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Objective Social media has fundamentally changed how the world shares and receives information. This review offers a perspective for the practicing clinician regarding how patients are being influenced by their online interactions and considerations for proactively discussing medical decision making with patients. Data Sources Literature search of PubMed database and online published market research data surrounding social media use. Study Selections Peer-reviewed studies, Pew research data, and editorials in the English language were selected and reviewed. Results There has been a substantial increase in the breadth and depth of literature surrounding the use of social media by patients and medical professionals. Increased focus on how it contributes to medical decision making and patient-clinician interactions has occurred in recent years. The coronavirus disease 2019 pandemic has highlighted the various sources of misinformation and disinformation and how they impact care on many levels. Best practices have been established to assist medical professionals in developing an online presence to combat misinformation or address individual patients. Conclusion There is growing understanding and recognition of the myriad of ways in which social media is impacting health care. Health care professionals from all backgrounds need to increase their understanding of these complex interactions to best assist patients with their medical decision making.

Background The State of Victoria in Australia introduced Chinese medicine practitioner registration in 2000 and issued its education guidelines in late 2002 for introduction in 2005. This study obtained practitioners' views on desired capabilities for competent Chinese medicine practice and to identify professional development needs. Methods A questionnaire, consisting of 28 predefined capabilities in four categories with a rating scale of importance from one to five, was developed and sent to all registered Chinese medicine practitioners in the State of Victoria, Australia in October, 2005. Results Two hundreds and twenty eight completed questionnaires were returned which represented a response rate of 32.5%. Of the four categories of capabilities, technical capabilities were considered to be the most important for clinical practice. Specifically, the ability to perform acupuncture treatment and/or dispense an herbal prescription was ranked the highest. In contrast, research and information management capabilities were considered the least important. The educational background of practitioners appeared to be an important factor influencing their rating of capabilities. Significantly, nearly double the number of practitioners with Australian qualifications than practitioners trained overseas valued communication as an important capability. For continuing professional education, clinical skills courses were considered as a priority while research degree studies were not. Conclusion Registered Chinese medicine practitioners viewed skills training as important but did not support the need for research and information management training. This represents a significant hurdle to developing Chinese medicine as a form of evidence-based healthcare.

Domestic violence creates multiple harms for women's health and is a ‘wicked problem’ for health professionals and public health systems. Brazil recently approved public policies to manage and care for women victims of domestic violence. Facing these policies, this study aimed to explore how domestic violence against women is usually managed in Brazilian primary health care, by investigating a basic health unit and its family health strategy. We adopted qualitative ethnographic research methods with thematic analysis of emergent categories, interrogating data with gender theory and emergent Brazilian collective health theory. Field research was conducted in a local basic health unit and the territory for which it is responsible, in Southern Brazil. The study revealed: 1) a yawning gap between public health policies for domestic violence against women at the federal level and its practical application at local/decentralized levels, which can leave both professionals and women unsafe; 2) the key role of local community health workers, paraprofessional health promotion agents, who aim to promote dialogue between women experiencing violence, health care professionals and the health care system. Resumo A violência doméstica (VD) cria múltiplos agravos à saúde das mulheres e é um desafio para profissionais e para os sistemas de saúde. O Brasil aprovou recentemente políticas públicas (PP) para manejo e cuidado de mulheres em situação de VD. Considerando essas PP, este estudo objetivou explorar como a VD contra mulheres é usualmente manejada na atenção primária à saúde brasileira, por meio da investigação de uma unidade básica de saúde e de sua estratégia de saúde da família. Foi adotada metodologia de pesquisa qualitativa de cunho etnográfico, com análise temática de categorias emergentes, interrogando os dados com teoria de gênero e com a produção teórica do campo da saúde coletiva brasileira. A pesquisa de campo foi conduzida em uma unidade básica de saúde e em seu território adscrito, localizado na região sul do Brasil. O estudo revelou: 1) um hiato entre PP direcionadas à VD contra mulheres implantadas a nível federal e sua aplicação prática a nível local/descentralizado, que pode deixar tanto profissionais quanto mulheres em risco; 2) o papel chave de agentes comunitários de saúde, profissionais de promoção da saúde, que objetivam promover o diálogo entre as mulheres experienciando violência, profissionais de saúde e o sistema de saúde.

Background Language and communication have an impact on how a clinical condition is treated and experienced, from both the health care professional (HCP) and patient perspective. Malnutrition is prevalent among community-dwelling older adults, yet perceptions of patient understanding of the term malnutrition to date remain underexplored. Objective This qualitative study explored the use and perceptions of the term malnutrition among HCPs and older adults at risk of malnutrition. Design Semi-structured interviews and focus groups were conducted with HCPs and older adults with a prescription for oral nutritional supplements (ONS) in the community, to explore perspectives. Participants and setting HCPs with experience of working with older adults were recruited in primary care centers, general practitioner practices, community health organizations, and community pharmacies in County Dublin, Ireland, between 2018 and 2019. Older adults, aged ≥60 years, with a current or previous prescription for ONS were recruited from daycare centers. One-to-one interviews were conducted with general practitioners (n = 16) and patients (n = 13), and focus groups were conducted with other HCPs, including dietitians (n = 22), nurses (n = 22), pharmacists (n = 9), physiotherapists (n = 12), occupational therapists (n = 6), and speech and language therapists (n = 4). Data analysis Data from interviews and focus groups were transcribed verbatim and analyzed using thematic analysis. Results There was mutual agreement between HCPs and patients on the main theme, “malnutrition is a term to be avoided.” There were three subthemes with varying input from the different HCP groups and patients: “Malnutrition is a term a patient doesn’t want to hear”—malnutrition has negative connotations that imply neglect and stigma; “malnutrition is a clinical term which patients don’t understand”—with perceptions that it is better to substitute the term with simpler motivating messages; and “lack of confidence identifying malnutrition”—expressed by non-dietetics HCPs who believed they had insufficient expertise on malnutrition to communicate effectively with patients. Conclusions HCPs and patients perceived negative connotations with the term malnutrition, and HCPs used alternatives in practice. Additional consultation with HCPs and patients is recommended to explore appropriate language for conveying health risks associated with malnutrition. Future research should also address how current communication challenges can be addressed as part of strategic management programs or interventions to prevent and treat malnutrition.

BackgroundTelemedicine for medical abortion care was rapidly introduced in Great Britain in response to the COVID-19 pandemic. A growing body of literature demonstrates that telemedicine abortion care is safe, effective and highly acceptable to patients. Less is known about the perspectives of abortion care providers (ACPs).MethodsQualitative research within the telemedicine abortion service in Lothian (Edinburgh and surrounding region), UK. We conducted qualitative in-depth interviews with ACPs between May and July 2020 (doctors, n=6; nurses, n=10) and analysed the data thematically.ResultsWe present three themes from our qualitative analysis: (1) Selective use of ultrasound – the move away from routine ultrasound for determination of gestational age was generally viewed positively. Initial anxiety about non-detection of ectopic pregnancy and later gestations was expressed by some ACPs, but concerns were addressed through clinical practice and support structures within the clinic. (2) Identifying safeguarding issues – in the absence of visual cues some ACPs reported concerns about their ability to identify safeguarding issues, specifically domestic violence. Conversely it was acknowledged that teleconsultations may improve detection of this in some situations. (3) Provision of information during the consultation – telephone consultations were considered more focused than in-person consultations and formed only part of the overall ‘package’ of information provided to patients, supplemented by online and written information.ConclusionsACPs providing telemedicine abortion care value this option for patients and believe it should remain beyond the COVID-19 pandemic. Safeguarding patients and the selective use of ultrasound can be initially challenging; however, with experience, staff confidence improves.

