Barriers To Care Research Articles

Culturally Safe Care Barriers and Facilitators in Organ Transplantation and Donation According to First Nations and Health Professionals in Quebec, Canada.

Introduction: First Nations are most at risk of developing end-stage kidney disease. Kidney transplantation is the best treatment option for these patients; however, First Nations donors are underrepresented. The aim of this study was to describe and understand barriers and facilitators of culturally safe organ transplantation and donation from the perspective of First Nations and Health Professionals in the Province of Quebec, Canada. Methods/Approach: This was a qualitative descriptive study using the decolonizing Two-Eyed Seeing approach. The sample consisted of First Nations people and health professionals living in Quebec, Canada, who have had an experience of organ transplantation or donation. Semi-structured interviews were conducted between May and September 2021 with 11 people, including 5 healthcare professionals and 6 First Nations people. Findings: This study enrolled 11 participants. Several individual and contextual factors influencing culturally safe organ transplantation and donation among First Nations people were identified: language barrier, impacts of relocation, lack of knowledge about transplantation, mistrust of the healthcare system, family support and accompaniment, and transplant testimonials. Discussion: This study identified several avenues for reinforcing culturally safe transplantation and donation among First Nations, including the presence of a companion in medical consultations, focusing on access to culturally safe accommodation and sharing transplant testimonials. Further work in partnership with First Nations is needed to improve access to culturally safe organ transplantation.

"Complete and Accurate, and Warmhearted Too": Telemedicine Experiences and Care Needs of Mandarin-Speaking Patients with Limited English Proficiency.

Despite greater care needs, patients with limited English proficiency (LEP) are less likely to use telemedicine. Given the expansion of telemedicine since the COVID-19 pandemic, identifying ways to narrow the telemedicine care gaps experienced by people with LEP is essential. Examine the telemedicine experiences of Mandarin-speaking adults with LEP, with a focus on perceived differences between in-person care, video, and telephone telemedicine. Random sample of Kaiser Permanente Northern California (KPNC) members who completed at least one primary care telemedicine visit in August 2021, aged 40years or older, and had electronic health record-documented need for a Mandarin interpreter. The sample was stratified by telemedicine visit type (video or phone). Semi-structured Mandarin-language telephone interviews with a bilingual and bicultural research assistant collected patient experiences with telemedicine in general and telemedicine visits assisted by interpreters. Two coders used rapid qualitative analytic techniques to capture themes. Among 20 respondents (n = 12, 60% women) age 41-81, all had prior experience with telephone visits and 17 (85%) had experience with video visits. Patients reported three major themes: (1) communication, language skills, and how patience impacts care quality; (2) the importance of matching patient preferences on communication modality; and (3) the need for comprehensive language services throughout the continuum of healthcare delivery. Mandarin-speaking adults with LEP see telemedicine as a convenient and necessary service. Issues with healthcare providers' and interpreters' communication skills and impatience were common. The lack of wrap-around language-concordant care beyond the visit itself was cited as an ongoing and unaddressed care barrier. Healthcare provider and interpreter training is important, as is availability of personalized and comprehensive language services in promoting patient autonomy, alleviating the burden on patients' families, and thus ensuring equitable healthcare access.

Artificial Intelligence as a Potential Catalyst to a More Equitable Cancer Care.

As we enter the era of digital interdependence, artificial intelligence (AI) emerges as a key instrument to transform health care and address disparities and barriers in access to services. This viewpoint explores AI's potential to reduce inequalities in cancer care by improving diagnostic accuracy, optimizing resource allocation, and expanding access to medical care, especially in underserved communities. Despite persistent barriers, such as socioeconomic and geographical disparities, AI can significantly improve health care delivery. Key applications include AI-driven health equity monitoring, predictive analytics, mental health support, and personalized medicine. This viewpoint highlights the need for inclusive development practices and ethical considerations to ensure diverse data representation and equitable access. Emphasizing the role of AI in cancer care, especially in low- and middle-income countries, we underscore the importance of collaborative and multidisciplinary efforts to integrate AI effectively and ethically into health systems. This call to action highlights the need for further research on user experiences and the unique social, cultural, and political barriers to AI implementation in cancer care.

"I don't think people should die young": perspectives of parents with children diagnosed with familial hypercholesterolemia.

