Care Communication Research Articles

SPIRITUAL NEEDS OF ELDERLY IN CHINESE FAITH-BASED NURSING HOME: ADMINISTRATOR VIEWS

Abstract Objectives Recognizing and addressing the spiritual needs of elderly individuals constitutes a crucial facet of comprehensive caregiving. Despite China’s immense aging population, research on the spiritual needs of Chinese seniors remains limited. This study aimed to: 1) delineate prevalent spiritual needs among Chinese nursing home residents, including those with dementia; 2) elucidate the method employed by staff to identify these needs in non-verbal residents; and 3) expound on the strategies utilized by staff to fulfill these identified needs. Methods In this qualitative exploration, semi-structured interviews were conducted with 21 administrators from faith-based nursing homes, chosen for their potential concentration of residents with dementia. Encompassing establishments across 14 Chinese provinces, interviews were conducted in the participants’ native language, subsequently translated into English. Utilizing a constant comparative approach, the collected data underwent analysis to uncover recurring themes. Results The analysis yielded five interconnected themes concerning the spiritual needs of older adults: expression of faith, reception of love and care, familial interaction, social engagement, and participation in activities. For individuals with dementia unable to articulate their needs, staff employed careful observation and communication with family members as means of identification. In response to identified needs, staff harnessed local resources and personalized services whenever feasible. Discussion The findings offer practical insights for holistic caregivers catering to the spiritual needs of Chinese elderly. This study fills an existing gap, aiding in the provision of culturally sensitive care that addresses the spiritual aspects of aging Chinese individuals.

VIRTUAL REALITY FOR PALLIATIVE CARE COMMUNICATION TRAINING: A NOVEL DISSEMINATION STRATEGY

Abstract Towards the end of life, 75% of older adults visit the emergency department (ED). During acute health decompensation, most older adults with serious illness (predicted survival of less than one year) do not have advance directives and are at risk of receiving care inconsistent with their goals. To deliver patient-centered care, palliative care communication skills are essential, especially during the shared decision-making for cardiopulmonary resuscitation (i.e., code status conversations). Facilitated by skilled faculty and trained actors playing the role of a seriously ill older adult in acute health decompensation, the traditional palliative care communication training combines role play and individual feedback to practice communication skills. These evidence-based, palliative care trainings have demonstrated to improve communication skills in trained clinicians with enduring skills 12-15 months later. However, these trainings take a minimum of four hours with highly trained faculty and professional actors to role play, which hinders wider dissemination. To improve nationwide dissemination of evidence-based practices in code status conversations, we have leveraged virtual reality technology to allow clinicians to experience in-person, palliative care communication training. In collaboration with a virtual reality company, a 360-degree view, virtual reality training content has been filmed in a real hospital environment. Using the same evidence-based, palliative care communication contents, clinicians in training can now experience the role play in a virtual reality environment in one hour instead of four. By leveraging virtual reality technology, evidence-based palliative care communication training can now be disseminated with much less institutional investment (e.g., training time, faculty resources, etc.).

QUALITY OF CARE INTERACTIONS IN ACUTE CARE

Abstract Care interactions are verbal or nonverbal exchanges between staff and patients and promote quality of care and optimize outcomes for hospitalized patients living with dementia. Care interactions vary regarding quality and are differentiated between positive interactions (e.g., interactions that provide beneficial companionship or appropriate care communication for residents), neutral interactions (e.g., brief, indifferent interactions), or negative interactions (e.g., interactions that restrict residents due to safety concerns or interactions that are restrictive for no justified reason). Patients exposed to negative care interactions, particularly those that are living with dementia, are at risk for negative outcomes such as increased resistiveness to care, anxiety, depression, and apathy. The Quality of Care Interactions Survey (QuIS) is an observation measure used to evaluate interactions between staff and patients based on definitions of positive social, positive care, neutral, negative protective, or negative restrictive interaction. Scores range from 0 to 7, with higher scores indicating more positive care interactions between staff and residents. Nursing interactions with the first 365 patients in the FFC-AC-EIT study indicated that on admission the majority of the care interactions were positive (82%), half were neutral (50%), and a small percentage were negative protective (7%) and negative restrictive (6%). By discharge, there was a decrease in neutral interactions to 47%, negative protective to 6% and negative restrictive to 5%. Ongoing oversight and education is needed to decrease neutral and negative interactions between staff and patients using techniques provided in our function focused care intervention.