Aim: this study aimed to determine the problems faced by physicians and nurses dealing with chronic wound care during the COVID-19 pandemic and their views on telehealth. Materials and methods: a descriptive and cross-sectional design was used in this study. The sample comprised physicians (n = 74) and nurses (n = 271) interested in chronic wound care. Data were collected through a questionnaire form consisting of open- and closed-ended questions. Results: of the participants, 21.4% (n = 74) were physicians and 78.6% (n = 271) were nurses. Of the physicians, 45.9% (n = 34) were obliged to work in another unit during the COVID-19 period, while 43.2% continued their service related to chronic wound care, and only 17.0% (n = 18) in the wound care service before the pandemic. These rates are 51.3% (n = 139), 51.6% (n = 157) and 36.8% (n = 128) for nurses, respectively. 40.7% of the physicians (n = 33) and 34.9% of the nurses (n = 106) stated that their time had been reduced for chronic wound care. When the telehealth experiences were examined, 32.4% (n = 24) of the physicians utilized telehealth, 29.7% (n = 22) used e-visit, 77.0% (n = 57) stated that they thought telehealth was a good option, 47.3% (n = 35) utilized it for wound evaluation and treatment, and 31.9% (n = 59) used smart phones. These rates for nurses were 16.6% (n = 45), 14.0% (n = 38), 72.7% (n = 197), 33.9% (n = 92), and 27.0% (n = 182), respectively. Conclusions: the COVID-19 pandemic negatively affected the manner of delivery, duration, and quality of service regarding wound management. During this period, face-to-face contact times with patients were reduced, some diagnosis and treatment attempts were not performed, and wound care services were suspended temporarily or permanently. On the other hand, a positive result was achieved in that the physicians and nurses gave positive feedback for the telehealth experience., NA

Aim Gout is a common form of inflammatory arthritis with suboptimal management. Management guidelines for gout highlight the importance of both pharmacological and non-pharmacological treatments. Dietitians can potentially assist in improving gout's associated dietary and lifestyle factors, and thereby play a role in improving its management. The aim of this study was to investigate perspectives of Australian community dietitians on whether their role in gout management could be expanded to improve management and treatment of gout. Method A snowballing recruitment strategy was used. Dietitians known to the research team were invited to participate and then they suggested further dietitians. Semi-structured interviews (one-on-one) were conducted with 16 dietitians. The focus was on their experiences of contributing to the management of gout, including any barriers and facilitators experienced. Interviews were transcribed verbatim and independently analyzed by 2 reviewers to identify themes. Results The main reported role of dietitians in gout management was providing patient education. An identified facilitator was dietitians' understanding of gout and its dietary management. Barriers included the emphasis placed on medications for treatment by clinicians and patients, consultation costs, limitations in the evidence for the efficacy of dietary changes and lack of specific training in gout for dietitians. Dietitians predominantly managed the other metabolic conditions commonly associated with gout. Conclusion Currently, the role dietitians play in gout management is limited. However, dietitians have the potential to take on larger roles in gout education and can also indirectly contribute by way of management of commonly associated comorbidities in gout patients.

OBJECTIVES Despite its efficacy, little is known about what makes Internet-based cognitive behavioral therapy (iCBT) effective. We, therefore, analyze participants' and therapists' experiences of Grawe's five general change mechanisms (alliance, resource activation, clarification, problem actuation, mastery) during an iCBT intervention for family dementia caregivers, and how their experiences were related to treatment outcomes. METHOD Participants (N = 30) exchanged eight weekly messages with a therapist via an Internet platform. We used the Bern Post Session Report to assess participants' and therapists' experiences of the general change mechanisms after each session. RESULTS Treatment outcomes were associated with therapists' overall experiences of alliance, clarification, and mastery. Participants experienced more problem actuation than therapists. Only participants' and therapists' experiences of clarification over time differed. CONCLUSIONS Grawe's general change mechanisms are also relevant for iCBT. We recommend considering Grawe's framework when designing Internet-based therapeutic interventions and when training therapists to deliver such interventions.

Objective To determine how often travel histories are obtained in pediatric patients. Methods A retrospective medical record review was performed at a single tertiary care children's hospital for patients aged 2 months to 18 years who were admitted October 2015-December 2017 with International Classification of Diseases, 10th Revision codes for potential travel-related illnesses. Demographic information and travel history documentation were obtained, along with travel-related testing. From May to June 2018, prospective, single-blinded, direct observation of a convenience sample of pediatric residents was performed during the initial patient encounter to determine the frequency and quality of travel histories obtained regardless of documentation. Results Of 249 charts reviewed, 27 (10.8%) patients had a travel history query documented. Patients with complex chronic conditions were significantly less likely to have a travel history documented (37% vs 67%; P = 0.005). Age, sex, length of stay, race, payer status, and critical care admission did not significantly differ between groups. Those with a travel history documented were more likely to have a documented exposure history (100% vs 52%; P Conclusions Travel histories are rarely asked for in pediatric patients. Missed diagnoses may not only affect the patient but also have broader public health implications. Simulation is an effective tool to improve history-taking skills, yet more work is still needed.

Thistudy compares patient satisfaction with primary health care services and identifies factors associated with patient satisfaction in two health districts in Egypt where a project for upgrading primary health care services had been running for three years. An exit interview was conducted for 1108 patients using a structured questionnaire. The results revealed that most clients using primary health care services were females. Patient satisfaction was high for accessibility, waiting area conditions and performance of doctors and nurses. The main complaints centred on the availability of prescribed drugs and laboratory investigations. Additionally, level of privacy in the consultation room was described as unsatisfactory by 33% of patients. There was no association between overall patient satisfaction and age, gender, education level or type of service received

Background Medication nonadherence is common among patients with hemodialysis, leading to poorer patient outcomes. Health care professionals have an important role in assessing risk of nonadherence and intervening to support adherence. The aim of this study was to explore physicians’ and nurses’ current medication adherence practices in hemodialysis settings. Method A generic qualitative design with inductive content analysis and focus group methodology. Focus groups with health care professionals were conducted in four Nephrology Centers, representing three different regions of Denmark. An interview guide was developed in collaboration with 3 patient representatives. Results Six focus group interviews involving a total of forty-two health care professionals were conducted. Five main categories were identified; Laboratory tests are the “gold standard” for assessing adherence, suggesting that abnormal results motivated investigation of adherence, Varying practices for supporting adherence, alluding to the impact of individual clinician priority and preference on choice of adherence interventions, Unclear allocation of roles and responsibility, specifically referring to uncertainty in the delegation of roles between physicians and nurses, Navigating time and resource limitations, intimating the resources needed to support medication adherence and Suggestions for future strategies. Conclusions We suggest implementing systematic use of validated patient-reported outcome measures for assessing adherence and deprescribing tools to support adherence, as these instruments might identify the patients who are in most need of support and promote patient adherence to their prescribed medications. The findings also point to a need for interdisciplinary clarification of roles and responsibilities regarding medication adherence, with the aim of building a strong collaborative partnership between professions.