Familial Hypercholesterolemia (FH) is an inherited disorder that significantly increases an individual's risk of developing premature cardiovascular disease (CVD). Early intervention involving lifestyle modification and medication is crucial in preventing CVD. Prior studies have shown that lipid-lowering therapy in children is safe and effective. Despite FH being a treatable and manageable condition, the condition is still underdiagnosed and undertreated. Universal lipid screening (ULS) in children has been recommended by some medical experts in the United States as a strategy to identify cases of FH and maximize the benefits of early invention. However, lipid screening is not routinely offered in pediatric clinics. This study aimed to explore parental experience with FH diagnosis in their children, identify key facilitators and barriers in children's diagnosis and care, and examine parental perspectives on ULS in children in the United States. A total of fourteen semi-structured interviews were conducted with participants recruited through the Family Heart Foundation. Thematic analysis identified three key themes: role of family history in facilitating child's FH diagnosis, barriers and challenges in post-diagnosis care, and attitudes towards ULS in children. All participants supported ULS in children and emphasized the value of early diagnosis and treatment for FH. However, a lack of guidance or referral after the child's diagnosis was a concern raised by many participants. This underscores the need for accessible and comprehensive care amid ongoing efforts to increase pediatric diagnosis of FH.

Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns – results of a pilot study in Berlin, Germany

BackgroundUtilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service.MethodsLow-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated.ResultsBetween December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service.ConclusionsWith this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits.Trial RegistrationGerman Clinical Trials Register (DRKS00023480); date 2020/11/27.

Navigating the Role of Mobile Audiology in Public Health: Overcoming Hearing Health Care Barriers That Impact the Underserved

Purpose: The purpose of this clinical focus article is to convey the significant role that mobile audiology could have in the public health space and discuss how mobile audiology can overcome obstacles that hinder access to traditional audiological care. This article also introduces strategies for delivering innovative audiological care. Method: The article is drawn from the authors' personal research, business, and clinical experiences. It describes the variations in mobile audiology that could aid in improving health care outcomes, identifying underserved areas, identifying barriers, implementing innovative solutions to overcome barriers, limitations of mobile audiology, and implications for optimized hearing health care. Conclusions: Mobile audiology services may play a vital role in public health programs and initiatives by bringing hearing health care to underserved communities, promoting accessibility, and addressing hearing health care concerns that disproportionately impact vulnerable populations. Mobile audiology services extend beyond the conventional concept of service delivery and can reduce barriers that prevent access to hearing health care, such as lack of transportation, geographical conditions/distance, time, lack of insurance coverage for evaluation/treatment, lack of qualified hearing health professionals, and financial constraints. Various services can be offered through mobile audiology, such as comprehensive screenings, diagnostic evaluations, and rehabilitation services/interventions. Mobile audiology services provide patients with the intervention necessary to improve communication abilities, quality of life, and overall health care outcomes.

The Double-Edged Sword of Extremely High Prices for Gene Therapies in Sickle Cell Disease

This Viewpoint discusses the high cost of new gene therapies for sickle cell disease, the challenges these costs pose for health care access, and new policy approaches to ensure fair reimbursement for payers and manufacturers without further increasing health care costs or barriers to access for underserved populations.

Steatotic liver disease and HIV: an agenda for 2030.

People living with HIV are particularly susceptible to developing metabolic disorders, including metabolic dysfunction-associated steatotic liver disease and other forms of SLD. However, people living with HIV have been historically excluded from clinical trials and large cohort studies of SLD. Therefore, our understanding of the risk factors and natural history of SLD in this population is poor. Moreover, relevant knowledge gaps on the epidemiology and barriers for adequate health care, such as stigma, hamper adequate responses to the ongoing HIV and SLD syndemic. This Viewpoint provides a comprehensive perspective on how to tackle SLD in people living with HIV by examining the role of social determinants of health in the development of liver disease and metabolic syndrome comorbidities among this population, emphasising the importance of prioritising SLD management, summarising the most urgent needs in the field, and offering recommendations for advancing research to fill key data gaps and protect liver health of people living with HIV.

"Little by little, I started feeling I am unable to handle my child alone" - Lived experiences of mothers with postpartum depression and anxiety.

