestepping issues such as addiction and opioid-related side effects.

CONCLUSION

It is desirable to understand the complexity of adults' experiences of pain management especially with opioid use and to support adults in achieving their pain management goals by implementing an individualised approach, effective communication and patient-clinician relationships. However, there is a dearth of studies that examine patients' experiences of postoperative opioid use and their involvement in opioid usage decision-making. A summary is provided regarding adults' experiences of peri-operative opioid use, which may inform future researchers, healthcare providers and guideline development by considering these factors when improving patient care and experiences.

Exploring geriatric trauma unit experiences through patients' eyes: a qualitative study

INTRODUCTION

The surgical management of older patients is complex due to age-related underlying comorbidities and decreased physiological reserves. Comanaged care models, such as the Geriatric Trauma Unit, are proven effective in treating the complex needs of patients with fall-related injuries. While patient-centered care is an important feature of these comanaged care models, there has been minimal research dedicated to investigating the patient experience within Geriatric Trauma Units. Therefore, it remains uncertain whether the Geriatric Trauma Unit's emphasis on a patient-centered approach truly manifests in these interactions. This study explores how patients with fall-related injuries admitted to a Geriatric Trauma Unit perceive and experience patient-centered care during hospitalization.

METHODS

This qualitative generic study was conducted in three teaching hospitals that integrated the principles of comanaged care in trauma care for older patients. Between January 2021 and May 2022, 21 patients were interviewed.

RESULTS

The findings highlight the formidable challenges that older patients encounter during their treatment for fall-related injuries, which often signify a loss of independence and personal autonomy. The findings revealed a gap in the consistent and continuous implementation of patient-centered care, with many healthcare professionals still viewing patients mainly through the lens of their injuries, rather than as individuals with distinct healthcare needs. Although focusing on fracture-specific care and physical rehabilitation aligns with some patient preferences, overlooking broader needs undermines the comprehensive approach to care in the Geriatric Trauma Unit.

CONCLUSION

Effective patient-centered care in Geriatric Trauma Units requires full adherence to its core elements: patient engagement, strong patient-provider relationships, and a patient-focused environment. This study shows that deviations from these principles can undermine care, emphasizing the need for a holistic approach that extends beyond treating immediate medical conditions.

The Effect of Artificial Intelligence on Patient-Physician Trust: Cross-Sectional Vignette Study

BACKGROUND

Clinical decision support systems (CDSSs) based on routine care data, using artificial intelligence (AI), are increasingly being developed. Previous studies focused largely on the technical aspects of using AI, but the acceptability of these technologies by patients remains unclear.

OBJECTIVE

We aimed to investigate whether patient-physician trust is affected when medical decision-making is supported by a CDSS.

METHODS

We conducted a vignette study among the patient panel (N=860) of the University Medical Center Utrecht, the Netherlands. Patients were randomly assigned into 4 groups-either the intervention or control groups of the high-risk or low-risk cases. In both the high-risk and low-risk case groups, a physician made a treatment decision with (intervention groups) or without (control groups) the support of a CDSS. Using a questionnaire with a 7-point Likert scale, with 1 indicating "strongly disagree" and 7 indicating "strongly agree," we collected data on patient-physician trust in 3 dimensions: competence, integrity, and benevolence. We assessed differences in patient-physician trust between the control and intervention groups per case using Mann-Whitney U tests and potential effect modification by the participant's sex, age, education level, general trust in health care, and general trust in technology using multivariate analyses of (co)variance.

RESULTS

In total, 398 patients participated. In the high-risk case, median perceived competence and integrity were lower in the intervention group compared to the control group but not statistically significant (5.8 vs 5.6; P=.16 and 6.3 vs 6.0; P=.06, respectively). However, the effect of a CDSS application on the perceived competence of the physician depended on the participant's sex (P=.03). Although no between-group differences were found in men, in women, the perception of the physician's competence and integrity was significantly lower in the intervention compared to the control group (P=.009 and P=.01, respectively). In the low-risk case, no differences in trust between the groups were found. However, increased trust in technology positively influenced the perceived benevolence and integrity in the low-risk case (P=.009 and P=.04, respectively).

CONCLUSIONS

We found that, in general, patient-physician trust was high. However, our findings indicate a potentially negative effect of AI applications on the patient-physician relationship, especially among women and in high-risk situations. Trust in technology, in general, might increase the likelihood of embracing the use of CDSSs by treating professionals.

Non-curative surgical oncology: postoperative needs and preferences

OBJECTIVE

When intended curative cancer surgery is not completed, the postoperative transition to palliative care represents a prognostic landmark to patients and their families. In patients referred for highly specialised surgery for peritoneal metastases from the intestinal tract and ovaries, surgery is not performed in approximately 25%. Still, little is known of their postoperative needs and preferences.