BACKGROUND For adults with intellectual disabilities living in a residential care facility, support staff, who are an integral part of their daily lives, can play an important role in supporting their sexuality. Even though multiple programmes exist, barriers remain when it comes to their application. This study aimed to identify factors affecting residential staff's perception of their role in supporting the sexuality of adults with intellectual disabilities living in a residential care facility as well as facilitators and barriers to that support. METHOD Semi-structured interviews were conducted with 12 support staff. RESULTS A thematic analysis revealed four factors, namely support staff's role, facilitators and barriers, sexuality of residents with intellectual disabilities and policies and regulations. CONCLUSION Results illustrate the importance of expanding support staff's knowledge, clarifying procedures for implementing the support staff's role and establishing a clear practise framework.

Key summary points Aim The purpose of this review was to synthesise and critically analyse the points of discordance and concordance between consumers and clinicians about quality end-of-life care. Findings Respecting patient autonomy and the role of family is now clearly understood, but the role of healthcare provider and purpose of treatment withdrawal are still a matter of conflict between clinicians and patients or families. Clinician awareness of the possibility of misunderstanding by patients or families is the first step in preventing discordance of views on care quality at the end of life. Message To prevent the conflict between parties, further efforts are needed to investigate ways to better communicate the goals of care, limitations of treatment and uncertainty associated with forecasting time to end of life. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00549-6., Background This scoping review aimed to investigate the presence of discordance or concordance in the perceptions of end-of-life (EOL) care quality between consumers (i.e. patients aged over 60 in their last years of life and/or their informal caregivers) and clinicians, to inform further improvements in end-of-life care service delivery. Methods A scoping review of qualitative and quantitative studies was systematically undertaken by searching for English language publications in MEDLINE database and manual reference search of eligible articles. Thematic analysis was employed to identify and extract common concordance and discordance themes leading to the development of analytical constructs. Articles were eligible for inclusion if they reported on consumers’ (i.e. older patients aged 60 + years in their final years of life and/or their informal caregivers) and clinicians’ (doctors, nurses, social workers, etc.) perspectives on quality of medical, surgical or palliative/supportive care administered to older adults in the last year of life across all healthcare settings. Results Of the 2736 articles screened, 21 articles were included. Four themes identified concordance between consumers’ and clinicians’ perceptions of care quality: holistic patient care; coordinated care that facilitated EOL; the role of family at EOL; and impact of prognostic uncertainty on care planning. Three themes emerged for discordance of perceptions: understanding the patient needs at EOL; capacity of healthcare system/providers to accommodate family needs; and knowledge and communication of active or palliative care at EOL. Conclusions While progress has been made on promoting patient autonomy and respecting the family role in representing patient’s best interest, gaps remain in terms of care coordination, communication of prognosis, public understanding of the meaning of goals of care including de-escalation of management and enactment of advance care directives by clinicians for people with diminished decision capacity. Public understanding of the meaning of “comfort” care and the need to prevent over-treatment are essential for their satisfaction with care and their ability to embrace the concept of a good death. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00549-6.

Background Despite the benefits of breastfeeding for women with Gestational Diabetes Mellitus (GDM) and their infants, breastfeeding is less likely to be performed by this group. This study aimed to examine the current levels of implementation of breastfeeding support to women with GDM in Japan and to clarify barriers to promoting breastfeeding among this population. Methods A 25-item questionnaire was developed by the authors to investigate the current levels of implementation of breastfeeding support for women with GDM provided in hospitals, and to explore barriers for promoting breastfeeding among these women. The questionnaire was sent to all 1046 hospitals facilitating childbirth in Japan. Descriptive statistics were used to analyze the quantitative data, and content analysis was used to analyze qualitative data from the open-ended questions. Results All 296 respondents were included in this study. Regarding breastfeeding support, 95.2% of the respondents provided general information on breastfeeding to GDM women during antenatal midwife consultations. However, the benefits of breastfeeding for preventing type 2 diabetes were addressed by only 48.0%. Likewise, although follow-up services (e.g., telephone support or breastfeeding consultations) were conducted in 88.9% of hospitals, only 50.7% of hospitals informed women that breastfeeding decreases the risk of developing type 2 diabetes after GDM. Regarding barriers, seven categories and 20 subcategories about promoting breastfeeding for women with GDM were extracted and abstracted into the following three themes: Barriers associated with mother and infant, Barriers associated with health professionals, and Organizational barriers. Conclusions In Japan, most hospitals that responded provided general breastfeeding support from the antenatal to postpartum periods. However, the benefits of breastfeeding in terms of preventing the incidence of type 2 diabetes following GDM were insufficiently communicated to women with GDM. Furthermore, there were numerous barriers to promoting breastfeeding among women with GDM.

To educate wound care practitioners about methods of communication that can help promote patient adherence to wound healing recommendations.This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.After participating in this educational activity, the participant will:1. Distinguish the use of theoretical frameworks to promote patient adherence to prescribed wound healing recommendations.2. Synthesize the principles of motivational interviewing to best encourage patients to adhere to prescribed wound healing recommendations.3. Select the appropriate self-care strategies for patients who have nonhealing wounds.Patients with chronic wounds make daily decisions that affect healing and treatment outcomes. Patient-centered education for effective self-management decreases episodes of care and reduces health expenditures while promoting independence. Theoretical frameworks, including the Health Belief Model, Theory of Planned Behavior, Social Cognitive Theory, and Transtheoretical Model of Behavior Change, can assist healthcare providers in identifying strategies that enhance adherence. These strategies include the use of motivational interviewing, a communication technique designed to elicit patients’ perspectives regarding treatment goals, outcome expectations, anticipated barriers, and intentions to follow provider recommendations.

Background The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality. Methods Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned. Results Nine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a ‘somatic’ symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit. Conclusion Current educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.

Background Individuals aged 65 and older face unique barriers to adoption of telehealth, and the coronavirus disease 2019 pandemic has provided a “natural experiment” in how to meet the health needs of older patients remotely. Physician perspectives on practical considerations surrounding telehealth adoption, motivations of use, and reasons for nonuse are necessary to inform the future of healthcare delivery. The objective is to understand the experiences of physicians using telemedicine for older patients. Methods From September to November 2020, we conducted 30‐min semi‐structured interviews using purposeful sampling to identify and enroll participants from diverse settings. We included 48 U.S.‐based physicians (geriatrician, n = 18, primary care, n = 15, emergency, n = 15) from all geographic regions, rural–urban and academic/community settings. Audio‐recorded interviews were professionally transcribed and analyzed using framework analysis. Major themes and subthemes were identified. Results Participants had a median (interquartile range) age of 37.5 (34–44.5), 27 (56%) were women. Five major themes emerged: (1) telehealth uptake was rapid and iterative, (2) telehealth improved the safety of medical care, (3) use cases were specialty‐specific (for geriatricians and primary care physicians telehealth substituted for in‐person visits; for emergency physicians it primarily supplemented in‐person visits), (4) physicians altered clinical care to overcome older patient barriers to telehealth use, and (5) telehealth use among physicians declined in mid‐April 2020, due primarily to patient needs and administrator preferences, not physician factors. Conclusion In this qualitative analysis, physicians reported a rapid, iterative uptake of telehealth and attenuation of use as coronavirus disease 2019 prevalence declined. Physician experiences during the pandemic can inform interventions and policies to help buoy telehealth for ongoing healthcare delivery and ensure its accessibility for older Americans.