Anxiety and depression during the postpartum period can have a significant impact on mothers' perceived sense of responsive caregiving, causing considerable distress. This association may be affected by mothers' perception about social support. In the context of low-and-middle-income countries where prevalence rates of maternal mental illnesses are high and access to health care services is limited, informal supports become more relevant. The study aims to understand the lived experience of mothers who had postpartum depression or anxiety and their perceived distress related to infant care giving. It also explores the role of social support in the motherhood experience. Six mothers with postpartum depression or anxiety were interviewed to understand their experience of postpartum depression and/or anxiety and their perceptions about social support. The interviews were analyzed using a reflexive thematic analysis approach. The thematic analysis revealed four themes, namely, (a) uncertainty and helplessness, (b) misattunement with the immediate family, (c) personal strength rooted in the family support system, and (d) other means of coping. Mothers with postpartum anxiety and depression can have emotional, informational, and tangible social support needs in the context of uncertainty and helplessness, which are associated with different challenges and barriers for infant care in the Indian context. Support from family members is viewed as a pillar of comfort and recovery for the mothers. At the same time, if it is not adequately attuned to the needs of the mother, it can become a major source of distress.

Exploring the Challenges in Palliative Care As Perceived by the Saudi Physicians: A Cross-Sectional Study.

Palliative care is essential for managing patients with life-limiting illnesses. In Saudi Arabia, providing effective palliative care is uniquely challenging due to cultural, religious, and social factors. Despite healthcare advancements, there is a gap in understanding the challenges faced by physicians in palliative care within this context. This study aimed to explore the challenges encountered in palliative care as perceived by physicians in Riyadh, Saudi Arabia. A cross-sectional survey was conducted using an electronic questionnaire distributed among physicians involved in palliative care at the specified healthcare institutions. The questionnaire assessed their perceptions of the challenges in palliative care and the influence of their socio-demographic backgrounds on these perceptions. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). The age distribution of the enrolled physicians showed that a majority were between 20-40 years old (48.48%, n = 96). Male physicians accounted for 64.65% (n = 128), and females for 35.35% (n = 70). Various specialties were represented, with critical care (15.66%, n = 31) and radiation oncology (16.67%, n = 33) being the most common. Major challenges identified included limited outpatient and inpatient services (54.55%, n = 108), restricted access to allied healthcare professionals (60.61%, n = 120), ethical dilemmas due to triaging (63.13%, n = 125), lack of telemedicine facilities (57.07%, n = 113), and the impact of the COVID-19 pandemic on pain and palliative care research (60.1%, n = 119). Strategies adopted to mitigate these challenges included creating triage systems (54.55%, n = 108), using telemedicine (60.61%, n = 120), advanced care planning (63.13%, n = 125), and providing necessary personal protective equipment (PPE) (60.1%, n = 119). This study highlights significant barriers in palliative care, such as limited services, ethical dilemmas, and lack of telemedicine facilities. Addressing these challenges requires ethical support for healthcare providers, integration of telemedicine, continuous education, and improved access to multidisciplinary care teams, which are crucial for enhancing palliative care quality and ensuring comprehensive patient support.

Towards equitable renal care: Strategies for enhancing kidney transplantation in Africa

Chronic kidney disease (CKD) is defined as the presence of kidney damage persisting for 3 months or more. Kidney transplantation stands as a vital intervention for individuals grappling with end-stage renal disease (ESRD) in Africa, offering the promise of extended life and improved quality of life. However, numerous challenges hinder its widespread implementation across the continent. This paper explored kidney transplantation in Africa, aiming to illuminate key strategies for bridging gaps and building pathways to enhanced renal care. There is a disproportionate burden of CKD on the region's population. Therefore, there is a critical need for early diagnosis and intervention. This paper outlines comprehensive strategies for improving kidney transplantation in Africa. Results indicate that financial support systems, infrastructure enhancement, public awareness campaigns, and legal frameworks are essential for addressing renal care barriers. Active measures such as government subsidy programs, international funding collaboration, and engagement with community leaders are highlighted as effective approaches. Drawing from global standards and best practices, the paper shows the importance of tailored approaches that address Africa's unique socio-economic and healthcare landscape. By leveraging collaborative efforts, regulatory frameworks, and public engagement, African nations can overcome barriers to kidney transplantation and pave the way for equitable access to life-saving treatment.