METHODS

We performed 14 qualitative research interviews with 12 patients (four men and eight women, aged 41-85 years) undergoing surgery for peritoneal metastases; five of these were together with a relative. Five of the participants had ovarian, and seven had colorectal cancer (four men and seven women). The interviews followed a semistructured interview guide, were audio recorded, transcribed verbatim and analysed using meaning condensation.

RESULTS

Patients accepted the surgeon's decision of refraining from the intended surgery. During the postoperative period, when realising the prognostic consequences, their needs changed rapidly, in some cases from day to day, and gradually they developed a reoriented focus on their lives. The findings were framed by two themes dealing with 'Change in treatment strategy' and 'Physical and psychosocial aspects of not undergoing curative surgery'.

CONCLUSION

When curative cancer surgery is not completed as intended, patient-centred communication is essential for patients' psychosocial reorientation and quality of life. Further, to support their well-being and action competences, patients have a need for basic supportive care and physical restitution. Finally, high-quality postoperative palliative care needs to be coordinated, which requires staff training and reorganisation of pathways.

Implementation of an innovative ERAS protocol in cardiac surgery: A qualitative evaluation from patients' perspective

OBJECTIVE

Enhanced recovery after surgery (ERAS) protocols aim to optimize the recovery process for patients after surgical interventions and focus on patient-centered care. In cardiac surgery, the ERAS concept is still in its early stages. Our university hospital has implemented an innovative ERAS protocol for minimally invasive heart valve surgery since 2021. Therefore, our study aimed to comprehensively assess the patient experience within this newly established ERAS protocol and focused on exploring and understanding the nuances of optimal healthcare delivery under the ERAS framework from the unique perspective of the patients undergoing cardiac surgery.

METHODS

Qualitative research was conducted using semi-structured interviews. Data was analyzed using Kuckartz´s qualitative content analysis.

RESULTS

The following main themes emerged from the 12 completed patient interviews: 1) information and communication flow, 2) perioperative patient care, and 3) rehabilitation. Patients found the pre-operative patient education and preconditioning very helpful. Patients were satisfied with the flow of information throughout the whole perioperative care process. Most patients expressed a need for more information about the course of surgery. The intensity of care provided by different professions was perceived as optimal. The support and inclusion of relatives in perioperative care were considered crucial. Patients appreciated the direct transfer to the rehabilitation and mainly were able to cope with daily life tasks afterward.

CONCLUSION

In summary, all patients experienced the ERAS protocol positively, and their healthcare process was well established. Active inclusion and education of patients in their treatment can improve patient empowerment. Two further aspects that deserve major consideration in the healthcare process are the inclusion of relatives and interprofessional cooperation.

Educational nutritional intervention to prevent loss of health-related quality of life among older adults after a surgical treatment: design of a randomised controlled trial

BACKGROUND

Disease-related malnutrition after a hospital stay has major consequences for older adults, the healthcare system and society. This study aims to develop and test the effectiveness of an educational video to prevent loss of health-related quality of life among live-at-home older adults after surgical treatment in a hospital.

METHOD

This randomised controlled trial will occur at a regional hospital in Norway. Participants will be live-at-home adults aged 65 years and older. They will be recruited from three different surgical departments after a surgical procedure. Individuals with a body mass index below 24 and a home address in one of nine selected municipalities will be eligible for inclusion. Participants will be randomly assigned to either the intervention group or the control group. Those assigned to the intervention group will obtain access to a 6-min educational video 5 days after being discharged from the hospital. The control group will not obtain access to the video. The primary outcome will be health-related quality of life using the Norwegian Rand 36-Item Short Form Health Survey. Furthermore, we will measure body composition, number of readmissions and nutritional knowledge at inclusion and 3-month follow-up.

DISCUSSION

This randomised controlled trial is expected to provide insight into whether an educational video can improve the nutritional status of older adults following a surgical procedure and discharge from the hospital. The findings will be useful for assessing how videos offering nutritional advice to older adults who have undergone a surgical procedure can improve their health-related quality of life, reduce loss of function, prevent readmission to hospital and reduce healthcare costs.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05950373. Registered on 11 July 2023.

Support or justice: a triangulated multi-focal view of sexual assault victim support in a UK sexual assault referral centre (SARC)

BACKGROUND

Despite vast levels of underreporting, sexual assault remains an issue at scale in the UK, necessitating the presence of statutory and voluntary organisations in the support of victims. Understanding the experiences of all parties within this context is important for the resilience of support that can be provided at a systems level. This study examines the barriers faced by service providers when working with victims of sexual assault.