Background Having a positive childbirth experience is an increasingly valued outcome. Few studies evaluated the women’s satisfaction with childbirth through face-to-face interviews out of the health service environment. The objective of this study was to identify factors associated with a higher level of satisfaction with the childbirth experience among Brazilian women. Methods This cross-sectional study involved 287 women giving birth in two hospitals in southern Brazil. Women who gave birth to healthy newborns at term were randomly selected. Face-to-face interviews were conducted 31–37 days after delivery, at the mothers’ homes, using a structured questionnaire. Satisfaction with the childbirth experience was measured using a Likert-type scale ranging from very satisfied to very dissatisfied. Prevalence ratios (PR) were estimated using Poisson regression with robust variance. Results Following hierarchical multivariate analysis, the following factors remained associated with a higher level of satisfaction with the childbirth experience: being satisfied with antenatal care (PR = 1.30; 95% confidence interval [95%CI] = 1.06−1.59), understanding the information provided by health professionals during labor and delivery (PR = 1.40; 95%CI = 1.01−1.95), not having reported disrespect and abuse (PR = 1.53; 95%CI = 1.01−2.31), and having had the baby put to the breast within the first hour of life (PR = 1.63; 95%CI = 1.26−2.11). No association was observed with type of delivery or hospital status (public or private). Conclusions A higher level of satisfaction with the childbirth experience is related to satisfactory antenatal care, a non-abusive, respectful, and informative environment during childbirth, and to the opportunity to breastfeed the baby within the first hour of life. In clinical practice, greater attention to these basic principles of care during pregnancy and delivery could provide more positive experiences during birth.

Study Objective To describe human papilloma virus (HPV) vaccination practice among adolescent girls with cystic fibrosis (CF) and to identify reasons for non-vaccination. Design Cross-sectional multicentric study. Setting and Participants Girls aged 9-17 years, attending 7 French pediatric CF centers, and their accompanying adult. Interventions Administration of a self-report questionnaire. Main Outcome Measures The proportion of girls having received or receiving HPV vaccination, compliance with the vaccination schedule, factors associated with vaccination, and reasons for vaccination and for non-vaccination. Results A total of 113 girls and 104 accompanying adults participated. The mean age was 13.6 years (standard deviation 2.5; range 9-17). A total of 34 (30.9%) patients reported having received HPV vaccination. Among the 34 girls aged 15 years or older, 15 (44.1%) were vaccinated. Most patients (58.8%) started vaccination between 11 and 14 years of age (mean age 13.9). Most vaccine prescriptions (67.6%) were made by a CF center health care provider. Factors associated with vaccination were older age (odds ratio [OR] = 1.27, 95% confidence interval [CI] = 1.01-1.6, P = .037 for each year older), previous vaccination by the accompanying parent of one of their children for hepatitis B (OR = 8.01, 95% CI = 0.96-67.02), P = .055), and parental influence on decision-making (OR = 2.77, 95% CI = 0.97-7.95, P = .058). Health care providers’ positive advice and fear of HPV-related disease were the main reasons given to justify vaccination decisions. Insufficient knowledge and concerns about potential side effects were the main barriers. Conclusion HPV vaccination remains insufficient among girls with CF. CF health care providers may play a crucial role in HPV vaccination acceptance, and their sensitization to cervical cancer prevention is mandatory.

Although telepsychiatry is not new, the COVID-19 pandemic has dramatically boosted and legitimized it, especially in the field of group therapy. Group therapists have been forced to move online without enough training in leading online groups. Online groups are not the same as meeting in person and present specific obstacles and challenges that should either be compensated for or acknowledged as losses. In this article, the author summarizes these obstacles, identifying factors in group therapy, such as body-to-body interaction, that are absent online and suggesting ways to compensate for other differences, such as the therapist's reduced control over the setting. Surprisingly, some group members may benefit from online groups more than from in-person ones, but the online format is not for everyone. Research on online therapy has already shown this format's effectiveness, and the therapeutic alliance that is positively correlated with outcome seems to be achievable online as well. However, more research is needed, especially on cohesion in online groups, which seems to develop slower online.

Item does not contain fulltext Therapy alliance has been studied largely in voluntary psychotherapy but less is known about its predictive factors for positive alliance and treatment outcome in forensic populations. The aim of this study was to examine the relationship between offenders' emotional states and therapy alliance. Moreover, we were interested in the predictive impact of emotional states early in treatment on alliance at 18 months into treatment. Self-ratings of emotional states and alliance by 103 male offenders, and therapist-ratings for therapy alliance were examined using hierarchical multiple regression analyses. Participants were primarily convicted for violent of sexual offenses, and were diagnosed with antisocial, borderline or narcissistic personality disorders. Healthy emotional states were predictive of mid-treatment agreement on therapy goals and therapist ratings on tasks within the therapy. Unhealthy emotional states were predictive of patient-rated agreement on tasks. Emotional states were not predictive for the reported therapist/patient bond or global alliance ratings. This study emphasizes the importance of healthy emotional states in treatment of offenders with personality disorders. 20 p.

Despite the clinical importance of assessing smoking history and advising patients who smoke to quit, patients with lung cancer often experience feelings of blame and stigma during clinical encounters with their oncology care providers (OCPs). Promoting empathic communication during these encounters may help reduce patients' experience of stigma and improve related clinical outcomes. This paper presents the evaluation of OCP- and patient-reported data on the usefulness of an OCP-targeted empathic communication skills (ECS) training to reduce the stigma of lung cancer and improve communication.What is the impact of the ECS intervention on OCPs' communication skills uptake and patient-reported outcomes (lung cancer stigma, satisfaction with communication, and perceived OCP empathy)?Study subjects included 30 multidisciplinary OCPs treating patients with lung cancer who participated in a 2.25 h ECS training. Standardized Patient Assessments were conducted prior to and following training to assess ECS uptake among OCPs. In addition, of a planned 180 patients who currently or formerly smoked (six unique patients per OCP [three pretraining, three posttraining]), 175 patients (89 pretraining, 86 posttraining) completed post-OCP visit surveys eliciting feedback on the quality of their interaction with their OCP.OCPs exhibited an overall increase in use of empathic communication skills [t(28) = -2.37; P .05], stigma-mitigating skills [t(28) = -3.88; P .001], and breadth of communication skill use [t(28) = -2.91; P .01]. Patients reported significantly higher overall satisfaction with communication post-ECS training, compared with pretraining [t(121) = 2.15; P = .034; Cohen d = 0.35]. There were no significant differences from pretraining to posttraining for patient-reported stigma or perceived OCP empathy.Empathy-based, stigma-reducing communication may lead to improved assessments of tobacco use and smoking cessation for patients with smoking-related cancers. These findings support the dissemination and further testing of a new ECS model for training OCPs in best practices for assessment of smoking history and engagement of patients who currently smoke in tobacco treatment delivery.