Transitional care model for older adults with multiple chronic conditions: An evaluation of benefits utilising an umbrella review.

To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions. The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home. An umbrella review. A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi-morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used. Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi-experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re-admissions and financial costs and increasing patients' quality of life and satisfaction during discharge. The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre-arranged structured post-discharge follow-ups. The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions. The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review.

Service users' perceptions of relevant and helpful components of an integrated care concept (ACCESS) for psychosis.

Psychotic disorders have a significant impact on patients' lives and their families, and long-term treatment with individually tailored multimodal combinations of therapies is often required. Integrated care (IC) concepts such as the "Hamburg Model (ACCESS)" with a focus on psychotic disorders, includes different (therapeutic) components with pharmaco- and psychotherapy, family involvement, home treatment and the option of using a 24/7 crisis hotline. All components are offered by a therapeutically-oriented assertive community treatment (TACT) team in a need-adapted manner. So far, however, little is known about which specific components are regarded as especially relevant and helpful by the users of IC. Patients currently participating in IC completed a questionnaire as part of the continuous quality assurance study (ACCESS II) in which they were asked to rate the different components of treatment according to their relevance and helpfulness, considering the individual's unique experiences with IC and needs in mental health care. Furthermore, they were asked to make suggestions regarding additional helpful components of treatment. Fifty patients participated in this survey (23% of the patients currently participating in the IC concept). For participants, the most helpful and important factors were having the same therapist in the long-term and the 24/7 crisis telephone. Additional components suggested by patients included more addiction-specific therapies and increased focus on vocational rehabilitation and integration. From the perspective of the users of IC, long-term care from a trusted therapist with whom there is a therapeutic relationship and the possibility to reach someone they already know from the TACT team 24/7 serves as the best basis for effective care, fostering trust, understanding, and open communication. In contrast, home treatment remains a relevant aspect of evidence-based care for people with severe mental illness, but perhaps surprisingly, is not viewed as the most important issue.

Navigating Compassion: A Comprehensive Review of Palliative Care in Respiratory Medicine.

Palliative care has emerged as a crucial aspect of comprehensive healthcare, particularly in respiratory medicine. This review navigates the intricate landscape of palliative care in the context of respiratory diseases, including chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and lung cancer. The exploration begins with a comprehensive examination of palliative care's definition, significance, and purpose in respiratory medicine. It progresses to understanding common respiratory diseases, their impact on patients' quality of life, and the nuances of disease progression and prognosis. Delving into the principles of palliative care, the review highlights the importance of a patient- and family-centered approach, emphasizing the multidisciplinary collaboration required for holistic care. Symptom management takes center stage, with a detailed exploration of dyspnea, cough, and pain, covering pharmacological and non-pharmacological interventions. The psychosocial and spiritual dimensions are then unveiled, recognizing the psychological impact of respiratory diseases and the significance of addressing spiritual needs with cultural sensitivity. Communication in palliative care is explored through breaking lousy news, advance care planning, and shared decision-making. The section acknowledges the complex considerations surrounding end-of-life care, including recognizing the end-of-life phase, establishing care goals, and withdrawing life-sustaining therapies. Recognizing the indispensable role of caregivers, the review underscores the importance of caregiver support. It delineates strategies for providing emotional and practical support alongside a crucial focus on self-care for caregivers who shoulder the responsibilities of providing palliative care. As the exploration concludes, the challenges in implementing palliative care in respiratory medicine are outlined, from late referrals to communication barriers. However, the review also envisions a future marked by innovation, with emerging approaches, such as telehealth and personalized medicine, offering promising avenues for improvement. Research gaps and areas for improvement are identified, emphasizing the need for a collaborative effort to enhance the quality of palliative care for individuals facing respiratory diseases. The review culminates in a call to action, urging early palliative care integration, investment in education and training, research initiatives, advocacy for accessible services, and collaboration across disciplines. By heeding this call, healthcare providers, researchers, and policymakers can collectively contribute to the evolution and enhancement of palliative care in the challenging landscape of respiratory medicine.

