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Introduction: Divided narratives pose long‐standing difficulties in physician and patient communication. In decision‐making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision‐making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. Methods: This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. Results: Both physicians and patients were concerned about goals and obstacles to their decision‐making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. Conclusion: Cancer treatment decision‐making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision‐making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision‐making approach, whereas patients generally adopt a relational decision‐making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision‐making. The results of this study provide a new perspective to treatment decision‐making, emphasizing the importance of narrative integration in reaching mutual agreement. Patient and Public Contribution: The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Divided narratives pose long‐standing difficulties in physician and patient communication. In decision‐making on cancer treatment, divided narratives between physicians and patients hinder mutual understanding and agreement over the illness and its treatment. For effective decision‐making on treatments, it is necessary to investigate the similarities and differences in these divided narratives. Methods This study adopted a qualitative research design of narrative inquiry to examine the data, which included interviews with 32 cancer patients and 16 paired physicians in two hospitals in China. Data analysis was conducted using grounded theory to generate findings. Results Both physicians and patients were concerned about goals and obstacles to their decision‐making on cancer treatment. Four common aspects of goal setting were identified from the divided narratives: decision pools, treatment goals, identity practice and preferred identity. Four common obstacles were identified: pains and trust, communication gap, financial issues and complex family. However, the meanings attached to these eight aspects differed between physicians and patients. Conclusion Cancer treatment decision‐making is an encounter of the scientific world and lifeworld. A divided narrative approach can identify the similarities and differences in the decision‐making on cancer treatment between physicians and patients. Physicians generally adopt a rational decision‐making approach, whereas patients generally adopt a relational decision‐making approach. Despite the common concerns in their goals and obstacles, physicians and patients differed in their contextualized interpretations, which demonstrates the physicians' and the patients' pursuit of preferred identities in decision‐making. The results of this study provide a new perspective to treatment decision‐making, emphasizing the importance of narrative integration in reaching mutual agreement. Patient and Public Contribution The findings were shared with 15 cancer patients and caregivers for feedback and advice in June 2024. This study was also presented at the international conferences of COMET (International and Interdisciplinary Conference on Communication, Medicine, and Ethics) and ICCH (International Conference on Communication in Healthcare) 2023 for continuous feedback and comments.

PURPOSE To learn how the highest-performing primary care practices manage change when implementing improvements to diabetes care delivery. METHODS We ranked a total of 330 primary care practices submitting practice management assessments and diabetes reports to the Understanding Infrastructure Transformation Effects on Diabetes study in 2017 and 2019 by Optimal Diabetes Care performance. We ranked practices from the top quartile by greatest annual improvement to capture dynamic change. Starting with the top performers, we interviewed practice leaders to identify their most effective strategies for managing change. Interview transcripts were qualitatively analyzed to identify change management strategies. Saturation occurred when no new strategies were identified over 2 consecutive interviews. RESULTS Ten of the top 13 practices agreed to interviews. We identified 199 key comments representing 48 key care management concepts. We also categorized concepts into 6 care management themes and 37 strategic approaches. We categorized strategic approaches into 13 distinct change management strategies. The most common strategies identified were (1) standardizing the care process, (2) performance awareness, (3) enhancing care teams, (4) health care organization participation, (5) improving reporting systems, (6) engaging staff and clinicians, (7) accountability for tasks, (8) engaging leadership, and (9) tracking change. Care management themes identified by most practices included proactive care, improving patient relationships, and previsit planning. CONCLUSIONS Top-performing primary care practices identify a similar group of strategies as important for managing change during quality improvement activities. Practices involved in diabetes improvement activities, and perhaps other chronic conditions, should consider adopting these change management strategies. Key words: quality of health care; quality of health care; diabetes mellitus, type 2; delivery of health care; primary health care; organizational culture, INTRODUCTION Although the need to improve diabetes outcomes in primary care is evident, exactly how a practice successfully manages change in care delivery in l the midst of a busy [...]

Family medicine is a champion of human-focused health care in the context of lasting relationships. What do humans need--those who seek care and those who offer it? Respect, understanding, and kindness. Without it, more money, more ancillary personnel, more time-saving technology cannot lift us from the profession's doldrums. The author believes that the deep desire to be of help to others can be rekindled in an office culture where the humanity in all of us is honored. Key words: office culture; humanism; doctor-patient relationship; practice transformation; family medicine, Every day and without fanfare, patients are leaving the family practice where I have worked many years. They are transferring to other practices, going to urgent care centers and emergency [...]

Purpose Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. Methods A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients [greater than or equal to] 18 years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180 days of index encounter. Results Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89-1.11), propensity weighting (OR 0.93; 95% CI 0.83-1.05), and entropy balancing (OR 0.94; 95% CI 0.83-1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180 days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180 days was not observed. Conclusion Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180 days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI., Author(s): Michael R. Ehmann [sup.1], Jonathon Mitchell [sup.1], Scott Levin [sup.1], Aria Smith [sup.1], Steven Menez [sup.2], Jeremiah S. Hinson [sup.1], Eili Y. Klein [sup.1] [sup.3] Author Affiliations: (1) grid.21107.35, [...]