Background Factors influencing the quality of end-of-life communication are relevant to improving end-of-life care. We assessed the quality of end-of-life communication and influencing factors in 2 intensive care unit (ICU) cohorts at high risk of death: patients living in nursing homes and those on extracorporeal membrane oxygenation (ECMO). Methods This retrospective cohort study included admissions to 4 ICUs in Winnipeg, Manitoba, from 2000 to 2017. We identified cohorts and influencing factors from the Winnipeg ICU database and by manual chart review. We assessed quality of end-of-life communication using 18 validated, binary quality indicators to calculate a weighted, scaled, composite score (range 0-100). We used median regression to identify factors associated with the composite score. Results The ECMO cohort (n = 109) was younger than the nursing home cohort (n = 230), with longer hospital stays and higher disease severity. Mean composite scores of end-of-life communication were extremely low in both cohorts (mean 48.5 [standard error of the mean (SEM) 1.7] for the nursing home cohort, 49.1 [SEM 2.5] for the ECMO cohort). Patient characteristics associated with higher median composite scores were older age (5.0 per decade, 95% confidence interval [CI] 2.1-7.8) and lower (worse) Glasgow Coma Scale (GCS) scores (1.8 per GCS point, 95% CI 0.5-3.2). The median composite score rose significantly over time (1.7 per year, 95% CI 0.5-2.8). Interpretation The quality of end-of-life communication in ICUs is poor, and factors associated with better prognosis are also associated with worse communication. Direct and early communication should occur with all patients in the ICU and their surrogates, not just those who are believed most likely to die.

Objective International guidelines recommend pneumococcal pneumonia and influenza vaccination for all patients with solid organ malignancies prior to initiating chemotherapy. Baseline vaccination rates (March 2019) for pneumococcal pneumonia and influenza at our tertiary cancer centre were 8% and 40%, respectively. The aim of this study was to increase the number of gynecologic chemotherapy patients receiving pneumococcal and influenza vaccinations to 80% by March 2020. Methods We performed an interrupted time series study using structured quality improvement methodology. Three interventions were introduced to address vaccination barriers: an in-house vaccination program, a staff education campaign, and a patient care bundle (pre-printed prescription, information brochure, vaccine record booklet). Process and outcome data were collected by patient survey and pharmacy audit and analyzed on statistical process control charts. Results We identified 195 eligible patients. Pneumococcal and influenza vaccination rates rose significantly from 5% to a monthly mean of 61% and from 36% to a monthly mean of 67%, respectively. The 80% target was reached for both vaccines during one or more months of study. The in-house vaccination and staff education programs were major contributors to the improvement, whereas the information brochure and record booklet were minor contributors. Conclusions Three interventions to promote pneumococcal and influenza vaccination among chemotherapy patients resulted in significantly improved vaccination rates. Lessons learned about promoting vaccine uptake may be generalizable to different populations and vaccine types. In response to the global COVID-19 pandemic, initiatives to expand the program to all chemotherapy patients at our centre are underway.

Background Studies on pharmacy communication have illustrated problems with patient-centeredness. Exploring pharmacists’ experiences of pharmacy counseling in depth is essential to understand what hinders patient-centeredness. Existing studies, based primarily on surveys and qualitative interviews, tap into perceptions of pharmacy counseling that are informed by general conceptualizations rather than what participants actually experience during the encounters. Thus, important aspects of the dynamics of pharmacy encounters might be missed. Objectives To explore the potential of the method video-stimulated recall interview (VSRI)( Wolters et al., 2017) 1 in a pharmacy setting to gain new insights into pharmacists’ experiences of patient encounters. This includes: 1) to investigate the potential of VSRI to reveal accurate and immediate perceptions of pharmacy encounters, and 2) to identify specific perceptions that pharmacists report in VSRIs. Methods Seven VSRIs conducted in 2 different community pharmacies in Denmark were analyzed. Videos of at-the-counter meetings were recorded (interaction1), and then selected for replay in a VSRI between a researcher and the pharmacist featured in the video (interaction2). Descriptive categories that characterized pharmacists’ experiences with the encounter were inferred from interview statements. Results New barriers to patient-centeredness were identified: pharmacists' experiences revealed that they were affected by patients' moods and that they found it inappropriate when patients disclosed personal perspectives. Also, pharmacists seemed to disregard that active listening requires responsiveness and should be seen as a process that pharmacists co-construct together with the patient. Conclusion The method of VSRI proved useful in revealing new dynamics of pharmacy interaction and pinpointing shortcomings in how pharmacists communicate with patients. Based on the findings, suggestions for how to establish better patient-centered communication are provided.

Objective: To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. Methods: Semi‐structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. Results: HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. Conclusions: In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs’ perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi‐faceted, person‐centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.

The novel Coronavirus pandemic (COVID‐19) and subsequent social distancing practices have altered the way we move through the world and access physical and mental healthcare. While researchers and clinicians have begun to explore the impact of telehealth delivery on psychotherapy and treatment outcomes, the purpose of this study was to explore the lived experiences of individuals in teletherapy, specifically those engaging in teletherapy with a romantic partner or family member. Using a thematic analysis of open‐ended online survey questions, we explored the experiences of 25 individuals who engaged in couple or family teletherapy after social distancing began. The resulting themes included “making do,” safe therapeutic space, convenience, logistical challenges, and therapist accommodation. We discuss the clinical implications of these themes to support effective couple and family teletherapy and offer suggestions and considerations for remote clinical interventions and practices. [Correction added on 22 March 2021, after first online publication: The term '19' has been changed to '(COVID‐19)' in the first line of the Abstract section, in this version.]

Immigrant and refugee patients may have limited English proficiency. Effective use of professional interpreter services reduces clinically significant errors and increases the quality of care. A multitude of professional interpreter services are available, and clinicians should carefully select the preferred modality of interpretation based on the type of encounter. Ad hoc interpreters, such as family members, are least preferred because of concerns of privacy and evidence of poorer outcomes. Children less than 18 years of age should only be used as interpreters in emergency situations. Professional telephonic, video, or in-person interpreters each have distinct advantages in specific clinical situations.

Objectives People of South Asian ancestry are the fastest growing non-Caucasian ethnic group in Canada and are at high risk for developing type 2 diabetes and coronary heart disease. Pregnant South Asian women have a 2-fold increased risk of developing gestational diabetes, which increases their risk of type 2 diabetes and coronary heart disease. The specific objectives of this study were to explore the perceptions of health behaviours (diet and physical activity) during pregnancy in the South Asian community. Methods We used interpretive description to further understand the cultural and contextual factors that influence the knowledge, attitudes and practices of diet and physical activity of South Asian women of childbearing age and those who provide health care to this group. Results Two major themes that emerged from the perspectives of 10 South Asian pregnant women included: (1) importance of considering an individual’s locus of control; and (2) support (emotional and information exchange) from family, friends and health-care providers. Two major themes identified by the 11 health-care providers were: (1) cultural awareness in caring for South Asian women during pregnancy; and (2) clinic management, logistics and resources. A common theme for both South Asian pregnant women and health-care providers was the importance of considering the cultural landscape in relation to how knowledge is obtained, shared and valued. Conclusion A better understanding of these cultural underpinnings may support the development of interventions tailored for pregnant South Asian women and their health-care providers.

Background To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic. Methods We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children’s hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication. Results We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7 ± 19.3%. Conclusions Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care. Impact This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.