Perception of inherited risk in type 2 diabetes: a systematic review.

A family history is impacting the individual's risk perception. The objective of this systematic review was to describe inherited risk perceptions of type 2 diabetes from the citizen's viewpoint. The aim was to summarize and increase understanding so that the increased knowledge could be used effectively in type 2 diabetes risk communication in health care. We conducted a systematic review using CINAHL, Medline, and Scopus databases for hereditary, risk, perception, and diabetes related concepts, within the date range of 1.1.2017 to 2.8.2022. Eligible articles were English, peer-reviewed, and addressed the research question: how is hereditary risk of type 2 diabetes perceived? Returns were viewed independently by two authors, and evaluated using the appraisal criteria of the Joanna Briggs Institute. A thematic analysis was used for the synthesis of the data, yielding three themes describing perceptions of inherited risk in type 2 diabetes. A total of 32 articles were included, of which 23 were quantitative, 5 qualitative, and 4 were mixed-methods studies. The extracted themes were (1) Identifying heredity as a risk factor, (2) Diversity of hereditary risk, and (3) Perception of the magnitude of personal risk. The perception towards hereditary risk can vary from a desire to actively make a lifestyle change, to the view that diabetes is inevitable regardless of lifestyle. A positive family history increases the risk perception of type 2 diabetes, but the perceived magnitude of the risk may vary from person to person. The findings have the potential to be applied in healthcare's risk communication.

Implementasi Kebijakan Pendidikan di MTs PAB 2 Sampali

This research discusses the planning, implementation and evaluation of educational policies at MTs PAB 2 Sampali as an integral part of efforts to improve the quality of secondary education. Qualitative methods were used with interviews, observation and document analysis. Madrasa heads were the main respondents, ensuring an in-depth understanding of the dynamics of policy implementation. 1) Policy planning begins with identifying needs and challenges involving analysis of student achievement, facilities and curriculum development. Consultation and participation of stakeholders, including teachers, parents and students, is the next step. Goals and objectives are set with a focus on improving achievement, strengthening the curriculum, and student participation. 2) The implementation process begins with careful planning, communication and socialization of policies to stakeholders, training and professional development for teachers, full implementation of policies, and ongoing evaluation. Positive impacts can be seen in increasing student achievement, student participation in extracurricular activities, and parental involvement. However, limited resources and resistance to change are challenges that need to be overcome. 3) This research provides a positive picture of MTs PAB 2 Sampali's efforts to improve the quality of education through policy planning, implementation and evaluation. Even though challenges exist, a commitment to continuous improvement can make this institution an inspiring example in planning education policies that have a positive impact.

Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care.

There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81days). Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.

Management of adult acute lymphoblastic leukemia in the Gulf Cooperation Council (GCC) countries: A consensus report from the GCC Adult ALL Working Group.

Leukemia burden is growing in the Gulf Council Cooperation (GCC) countries. Nonetheless, there is no unified protocol for managing adult acute lymphoblastic leukemia (ALL) patients in the GCC-countries. Therefore, the GCC Adult-ALL Treaters working group developed this consensus to address the adult-ALL treatment protocols in the GCC-countries and related toxicities' management. Besides, the consensus aimed to highlight the current unmet needs and treatment gaps and provide recommendations to optimize adult-ALL care and patient-centered communication. A three-step modified Delphi method to develop evidence-based recommendations through two-voting rounds and in-between virtual meetings are used in the manuscript development. A 12 experts' panel from five GCC-countries and two international experts were invited to participate in this consensus. This consensus consisted of 35-statements that highlighted the experts' recommendations to optimize ALL adults' care in the first line setting and manage pediatric or pediatric-inspired regimens-related toxicities. Besides, guidance was provided for future research direction and improve patient-centered communication. In conclusion, the adult-ALL management landscape is evolving, and the current evidence highlights better response and survival outcomes with pediatric or pediatric-inspired regiments. Therefore, protocols are needed to optimize the adult-ALL management in the GCC and tailored clinical-trials findings according to the GCC patients' characteristics and local-healthcare infrastructure.

Colorectal cancer survivors' experiences and views of shared and telehealth models of survivorship care: A qualitative study.