Countering the Identified Barriers to Delivered Oral Care for Children With Special Healthcare Needs: A Narrative Review.

Children with Special Health Care Needs (SHCNs) have poor oral health as a result of structural and systemic barriers. These children frequently have limited access to dental treatment, a higher prevalence and incidence of dental problems, and worse oral hygiene than the rest of the population.This review aims to offer an understanding of the existing oral care barriers of children with SHCNs. We reviewed the literature on children with SHCNs and their caregivers to identify the implications of the barriers faced by these individuals. Some of the perceived barriers to appropriate oral healthcare faced by these children include obstacles to adequate oral care and hygiene in the home, challenging behaviours, and limited preventive care and accessibility. We focussed on interventions and different management approaches to support the stakeholders responsible for these children. There is a need for strong communication as well as care coordination between caregivers, dentists, and other providers to achieve positive outcomes. The current dental healthcare system appears to desert the needed demands of this demographic.

Care Patterns and Barriers to Outpatient Care for Adults With AML Following Intensive Chemotherapy at NCCN Member Institutions.

Prolonged hospitalization following intensive (re)induction chemotherapy for acute myeloid leukemia (AML), while standard, is costly and resource intense, limits inpatient bed capacity, and negatively impacts quality of life. Early hospital discharge (EHD) following completion of chemotherapy has proven safe as an alternative at select institutions, but is not widely implemented. From February 2023 through May 2023, the NCCN Best Practices Committee conducted a survey evaluating AML hospitalization patterns, care models, and barriers to EHD at its 33 member institutions. A total of 30 (91%) institutions completed the survey; two-thirds treat >100 patients with AML annually and 45% treat more than half of these with intensive chemotherapy. In the (re)induction setting, 80% of institutions keep patients hospitalized until blood count recovery, whereas 20% aim to discharge patients after completion of chemotherapy if medically stable and logistically feasible. The predominant reasons for the perceived need for ongoing hospitalization were high risk of infection, treatment toxicities, and lack of nearby/accessible housing. There was no significant association between ability to practice EHD and annual AML volume or treatment intensity patterns (P=.60 and P=.11, respectively). In contrast, in the postremission setting, 87% of centers support patients following chemotherapy in the outpatient setting unless toxicities arise requiring readmission. Survey responses showed that 80% of centers were interested in exploring EHD after (re)induction but noted significant barriers, including accessible housing (71%), transportation (50%), high toxicity/infection rate (50%), high transfusion burden (50%), and limited bed availability for rehospitalization (50%). Hospitalization and care patterns following intensive AML therapy vary widely across major US cancer institutions. Although only 20% of surveyed centers practice EHD following intensive (re)induction chemotherapy, 87% do so following postremission therapy. Given the interest in exploring the EHD approach given potential advantages of EHD for both patients and health care systems, strategies to address identified medical and logistical barriers should be explored.

Effects of Chatbot Components to Facilitate Mental Health Services Use in Individuals With Eating Disorders Following Online Screening: An Optimization Randomized Controlled Trial.

Few individuals with eating disorders (EDs) receive treatment. Innovations are needed to identify individuals with EDs and address care barriers. We developed a chatbot for promoting services uptake that could be paired with online screening. However, it is not yet known which components drive effects. This study estimated individual and combined contributions of four chatbot components on mental health services use (primary), chatbot helpfulness, and attitudes toward changing eating/shape/weight concerns ("change attitudes," with higher scores indicating greater importance/readiness). Two hundred five individuals screening with an ED but not in treatment were randomized in an optimization randomized controlled trial to receive up to four chatbot components: psychoeducation, motivational interviewing, personalized service recommendations, and repeated administration (follow-up check-ins/reminders). Assessments were at baseline and 2, 6, and 14 weeks. Participants who received repeated administration were more likely to report mental health services use, with no significant effects of other components on services use. Repeated administration slowed the decline in change attitudes participants experienced over time. Participants who received motivational interviewing found the chatbot more helpful, but this component was also associated with larger declines in change attitudes. Participants who received personalized recommendations found the chatbot more helpful, and receiving this component on its own was associated with the most favorable change attitude time trend. Psychoeducation showed no effects. Results indicated important effects of components on outcomes; findings will be used to finalize decision making about the optimized intervention package. The chatbot shows high potential for addressing the treatment gap for EDs.