Background Respectful maternal and newborn care (RMNC) is an important component of high-quality care but progress is impeded by critical measurement gaps for women and newborns. The Every Newborn Birth Indicators Research Tracking in Hospitals (EN-BIRTH) study was an observational study with mixed methods assessing measurement validity for coverage and quality of maternal and newborn indicators. This paper reports results regarding the measurement of respectful care for women and newborns. Methods At one EN-BIRTH study site in Pokhara, Nepal, we included additional questions during exit-survey interviews with women about their experiences (July 2017–July 2018). The questionnaire was based on seven mistreatment typologies: Physical; Sexual; or Verbal abuse; Stigma/discrimination; Failure to meet professional standards of care; Poor rapport between women and providers; and Health care denied due to inability to pay. We calculated associations between these typologies and potential determinants of health – ethnicity, age, sex, mode of birth – as possible predictors for reporting poor care. Results Among 4296 women interviewed, none reported physical, sexual, or verbal abuse. 15.7% of women were dissatisfied with privacy, and 13.0% of women reported their birth experience did not meet their religious and cultural needs. In descriptive analysis, adjusted odds ratios and multivariate analysis showed primiparous women were less likely to report respectful care (β = 0.23, p-value p-value 0.037) than women identifying as Chettri/Brahmin. Women who had caesarean section were less likely to report poor care during childbirth (β = − 0.42; p-value Conclusions Measurement of respectful care at exit interview after hospital birth is challenging, and women generally reported 100% respectful care for themselves and their baby. Specific questions, with stratification by mode of birth, women’s age and ethnicity, are important to identify those mistreated during care and to prioritise action. More research is needed to develop evidence-based measures to track experience of care, including zero separation for the mother-newborn pair, and to improve monitoring.

Contains fulltext : 232372.pdf (Publisher’s version ) (Closed access) OBJECTIVE: It is generally unknown how the attitudes and beliefs of health care professionals (HCPs) might affect the attitudes, beliefs, and medication-taking behavior of patients with rheumatoid arthritis (RA). This study aims 1) to examine the attitudes, health-related associations (both implicit and explicit), and beliefs of HCPs about conventional disease-modifying antirheumatic drugs, and 2) to assess whether these attitudes, health-related associations, and beliefs of HCPs are associated with those of their patients, with their patients' medication-taking behavior, and disease activity. METHODS: HCPs were recruited from 2 centers that specialized in rheumatology across The Netherlands, and patient recruitment followed. In this observational study, implicit outcomes were measured with single-category implicit association tests, whereas explicit outcomes were measured with a bipolar evaluative adjective scale and the Beliefs About Medicines Questionnaire-Specific. Spearman's rank correlations were used to describe correlations between implicit and explicit measures of the attitudes of HCPs. Multilevel, mixed-effects linear models were used to examine the association of HCP-related characteristics, including the implicit and explicit outcomes of HCPs, with those of their patients, their medication-taking behaviors, and disease activity. RESULTS: Of the 1,659 initially invited patients, 254 patients with RA (mean age 62.8 years, mean disease duration 11.8 years, and 68.1% of the patients were female) who were treated by 26 different HCPs agreed to participate in this study. The characteristics, attitudes, health-related associations, and beliefs about medicines of HCPs were not significantly associated with those of their patients, nor with their medication-taking behaviors or disease activity scores. CONCLUSION: This study demonstrated that the attitudes, health-related associations (as measured both implicitly and explicitly), and beliefs of HCPs were not significantly associated with the attitudes, beliefs, medication-taking behavior, and disease activity of patients with RA. 10 p.

Objectives The aims of the study were to identify unmet basic needs (BNs) among women referred to colposcopy, to assess patient acceptability/satisfaction with assistance from a navigator to address unmet BNs, and to estimate adherence to colposcopy. Methods Women were recruited between September 2017 and January 2019 from 2 academic colposcopy centers, one serving a rural and one an urban area. Basic needs were assessed by phone before colposcopy appointments and considered unmet if unlikely to resolve in 1 month. Colposcopy adherence prestudy and poststudy implementation was abstracted over 4-6 months from administrative records. After a lead-in phase of 25 patients at each site, a BN navigator was offered to new participants with 1 or more unmet BNs. Primary outcome was adherence to initial appointment. Results Among 100 women, 59% had 1 or more unmet BNs, with similar prevalence between urban and rural sites. Adherence to initial colposcopy was 83% overall, 72% at the rural clinic, and 94% at the urban clinic (p = .006). These adherence rates were improved from 4 months before study launch (30/59 [51%] rural clinic and 68/137 [50%] urban clinic). Although acceptability of BN navigation was greater than 96% and women felt that it helped them get to their colposcopy visit, having a navigator was not associated with adherence. Women reporting no unmet BNs had the lowest adherence compared with women with 1 or more unmet BNs, regardless of navigator assistance (p = .03). Conclusions Disadvantaged women who need colposcopy have unmet BNs and value navigator assistance for initial appointments. However, when appointment scheduling includes telephone reminders and inquiring about BNs, a navigator may not add value.

Purpose: LGBTQ+ individuals experience multiple challenges receiving quality care at the end of life, such as lack of confidence in the healthcare system to address their needs and lack of knowledge about advance care planning. Important gaps remain about the needs of LGBTQ+ individuals in the provider-patient relationship and how critical discussions about the end of life occur or do not occur in that relationship. The purpose of this study is to explore patients’ narratives of their relationship with their provider and their experiences discussing end-of-life care with their providers, among patients who do and do not identify as LGBTQ+. Methods: Twenty-nine attendants of an event devoted to LGBTQ+ health, 15 of which identified as LGBTQ+, completed an altered version of the CAHPS® Patient Narrative Elicitation Protocol. We used inductive content analysis to qualitatively analyze the data. Results: Respondents described wanting to be heard, finding safety and trust, and valuing competency in their relationship with their provider. Respondents who identified as LGBTQ+ additionally 1) valued providers who avoided making assumptions, 2) looked for cues of safety to indicate they would be accepted by the provider, and 3) sought providers competent in LGBTQ+ care needs. Few respondents had discussed end-of-life care with their provider, although some assumed that their provider may or may not be able to meet their needs based on aspects of their provider-patient relationship. Conclusions: Strengthening patient-provider relationships may help improve the care of LGBTQ+ populations, particularly for the end of life.

Objective In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. Methods State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. Results Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. Conclusion Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.

Contains fulltext : 227913.pdf (Publisher’s version ) (Open Access) Background: Neuropsychological feedback is an important part of the neuropsychological assessment process. However, patients have difficulties remembering this information. Objective: The aim of this study was to develop a web-based visual tool to improve the understanding of neuropsychological results, information retention, and psychologist-patient communication. Methods: The visual tool was developed and optimized using an iterative three-phase stepwise approach to determine its usability, technology acceptance, and feasibility in a memory clinic population. Feedback from different user perspectives (patients, family members, and psychologists) was obtained in each phase using a multimethod approach (e.g., a multidisciplinary brainstorm session, think-aloud sessions, focus groups). The prototype was subsequently tested in a pilot study. Results: The first phases offered insights that led to optimization of the prototype. On a scale ranging from 0 to 100, psychologists evaluated the usability as high [88.1±7.6,70-87]. During the pilot study, both patients and significant others gave positive feedback, but information retention in patients remained low. All participants thought the benefits of the visual tool included seeing cognitive strengths and weaknesses with a translation to daily life all at one glance and receiving feedback on paper to take home. Important barriers were mentioned by psychologists, such as a limited set of tests included and no integration with hospital systems. Conclusion: Overall, patients, family members, and psychologists reported that a visual display of the cognitive profile with insights into daily life had added value to clinical practice. Feedback from the pilot study was adopted in the tool for future implementation purposes. 14 p.