The number of colorectal cancer (CRC) survivors is increasing and current models of survivorship care are unsustainable. There is a drive to implement alternative models of care including shared care between general practitioners (GPs) and hospital-based providers. The primary objective of this study was to explore perspectives on facilitators and barriers to shared care. The secondary objective was to explore experiences of telehealth-delivered care. Qualitative data were collected via semi-structured interviews with participants in the Shared Care for Colorectal Cancer Survivors (SCORE) randomised controlled trial. Interviews explored patient experiences of usual and shared survivorship care during the SCORE trial. In response to the COVID pandemic, participant experiences of telehealth appointments were also explored. Interviews were recorded and transcribed for thematic analysis. Twenty survivors of CRC were interviewed with an even number in the shared and usual care arms; 14 (70%) were male. Facilitators to shared care included: good relationships with GPs; convenience of GPs; good communication between providers; desire to reduce public health system pressures. Barriers included: poor communication between clinicians; inaccessibility of GPs; beliefs about GP capacity; and a preference for follow-up care with the hospital after positive treatment experiences. Participants also commonly expressed a preference for telehealth-based follow-up when there was no need for a clinical examination. This is one of few studies that have explored patient experiences with shared and telehealth-based survivorship care. Findings can guide the implementation of these models, particularly around care coordination, communication, preparation, and personalised pathways of care.

Developing a Collaborative Agenda-Setting Intervention (CASI) to promote patient-centered communication in ovarian cancer care: A design thinking approach

ObjectivesPatient-centered communication (PCC) occurs when clinicians respond to patients’ needs, preferences, and concerns. While PCC is associated with better health-related quality of life in patients with cancer, patients with ovarian cancer have reported unmet communication needs. We used design thinking to develop an intervention to promote PCC in ovarian cancer care. MethodsFollowing the steps of design thinking, we empathized with stakeholders by reviewing the literature, then created stakeholder and journey maps to define the design challenge. To ideate solutions, we developed a challenge map. Finally, we developed wireframe prototypes and tested them with stakeholders. ResultsEmpathizing revealed that misaligned visit priorities precipitated suboptimal communication. Defining the design challenge and ideating solutions highlighted the need to normalize preference assessments, promote communication self-efficacy, and enhance visit efficiency. The Collaborative Agenda-Setting Intervention (CASI) elicits patients’ needs and preferences and delivers communication guidance at the point of care. Stakeholders approved of the prototype. ConclusionDesign thinking provided a systematic approach to empathizing with stakeholders, identifying challenges, and innovating solutions. Practice ImplicationsTo our knowledge, the CASI is the first intervention to set the visit agenda and support communication from within the electronic health record. Future research will assess its usability and acceptability.

Development and psychometric properties of the age-friendly hospitals scale in older adults

Age-friendly Primary Health Care by the World Health Organization (WHO) provided a framework to guide countries in developing concrete and appropriate care in the health system, including encouraging the development of an Age-Friendly Hospital (AFH) care network. The study aimed to develop and evaluate the psychometric properties of the AFH scale (AFHS) in older adults. A cross-sectional study collected and analyzed data from 330 older adults between June 2018 and June 2019. The instrument was developed and validated according to the proposed guidelines. The study involved item generation and scale development, including content and face validity, pilot testing, exploratory factor analysis (EFA), internal consistency, and test-retest reliability. EFA was performed using principal axis factoring with a promax rotation. The original model of four factors and 22 items was conducted. Three factors with eigenvalues greater than one were extracted, and the scree plot examination confirmed the retention of three factors with 22 items after performing EFA. Using the EFA, we identified three main factors: care processes, communication and service, and physical environment. The developed scale can contribute to establishing AFH and quality healthcare institutions. It may be a valuable reference for healthcare facilities to evaluate and enhance their services, considering factors like limited resources and workforce. Furthermore, this scale can facilitate continuous improvement and long-term development of age-friendly healthcare institutions.

Online Forums as a Tool for Broader Inclusion of Voices on Health Care Communication Experiences and Serious Illness Care: Mixed Methods Study.