Investigation on pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China

ObjectiveThis study aimed to understand the current status of pharmaceutical care barriers perceived by clinical pharmacists in secondary and tertiary hospitals in China, and to provide a reference for further improving the quality of pharmaceutical care and perfecting the construction of pharmaceutical care system in China. MethodsThe PCBS-CH scale (Pharmaceutical Care Barriers Scale in Chinese Hospitals) was used to measure the perceived pharmaceutical care barriers of clinical pharmacists, and descriptive statistical analysis was used to identify the main barriers faced by clinical pharmacists. The different barriers perceived by clinical pharmacists with various characteristics was investigated by subgroup analysis. ResultsA total of 1266 clinical pharmacists from 31 provinces were finally included. The results revealed that the main barriers faced by clinical pharmacists in the process of implementing pharmaceutical care included lack of additional staffing, lack of time for pharmaceutical care provision and continuing education, and lack of an electronic information system and prescription evaluation system for pharmaceutical care. Subgroup analysis found that clinical pharmacists who are without training (P < 0.001), worked in tertiary hospitals (P = 0.036), and had other training certificates (P < 0.001) perceived higher pharmaceutical care barriers. ConclusionClinical pharmacists in secondary and tertiary hospitals in China have a low perception of overall pharmaceutical care barriers, but still face some important barriers. In order to promote the development of pharmaceutical care in China, the quality of clinical pharmacists should be improved, strict entry criteria should be established, clear responsibilities should be defined, the rights of female clinical pharmacists should be protected, and hospital facilities should be upgraded.

Non-Suicidal Self-Injury among Adolescents: Effect of Knowledge, Attitudes, Role Perceptions, and Barriers in Mental Health Care on Teachers' Responses.

Non-suicidal self-injury (NSSI) involves the deliberate harm of one's body without the intent to commit suicide and is particularly concerning among adolescents. Teachers play a critical role as gatekeepers in identifying and addressing self-harm, underscoring the importance of their knowledge and response strategies in this area. This study explored how teachers' knowledge, attitudes towards NSSI, perceived roles, and workplace barriers affect their responses to students exhibiting NSSI behaviors. A cross-sectional survey was conducted among 203 middle and high school teachers in Israel. Data were collected during July and August 2023 using six validated questionnaires. Higher levels of teacher knowledge, positive attitudes, and strong role perceptions correlated with more effective responses to NSSI, whereas increased workplace barriers tended to diminish response efficacy. Positive correlations emerged between role perception and both knowledge and attitudes, whereas negative correlations emerged between workplace barriers, attitudes, and role perceptions. Teaching experience moderated the impact of role perception and workplace barriers on responses. Significant differences were observed between regular and special education settings, although no differences were noted in referral rates or years of seniority. These findings suggest that enhancing teacher knowledge and attitudes towards NSSI, while addressing workplace barriers, can improve response efficacy in educational settings.

Who Are the People With Chronic Severe Back Pain Not Receiving Pain Treatment?

There is substantial access to care barriers for persons with chronic pain. Little is known about persons who do not receive treatment for chronic severe back pain as most studies rely on clinical samples. We sought to explore demographic, socioeconomic, and clinical characteristics of U.S. adults with chronic severe back pain who had not received pain care in the preceding 3 months. In this cross-sectional study, we used data from the 2019 National Health Interview Survey and identified persons who did/did not receive treatment (including self-management strategies) in the last 3 months for their chronic severe back pain. We used bivariate and multivariable analyses to explore factors associated with not receiving pain treatment. Almost 21% of persons with chronic severe back pain did not receive treatment in the past 3 months. The following were independently associated with not having treatment in the preceding 3 months: male sex (OR: 1.40, 95% CI: 1.11–1.76), living near or below the poverty level (OR: 1.92, 95% CI: 1.33–2.77), having less than a high school education (OR: 2.37, 95% CI: 1.52–3.68), not having insurance coverage (OR: 1.77, 95% CI: 1.21–2.59), living in the South (OR: 2.05, 95% CI: 1.40–3.00), and having heart disease (OR: 1.47, 95% CI: 1.11–1.93). Being a single parent, having depression, and multiple comorbid painful health conditions were associated with having treatment. Our conclusions are that one-fifth of persons with chronic severe back pain did not receive treatment for at least 3 months and socioeconomic factors were highly associated with not receiving treatment. PerspectiveIn a nationally representative sample of persons with chronic severe back pain, one-fifth did not receive treatment for at least 3 months. Socioeconomic factors were highly associated with not receiving treatment. There is a need to implement solutions to reduce barriers to care.