Purpose Aphasia after stroke has been shown to lead to communication difficulties between healthcare professionals (HCP) and people with aphasia. Clinical guidelines emphasize the importance of teaching HCP to use supportive conversative techniques through communication partner training (CPT). The aim of this study is to explore and describe the experiences of HCP in communicating with people with aphasia and their needs and wishes for the content in CPT. Materials and methods The data were collected through qualitative semi-structured interviews with 17 HCP. HCP were recruited from two geriatric rehabilitation centres in the Netherlands and one academic hospital in Belgium. The interviews drew upon the qualitative research methodologies ethnography and phenomenology and were thematically analysed using the six steps of Braun & Clarke. Results Three themes were derived from the interviews. HCP experienced that communication difficulties impede healthcare activities (theme 1) and reported the need to improve communication through organizational changes (theme 2), changing the roles of SLTs (theme 3) and increasing knowledge and skills of HCP (theme 4). Conclusions According to HCP, communication difficulties challenge the provision of healthcare activities and lead to negative feelings in HCP. HCP suggest that communication can be improved by providing more time in the healthcare pathway of people with aphasia, adapting healthcare information to the needs of people with aphasia, commitment of physicians and managers, changing the roles of SLTs and improving knowledge and skills of HCP. Implications for rehabilitation Communication between healthcare professionals (HCP) and people with aphasia can be improved by training HCP to use supportive conversation techniques and tools. An important condition for successful implementation of communication partner trainings in healthcare centres is to identify the experiences of HCP with communication with people with aphasia and their needs and wishes for training content. This study shows that communication problems between HCP and people with aphasia impede diagnosis and therapy with considerable implications for healthcare quality. The suggestions that HCP have concerning the content of communication partner trainings can be placed under "education" and "implementation and post-training support." HCP describe specific roles for speech-and language therapists to fulfil after the training and suggest two main changes that should be made at an organizational level.

BackgroundRwanda has made great progress in improving reproductive, maternal, and newborn health (RMNH) care; however, barriers to ensuring timely and full RMNH service utilization persist, including women’s limited decision-making power and poor-quality care. This study sought to better understand whether and how gender and power dynamics between providers and clients affect their perceptions and experiences of quality care during antenatal care, labor and childbirth.MethodsThis mixed methods study included a self-administered survey with 151 RMNH providers with questions on attitudes about gender roles, RMNH care, provider-client relations, labor and childbirth, which took place between January to February 2018. Two separate factor analyses were conducted on provider responses to create a Gender Attitudes Scale and an RMNH Quality of Care Scale. Three focus group discussions (FGDs) conducted in February 2019 with RMNH providers, female and male clients, explored attitudes about gender norms, provision and quality of RMNH care, provider-client interactions and power dynamics, and men’s involvement. Data were analyzed thematically.ResultsInequitable gender norms and attitudes – among both RMNH care providers and clients – impact the quality of RMNH care. The qualitative results illustrate how gender norms and attitudes influence the provision of care and provider-client interactions, in addition to the impact of men’s involvement on the quality of care. Complementing this finding, the survey found a relationship between health providers’ gender attitudes and their attitudes towards quality RMNH care: gender equitable attitudes were associated with greater support for respectful, quality RMNH care.ConclusionsOur findings suggest that gender attitudes and power dynamics between providers and their clients, and between female clients and their partners, can negatively impact the utilization and provision of quality RMNH care. There is a need for capacity building efforts to challenge health providers’ inequitable gender attitudes and practices and equip them to be aware of gender and power dynamics between themselves and their clients. These efforts can be made alongside community interventions to transform harmful gender norms, including those that increase women’s agency and autonomy over their bodies and their health care, promote uptake of health services, and improve couple power dynamics.

Background Between 2006 and 2013, Peru implemented national programs which drastically decreased rates of maternal and neonatal mortality. However, since 2013, maternal and neonatal mortality in Peru have increased. Additionally, discrimination, abuse, and violence against women persists globally and impacts birthing experiences and mental health. This qualitative study sought to better understand the attitudes and beliefs regarding childbirth among women and providers in Southern Peru. This study also explores how these beliefs influence utilization of skilled care, patient-provider dynamics, and childbirth experiences and identifies factors that impact providers’ provision of care. Methods Thirty semi-structured interviews were conducted with 15 participants from rural Colca Canyon and 15 participants from urban Arequipa between April and May 2018. In each region, 10 women who had experienced recent births and five providers were interviewed. Provider participants predominantly identified as female and were mostly midwives. All interviews were conducted, transcribed, and coded in Spanish. A framework analysis was followed, and data were charted into two separate thematic frameworks using contextual and evaluative categories of conceptualization of childbirth. Results All recent births discussed were facility-based births. Four domains emerged: women’s current birth experiences, provision of childbirth care, beliefs about childbirth among women and providers, and future health-seeking behavior. Findings suggest that women’s feelings of helplessness and frustration were exacerbated by their unmet desire for respectful maternity care and patient advocacy or companionship. Providers attributed strain to perceived patient characteristics and insufficient support, including resources and staff. Conclusions Our findings suggest current childbirth experiences placed strain on the patient-provider dynamic and influenced women’s attitudes and beliefs about future experiences. Currently, the technical quality of safe childbirth is the main driver of skilled birth attendance and facility-based births for women regardless of negative experiences. However, lack of respectful maternity care has been shown to have major long-term implications for women and subsequently, their children. This is one of the first studies to describe the nuances of patient-provider relationships and women’s childbirth experiences in rural and urban Peru.

Introduction Patient navigation programs can help people overcome barriers to outpatient care. Patient experiences with these programs are not well understood. The goal of this study was to understand patient experiences and satisfaction with an emergency department (ED)-initiated patient navigation (ED-PN) intervention for US Medicaid-enrolled frequent ED users. Methods We conducted a mixed-methods evaluation of patient experiences and satisfaction with an ED-PN program for patients who visited the ED more than four times in the prior year. Participants were Medicaid-enrolled, English- or Spanish-speaking, New Haven-CT residents over the age of 18. Pre-post ED-PN intervention surveys and post-ED-PN individual interviews were conducted. We analyzed baseline and follow-up survey responses as proportions of total responses. Interviews were coded by multiple readers, and interview themes were identified by consensus. Results A total of 49 participants received ED-PN. Of those, 80% (39/49) completed the post-intervention survey. After receiving ED-PN, participants reported high satisfaction, fewer barriers to medical care, and increased confidence in their ability to coordinate and manage their medical care. Interviews were conducted until thematic saturation was reached. Four main themes emerged from 11 interviews: 1) PNs were perceived as effective navigators and advocates; 2) health-related social needs were frequent drivers of and barriers to healthcare; 3) primary care utilization depended on clinic accessibility and quality of relationships with providers and staff; and 4) the ED was viewed as providing convenient, comprehensive care for urgent needs. Conclusions Medicaid-enrolled frequent ED users receiving ED-PN had high satisfaction and reported improved ability to manage their health conditions.

Background Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. Methods A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. Results Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician–patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%). Conclusions There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.

Background Stigma and bias experienced during prenatal care can affect quality of care and, ultimately, the health of pregnant women with obesity and their infants. We sought to 1) better understand the bias and stigma that women with BMIs ≥40 kg/m2 experience while receiving prenatal care, 2) gauge women’s interest in group prenatal education for women with obesity, and 3) gather feedback about their preferred weight-related terminology. Methods We conducted and thematically content-analyzed 30 semi-structured interviews of women with BMIs ≥40 kg/m2 who received prenatal care at a university-affiliated teaching hospital in the Midwest region of the United States. Results All women recalled positive experiences during their perinatal care during which they felt listened to and respected by providers. However, many also described a fear of weight-related bias or recalled weight-based discrimination. Women reacted favorably to a proposed group prenatal care option for pregnant women with obesity that focused on nutrition, physical activity, and weight management. Women rated “weight” and “BMI” as the most desirable terms for describing weight, while “large size” and “obesity” were rated least desirable. Conclusions Many pregnant women with BMIs ≥40 kg/m2 experience bias in the prenatal care setting. Potential steps to mitigate bias towards weight include improving provider awareness of the experiences and perspectives of this population, expanding prenatal care options targeted towards women with high BMIs, including group care, and using patient-preferred weight-related terminology. Through the remainder of this manuscript, wherever possible, the term “high BMI” will be used in place of the term “obesity” to describe women with BMI ≥ 30 kg/m2 in order to respect the preferred terminology of the women we interviewed.