Existing health care research, including serious illness research, often underrepresents individuals from historically marginalized communities. Capturing the nuanced perspectives of individuals around their health care communication experiences is difficult. New research strategies are needed that increase engagement of individuals from diverse backgrounds. The aim of this study was to develop a mixed methods approach with qualitative online forums to better understand health communication experiences of individuals, including people from groups historically marginalized such as Black and Latino individuals; older adults; and people with low income, disability, or serious illness. We used a multiphase mixed methods, community-informed research approach to design study instruments and engage participants. We engaged a diverse group of collaborators with lived experience of navigating the health care system who provided feedback on instruments, added concepts for testing, and offered guidance on creating a safe experience for participants (phase 1). We conducted a national quantitative survey between April and May 2021 across intrapersonal, interpersonal, and systems-level domains, with particular focus on interpersonal communication between patients and clinicians (phase 2). We conducted two asynchronous, qualitative online forums, a technique used in market research, between June and August 2021, which allowed us to contextualize the learnings and test concepts and messages (phase 3). Using online forums allowed us to probe more deeply into results and hypotheses from the survey to better understand the "whys" and "whats" that surfaced and to test public messages to encourage action around health. We engaged 46 community partners, including patients and clinicians from a Federally Qualified Health Center, to inform study instrument design. In the quantitative survey, 1854 adults responded, including 50.5% women, 25.2% individuals over 65 years old, and 51.9% individuals with low income. Nearly two-thirds identified as non-Hispanic white (65.7%), 10.4% identified as non-Hispanic Black, and 15.5% identified as Hispanic/Latino. An additional 580 individuals participated in online forums, including 60.7% women, 17.4% individuals over 65 years old, and 49.0% individuals with low income. Among the participants, 70.3% identified as non-Hispanic white, 16.0% as non-Hispanic Black, and 9.5% as Hispanic/Latino. We received rich, diverse input from our online forum participants, and they highlighted satisfaction and increased knowledge with engagement in the forums. We achieved modest overrepresentation of people who were over 65 years old, identified as non-Hispanic Black, and had low income in our online forums. The size of the online forums (N=580) reflected the voices of 93 Black and 55 Hispanic/Latino participants. Individuals who identify as Hispanic/Latino remained underrepresented, likely because the online forums were offered only in English. Overall, our findings demonstrate the feasibility of using the online forum qualitative approach in a mixed methods study to contextualize, clarify, and expound on quantitative findings when designing public health and clinical communications interventions.

Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora

ObjectiveTo know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. DesignCross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. SitePhysicians with healthcare duties in primary care in Aragon. ParticipantsSpecialist physicians and resident interns in Family and Community Medicine. MeansurementsJob characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. Results202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. ConclusionsVirtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.

Challenges and Opportunities in a Resource Desert: Las Vegas Boot Camp Translation

AbstractBackgroundThe state of Nevada has the 3rd fastest growing rate of Alzheimer’s disease and related dementias (ADRD) in the country with a 30.6% projected increase between 2020 and 2025. Growth in ADRD is complemented by growth in the diversity of residents, particularly in Las Vegas, where the growth of minoritized populations outpaces national rates. Nevada is 30% Hispanic/Latino (H/L) and Las Vegas is 33% H/L. Among the challenges presented by this growth, Nevada is characterized as a ‘neurology desert’, lacking the necessary specialists to meet the state’s care demands and lacking the traditional infrastructure for care and research referral. In order to better understand local experiences seeking care and address communication barriers, we applied the Boot Camp Translation model for the Las Vegas H/L community.MethodWe identified 14 community members to participate in our ADRD BCT through community connections, targeted email blasts, and social media. BCT members ranged in age from 23 to 62 (M = 43, SD = 13.74), were majority female (10/14) and H/L (11/14), and most (10/14) were connected to local non‐profit organizations serving H/Ls, those with ADRD, and/or older adults.ResultBCT members identified messages to increase AD awareness that reflected love, “respeto” (respect), resilience, and connection; messages targeted younger and middle‐age adults and community organizations: 1) “Amar es saber” (“To love is to know”), which encourages discussions among family members; 2) “The community cares. Let’s talk.”; and 3) “Podemos afrontar el Alzheimer juntos.” (”We can face Alzheimer’s disease together.”). BCT members identified our resource desert as a key challenge to message‐based calls to action. As reflected by their messages, they also highlighted opportunities for community members to engage and support message dissemination.ConclusionThe Las Vegas BCT effectively identified messages, challenges, and opportunities to increasing AD knowledge and research engagement. Many BCT members joined our community advisory board; they emphasize the need for ongoing advocacy in the state, Spanish‐language resources, and an online presence that simplifies and supports navigation of services and information.