Preventative dental practices and cardiometabolic health in adolescents.

The aim of this study was to identify the relationship between preventative dental practices and cardiometabolic health in adolescents. Analysis included children aged 13-17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011-2018 who completed an Oral Health Examination and Questionnaire. Deferred dental care was defined as not having a dental visit in the past year. Financial barriers to seeking dental care (vs. no financial barriers) were assessed among those with deferred dental care in the past year. Primary cardiometabolic outcomes included obesity, elevated blood pressure and hypertensive blood pressure. Secondary outcomes included dyslipidemia, glucose intolerance, uric acid, glomerular hyperfiltration, and albuminuria. Regression models adjusted for age, sex, ethnicity, household income, food insecurity, health insurance status, household education, and body mass index z-score examined associations using complex survey design procedures. Of 2,861 adolescents, 17.6% (SE 0.9%) did not receive dental care in the past year and 20.2% (SE 1.9%) had a financial barrier to accessing dental care. In adjusted regression models, adolescents with deferred dental care had higher odds of dyslipidemia (OR= 1.51, 95% CI 1.07, 2.11 p = 0.020). Having a financial barrier was associated with a lower odd of dyslipidemia (OR=0.35, 95% CI 0.14, 0.89 p = 0.03). Financial barriers were associated with lower non-HDL (b=-7.95, 95% CI -14.87, -1.05 p=0.03) and higher HDL (b=3.06, 95% CI 0.37, 5.75 p=0.03) in adjusted models. Deferred dental care and financial barriers were not associated with any other cardiometabolic parameters. In this nationally representative cohort of adolescents, there was an association between lack of preventative dental care and the cardiometabolic health marker of dyslipidemia. However, financial barriers to dental care were surprisingly associated with higher HDL levels and lower odds of dyslipidemia.

The Experiences of Migrant Care Workers in Long-term Care Facilities: A Scoping Review.

The employment of migrant care workers provides a remedy to face the challenges of increased demand for care of older adults. A scoping review aimed to identify, categorize, and summarize the existing knowledge about migrant care workers' working experiences in long-term care facilities. Identifying gaps in the literature can inform future research. Five electronic databases were searched in April 2024 in addition to a manual search for articles published in English. Forty-five articles were reviewed. A few studies described migrant care assistants' main tasks as assisting physical care and care assistants' characteristics grouped into personal and acquired qualities to provide good quality care. Migrant care workers experienced work satisfaction, achievement, adaptability and adjustment, organizational support, work burden, sense of loneliness, low wages, low social status, and loss of profession. They faced challenges involving inadequate knowledge of palliative care, communication and language barriers, cultural and religious differences, and health concerns. Friendly and discriminatory relationships were found between migrant care workers and stakeholders. Existing evidence regarding the experiences of migrant care workers in delivering palliative care to dying residents or facilitating death preparation is limited. Additionally, there is a notable absence of data from the perspectives of employers and residents on discrimination issues. Further research is necessary to investigate these areas.

Adult endocrinologists' perspectives on transitioning adolescent patients with congenital adrenal hyperplasia.

The study aimed to evaluate adult endocrinologists' perspectives on caring for patients with congenital adrenal hyperplasia (CAH) and views on their transition from pediatric to adult care. An online survey was conducted among adult clinical endocrinologists at Harvard Medical School-affiliated hospitals from March to October 2022. Most participants (25/34, 73.5 %) treat patients with CAH and expressed moderate to high confidence (23/32, 71.9 %) in their care. Those that did not treat or accept referrals cited insufficient expertise, knowledge, and resources as reasons. Only half of respondents correctly answered at least 50 % ofstandard of care questions. The main transition of care barrieridentified was the absence of standardized policies (12/34, 35.3 %). Participants, though involved in care of patients with CAH, had varied responses to standard of care questions and transition of care barriers, emphasizing the need for standardized transition protocols and additional training to ensure up-to-date clinical knowledge.