Sickle cell disease, the most common inherited disorder at birth in the UK, has been included in the UK newborn screening programme since 2006. For parents, receiving the news that their newborn has a serious long-term condition can trigger reactions such as shock, disbelief and guilt. Guidelines on sickle cell disease provide clear screening pathways, but there is variation in how and by whom positive results are communicated to parents. The way in which this is done is crucial, not only for parents' acceptance of the diagnosis but also for their future therapeutic relationships with healthcare professionals and therefore for their child's future health outcomes. Being given reliable and relevant information by confident and knowledgeable staff gives parents hope that their child will achieve a good quality of life. Based on the literature and on the author's experience as a haemoglobinopathy nurse specialist, this article discusses how to improve the communication of positive newborn screening results to parents of children with sickle cell disease.

Perinatal mood and anxiety disorders (PMADs) affect up to 20% of pregnant and postpartum women and can have negative sequelae for maternal-child health. Nurses with clinical and research roles are on the front line of efforts to assess for and assist with prevention and intervention with PMAD symptoms. Thus, they can play an essential role in enhancing the mental well-being of women in the perinatal period and maternal-child health outcomes. The aim of this article is to assist nurses in this work by outlining the Comprehensive Model of Mental Health during the Perinatal Period, a conceptual framework for considering clinical and research opportunities to enhance perinatal mental health. The framework uses key principles that recognize biopsychoneuroimmunologic mechanisms involved in mental health; the key role that the experience of matrescence ("becoming a mother") plays in mental health and maternal-child health; and the mother-infant dyad as the functional unit during the perinatal period. Examples are provided of how the key principles of this framework might be used to enhance research and clinical practice about PMADs and, ultimately, enhance maternal-child health outcomes.

Positive patient outcomes depend on successful communication. Increased use of personal protective equipment such as face masks during the COVID-19 pandemic can exacerbate communication difficulties. This article describes situations in which miscommunications may occur, identifies sources of communication breakdowns, and offers strategies to prevent them in real-life scenarios.

Background The importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed. Methods Data collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data. Results Therapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional. Conclusion This study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.

Empathy is an important characteristic for healthcare students and professionals that may improve the quality of healthcare interactions. Empathy has predominantly been studied within medicine, but also among various allied health personnel. Within paramedicine, empathy has previously been examined internationally, but not within Japan. This study used a descriptive, cross-sectional methodology which aimed to examine self-reported empathy in Japanese paramedic students using the Jefferson Scale of Empathy, and compare results with similar international cohorts. Empathy levels in the Japanese cohort were higher among females compared to males. In addition, there was a decrease in empathy with each subsequent year of the paramedic program, and a general decrease as age increased. This contrasts with comparable Australian cohorts which demonstrate no significant change in empathy levels during the undergraduate program. Empathy levels measured in the Japanese paramedic cohort were generally lower than for Australian cohorts. The reasons for the differences are unclear at present and thus further research in this area is required to fully determine and describe the contributing factors.

Recommendations to routinely question patients about violence victimization have been around for many years; nonetheless, many patients suffering in the aftermath of violence go unnoticed in health care. The main aim of this study was to explore characteristics associated with being asked about experiences of violence in health care and thereby making visible victims that go unnoticed. In this study, we used cross-sectional survey data from 754 men (response rate 35%) and 749 women (response rate 38%) collected at random from the Swedish population, age 25-85. Questions were asked about experiences of emotional, physical, and sexual violence from both family, partner, and other perpetrators. Only 13.1% of those reporting some form of victimization reported ever being asked about experiences of violence in health care. Low subjective social status was associated with being asked questions (adj OR 2.23) but not with victimization, possibly indicating prejudice believes among providers concerning who can be a victim of violence. Other factors associated with increased odds of being asked questions were: being a woman (adj OR 2.09), young age (24-44 years, adj OR 6.90), having been treated for depression (adj OR 2.45) or depression and anxiety (adj OR 2.19) as well as reporting physical violence (adj OR 2.74) or polyvictimization (adj OR 2.85). The main finding of the study was that only few victims had been asked questions. For example, among those reporting ≥4 visits to a primary care physician during the past 12 months, 43% reported some form of victimization but only 6% had been asked questions. Our findings underline the importance of continuing to improve the health care response offered to victims of violence. Funding: Region Ostergotland [LIO-514621]

Introduction As the number of women surviving breast cancer grows, it becomes increasingly important to investigate their unique psychosocial and physical needs in the post-treatment period. The period of transition from patient to survivor is a time fraught with physical and emotional challenges. This qualitative study was conducted to gain insight into the perspective of breast cancer patients transitioning to survivorship after receiving RT in Alberta. Methods Ten patients receiving radiation therapy (RT) for breast cancer in Alberta participated in an open-ended telephone interview two to three weeks following the cessation of treatment. The data was analyzed using a qualitative interpretive phenomenological approach. Data was clustered and categorized, and emerging themes were examined. Results Though participants reported to be satisfied with the care and information they received, a need for more robust and detailed skin care education was identified. Patients expressed a sense of anxiety around returning to normalcy following RT, and described feeling lonely, and unsure of themselves in the post-treatment period. A post-treatment phone call may allow Radiation Therapists (RTTs) to mitigate the ongoing needs of patients in the period between their last day of treatment and their first follow-up visit. Conclusion This project has given us an opportunity to hear the voice of the patient, thus laying the groundwork to allow for a more patient-centred approach to the transition of care following RT. The data gathered suggests possible areas for development of interventions and supports for breast cancer patients as they transition into survivorship.

Background The concept of caring is rapidly becoming an area of interest in healthcare research, especially in medical imaging. While patients, academic institutions, hospitals and policy makers have an expectation for healthcare professionals to be caring, the effects of such a relationship between patient and professional is equally important to understand. Within sonography, a discipline of radiography, there is limited literature on this concept. Purpose The purpose of the main study was to explore and describe the sonographers’ experiences of being caring professionals within private practices in the province of Gauteng, South Africa. This paper focuses on one essential theme that emerged from the study: the effects of a caring relationship between sonographer and patient. Guidelines to enhance caring relationships are also provided. Materials and methods A qualitative, exploratory, descriptive, contextual, phenomenology research design was utilised. Four focus group interviews (n = 14) were conducted with qualified sonographers working in the private sector, in Gauteng. Data collection took place until data saturation was reached. Results Sonographers described caring for their patients as having both positive and negative effects on themselves. Sonographers explained having developed protective mechanisms to help them when caring for tenacious patients. There was also a sense of emotional and psychological strain identified. Despite this, sonographers displayed a sense of professional pride for their careers. Conclusion Guidelines were developed to alleviate the emotional and psychological strains sonographers are burdened with. These guidelines included; the facilitation of a supportive and healing environment through reflective practice, availability of a psychologist, and having a tea garden at work.