Abstract C076: Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions

Abstract Background: In Puerto Rico, colorectal cancer (CRC) is the leading cause of cancer deaths. Patients with CRC often present with multiple chronic conditions (MCC), making it difficult for oncologists to coordinate their care. This qualitative study explores oncologists' perspectives of care among patients with CRC and MCC in Puerto Rico. Methods: Semi-structured interviews (n=9) were conducted with oncologists providing care for Hispanic older adults with CRC in Puerto Rico. Thematic analysis was employed to identify key themes and subthemes. Results: We identified several key themes related to social determinants of health, diagnosis pathways, treatment decisions, survivorship, end-of-life care, and care coordination. Oncologists reported a high prevalence of MCC, including comorbidities such as diabetes, high blood pressure, cholesterol problems, and hypothyroidism. Limited social support was identified as a care coordination challenge, as many patients undergo treatments without adequate support networks. Access to healthcare providers was a noted concern, due to a provider shortage and the absence of specialized cancer care. The health insurance system has been identified as having several issues, particularly concerning the requirement of pre-authorization for different procedures and treatments. These challenges can be especially problematic for older adults, who often lack a strong support system and may experience difficulties comprehending the process. Transportation issues and a lack of nearby services were noted as barriers for patients requiring specialized care. Diagnosis pathways varied, with some patients having undergone routine screenings when CRC was identified, while others presented with suspected CRC symptoms. Oncologists noted that the cancer stage was the most important factor when making treatment decisions, in addition to the diagnosis of MCC and the patient's ability to tolerate treatment. Other factors influencing treatment decisions included the patient's age, physical condition, and appointments attendance. For patients in advanced stages, end-of-life planning and palliative care were crucial for ensuring a dignified and comfortable transition, with discussions around hospice care and managing pain and symptom relief being essential components. Care coordination and communication were identified as challenging to manage when multiple providers and procedures were needed, often requiring patients to schedule appointments with different specialists themselves. Inter-provider communication and collaboration relied on various methods; however, phone calls or notes sent through the patient were the primary methods. Conclusions: Oncologists caring for Hispanic older adults with CRC and MCC face multiple, complex challenges influenced by social determinants of health and the presence of comorbidities. Tailored approaches to address disparities, culturally sensitive care, and improved coordination among healthcare providers are needed to enhance the quality of care in this patient population. Citation Format: Maira A. Castaneda-Avila, Daniela Latoni, Meagan J. Sabatino, Karen J. Ortiz-Ortiz, Kate Lapane. Experiences of oncologists caring for Hispanic older adults with colorectal cancer and multiple chronic conditions [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C076.

Workshop 5: Mitigating Ageism in Everyday Clinical Care

Learning objectives:At the end of this workshop, participants will be able to: -Integrate a human rights and dignity-based strategies into daily clinical care for older persons with mental health conditions-Identify the effects of intersections of ageism, ableism, mentalism and elder abuse on the care provided to older persons with mental health conditions-Describe and support the need for an international (UN) Convention on the rights of older persons to improve the care of older persons with mental health conditionsBackground:Our world faces rapid population aging. Based on the WHO estimates, nearly 20% of older persons will have mental health conditions such as dementia, depression, anxiety and substance use, often complicated by physical and psychosocial comorbidities. Various mental health inequalities exist in this vulnerable population negatively influencing their healthcare and social status. This includes the ‘triple jeopardy’ of ageism, ableism and mentalism. The ongoing COVID-19 crisis has only widened the marginalization of older persons and especially those with mental health conditions.Methods:Even though there has been a paradigm-shift in neurobiological understanding of psychogeriatrics, dignity-based mental healthcare is still silent in research as well as practice. This workshop brings in recommendations to include the principles of rights, dignity, equality, equity and respect in clinical care for older persons living with mental health conditions, including dementia. These suggestions are based on literature review, position statements of global organizations working in this area, the Decade enablers of the UN Decade of Healthy Aging (2021-2030) and also clinical experience of the authors. Special focus will be on end-of-life care, advance directives and those in institutionalized settings.Mode of conduction:The workshop will involve a strategic and interactive discussion based on real-life case vignettes. Feedback will be sought on the perceived status of dignity and human rights in current clinical practice. Focus will be on ensuring dignity and promoting human rights in routine clinical care and patient-physician communication, age-friendly healthcare settings for older persons and the role of dignity therapy. The need for an International Convention for the rights of older persons will also be highlighted with evidence.Elder abuse and inadequate end-of-life care as two of the many common manifestations of the implicit bias and core root cause of the phenomenon of the “ageism spectrum”. Ensuring dignity and human rights in older persons can combat ageism and prevent elder abuse. Adequate sensitivity and training of professionals in this area will set the future pathway for dignified mental health interventions in the older persons with mental health conditions that are devoid of age-based discrimination and prejudice.