METHODS

Semi-structured interviews took place with eleven professionals working in or in conjunction with a Sexual Assault Referral Centre (SARC) in Southeast England, which were subsequently analysed using inductive thematic analysis.

RESULTS

Five themes were identified exploring SARC staff's experiences with (i) communication breakdowns with external services; (ii) delivering support in an underfunded system; (iii) tailoring support to survivors' needs; (iv) the Criminal Justice System fails victims of sexual assault; and (v) reckoning with burnouts and vicarious trauma.

CONCLUSION

Significant gaps in UK service provision for sexual assault victims are identified, particularly within the criminal justice system, where legal and investigative processes are cited as retraumatizing. The results emphasize the urgency of enhanced training, coordination, resources, and trauma-informed practices across organizations to better serve victims and support overwhelmed providers. Prioritizing systemic improvements is crucial to address the complex needs of both victims and service professionals.

Associations between nursing home care environment and unfinished nursing care explored. Secondary analysis of cross-sectional data

Understanding unfinished nursing care and its relationship with modifiable care environment factors is crucial for the service delivery to long-term frail patients. This secondary analysis aimed to explore the associations between characteristics of the care environment and unfinished nursing care, as reported by nursing care workers in Norwegian nursing homes. Of 931 respondents (37% response rate) from 66 nursing homes, six care environment characteristics correlated with at least two types of unfinished nursing care. Resources and Multidisciplinary collaboration showed a positive association with all four unfinished care categories. Input and acknowledgement, Professional, or Interpersonal leadership were not associated to unfinished care. In summary, our findings suggest that nursing care workers reporting positive care environment descriptions also reported lower frequencies of unfinished nursing care. This study offers insights crucial for human resource management which ultimately can be used to improve patient outcomes in nursing homes.

My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity

BACKGROUND

Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team.

OBJECTIVE

To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity.

DESIGN

We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers.

SETTING AND PARTICIPANTS

Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care.

RESULTS

A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking.

DISCUSSION AND CONCLUSIONS

Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity.

PATIENT OR PUBLIC CONTRIBUTION

Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.

'I wasn't made to feel like a nut case after all': A qualitative story completion study exploring healthcare recipient and carer perceptions of good professional caregiving relationships

BACKGROUND

Professional caregiving relationships are central to quality healthcare but are not always developed to a consistently high standard in clinical practice. Existing literature on what constitutes high-quality relationships and how they should be developed is plagued by dyadic conceptualisations; discipline, context and condition-specific research; and the absence of healthcare recipient and informal carer voices. This study aimed to address these issues by exploring how healthcare recipients and carers conceptualise good professional caregiving relationships regardless of discipline, care setting and clinical condition.

DESIGN

A qualitative story completion approach was used. Participants completed a story in response to a hypothetical stem that described a healthcare recipient (and, in some instances, carer) developing a good relationship with a new healthcare provider. Stories were analysed using reflexive thematic analysis.

PARTICIPANTS

Participants were 35 healthcare recipients and 37 carers (n = 72 total).

RESULTS

Participants' stories were shaped by an overarching discourse that seeking help from new providers can elicit a range of unwanted emotions for both recipients and carers (e.g., anxiety, fear, dread). These unwanted emotions were experienced in relation to recipients' presenting health problems as well as their anticipated interactions with providers. Specifically, recipient and carer characters were fearful that providers would dismiss their concerns and judge them for deciding to seek help. Good relationships were seen to develop when healthcare providers worked to relieve or minimise these unwanted emotions, ensuring healthcare recipients and carers felt comfortable and at ease with the provider and the encounter. Participants positioned healthcare providers as primarily responsible for relieving recipients' and carers' unwanted emotions, which was achieved via four approaches: (1) easing into the encounter, (2) demonstrating interest in and understanding of recipients' presenting problems, (3) validating recipients' presenting problems and (4) enabling and respecting recipient choice. Participants' stories also routinely oriented to temporality, positioning relationships within recipients' and carers' wider care networks and biographical and temporal contexts.

CONCLUSION

The findings expand our understanding of professional caregiving relationships beyond dyadic, static conceptualisations. Specifically, the findings suggest that high-quality relationships might be achieved via a set of core healthcare provider behaviours that can be employed across disciplinary, context and condition-specific boundaries. In turn, this provides a basis to support interprofessional education and multidisciplinary healthcare delivery, enabling different healthcare disciplines, specialties, and teams to work from the same understanding of what is required to develop high-quality relationships.

PATIENT OR PUBLIC CONTRIBUTION

The findings are based on stories from 72 healthcare recipient and carer participants, providing rich insight into their conceptualisations of high-quality professional caregiving relationships.

Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs

This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.