FC26: What have staff got to do with it? Untangling complex relationships between residential aged care staff, the quality of care they provide, and the quality of life of people with dementia

Background:Despite the integral role long term residential care staff play in the lives of residents with dementia, the mechanisms for supporting staff to bring about good quality of care (QOC) and quality of life (QOL) are poorly understood. This study focused on establishing the key mechanisms to improve QOC and in turn QOL of residents with dementia.Method:Over a 10-month period we followed: 247 older adults with dementia from 12 not-for-profit residential care facilities, their families/care partners (n=225), managers (n=12) and staff (n=232). Facilities ranged in size from 10 to 137 beds, located across remote, rural and metropolitan areas of south eastern Australia. Measures included: staff surveys, family member and resident interviews, resident file audits, live resident and staff observations and organisational audits. Multilevel Modelling or Generalised Estimating Equations analyses were conducted for each of the 12 QOC variables, with 22 staff and control variables as the predictors, and for each of the 11 QOL variables, with 20 QOC and control variables as predictors.Results:Analyses established significant associations between a large number of staff and QOC variables and between QOC and QOL variables.Conclusions:The quality of the care provided to residents has strong, widespread influences on the QOL of residents. The most promising areas for intervening with staff were: increasing the relevance and applicability of staff training and qualifications, upskilling staff in empathic care provision, communication, and restraint reduction, using a mixture of permanent and rotating shifts, prioritising recreational activity provision by all staff and increasing assistance with meals. patients with cognitive impairment in rural hospitals.

Clinical yarning education: development and pilot evaluation of an education program to improve clinical communication in Aboriginal health care - participant, and health manager perspectives

BackgroundEffective communication between health care clinicians and Aboriginal patients is critical to delivering high quality, accessible, culturally secure health care. Despite this, ineffective communication is a well-documented barrier, and few studies have reported interventions to improve communication. Clinical Yarning is a patient centred communication framework for Aboriginal health care. Building on this framework, this study reports the development and evaluation of a Clinical Yarning education program.MethodsA Clinical Yarning education program was developed, underpinned by the principles of cultural security and adult learning, informed by a behavioural skills approach. The program was delivered in five health/education settings in one rural Western Australian region. Mixed-methods evaluation included a retrospective pre/post questionnaire to ascertain changes in participants’ knowledge, confidence, competence and their perceptions about communication in Aboriginal health care, and the program. Qualitative semi-structured interviews were undertaken with health service managers who oversaw each health care setting and who had not participated in the education program, to explore perceptions about the program and implementation considerations.ResultsTwenty-eight health care clinicians and six students completed training and the evaluation survey. There were significant improvements in self-rated communication skills, ability, confidence, knowledge, and perceived importance of communication training from pre to post-program. Participants strongly recommended the program to others, and most commonly valued the simulation/interactive learning activities. Health service managers acknowledged the limitations in most existing cultural training, and felt Clinical Yarning addressed a need; both the concept of Clinical Yarning and the education program provided were valued. Considerations identified for future implementation included: building multilevel partnerships within health services, offering alternate training options such as eLearning or train-the-trainer approaches, and integrating into existing development programs. Workforce transiency and availability were a barrier, particularly in remote areas.ConclusionsThis study offers preliminary support for the Clinical Yarning education program and provides a foundation for further development of this training approach. A future priority is implementation research to investigate the impact of the Clinical Yarning education program on health care and patient outcomes.