Care Practices Research Articles

Boxed In and-and Busting Out

Working with a group of Alberta Grade 1 and 2 teachers we have observed and heard described several of the complexities they face in practicing well amidst multiple and competing dimensions of contemporary literacy instruction. The outcomes-driven machinery of their provincial context, their school district’s system for communicating classroom assessments, and the increasing dominance of synthetic phonics are factors the teachers note as constraining their knowledge, skills, and ways of being/doing, and that of their students. When these material expectations are positioned against other commitments to literacy education and diverse ways of being/becoming literate they both intend a certain future and serve as reminders of literacy education’s philosophical and practical “trouble without end” (Tsing, 2015, p. 2). Conceptualizing instructional contexts and practices as research assemblages, the study in which this paper is based investigates how early elementary teachers work at, with, and within the current conditionings of school-based literacy practices. Drawing on teacher interviews, photographs from within literacy teaching and learning situations (Snaza, 2019), and extended observations with a Grade 1 French Immersion teacher and class, the purpose of this paper is to explore liveable possibilities in reading, writing, and language instruction for the “right now” of literacy education (Kuby et al., 2019). Focusing on examples in which teachers seek “and…and…and…” pedagogies (Deleuze & Guattari, 1987, p. 25) our purpose is not to settle the troubled waters of literacy education but to trace contours of possibility as teachers encounter literacy education’s boxes and boundaries and exceed their confines. We follow teachers’ material and social participation in curricular attentions to affect and cultivations of newness as a practice of care for and curiosity about a shared world in early elementary literacy instruction.

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review.

Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer-reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity-affirming care practices that may increase mental healthcare engagement and improve long-term mental health outcomes.

Factors that influence the uptake of virtual care solutions in Australian primary care practice: a systematic scoping review.

Uptake of virtual care solutions in primary care settings has increased exponentially, and current evidence suggests high patient satisfaction but mixed clinician views. This paper aimed to identify factors influencing its' implementation to support delivery to the right patient, in the right clinical context, at the right time. Further, this paper evaluates how the updated Consolidated Framework for Implementation Research (CFIR) can be used to assess these factors that contribute to the uptake of virtual care innovations. This systematic scoping review identified empirical research on factors influencing the uptake of virtual care solutions in the Australian primary care setting. Searches were undertaken in Embase, PubMed, Scopus, and Web of Science. The CFIR was used to code factors influencing the implementation of virtual care solutions. Inductive coding was used to generate new constructs where no appropriate CFIR construct could be identified. Fourteen eligible studies were identified as eligible for inclusion. Five common influencing factors were identified. Three are from the existing CFIR framework, and two are newly developed constructs. CFIR constructs included innovation relative advantage, capability, and IT infrastructure. New constructs included accessibility and suitability. A further six new constructs were identified (trust, privacy, governance, unintended consequences, preference, and choice) but these were not prominently mentioned. Common factors influence virtual care uptake in Australian primary care. The CFIR assisted in conceptualizing these but was not sufficient for capturing factors unique to virtual care. Newly developed constructs are noted to be of importance in the literature, but further research is needed to understand whether they are applicable in multiple contexts. http://links.lww.com/IJEBH/A286.

Current oral care practices in an acute aged care setting: An Australian metropolitan hospital perspective

Purpose To evaluate current oral care practices in an acute aged care hospital setting, and staff perceptions of the barriers and enablers to delivery of evidence-based oral care practices. Method A mixed method study comprised of retrospective file audit and cross-sectional survey was conducted within a single acute aged care unit. Medical records of patients aged ≥ 65 years admitted over a 6 month period were retrospectively audited. A clinician survey was used to explore barriers to and enablers of the delivery of oral care practices using the Capability, Opportunity, Motivation, Behaviour (COM-B) questionnaire. Result were analysed using descriptive statistics. Result Patient file audits (n = 206) found 13.6% (n = 28) of patients had oral care completed, despite 23% (n = 47) of patients being recommended by a speech language pathologist to receive oral care. Staff survey respondents (n = 31) reported they do not have the physical or social opportunities to provide oral care (i.e. adequate resources, time, and social support), however, they were motivated and reported they have the required knowledge and skills to provide oral care. Conclusion There is a need for implementation strategies to enable an interprofessional response to improve the delivery of evidence-based oral care practices and optimise patient outcomes.

Improving the nursing quality of non-pharmacological interventions for elderly constipation patients in the hospital: a best practice implementation project.

Non-pharmacological interventions are the preferred treatment for constipation; however, health care professionals in clinical settings tend to focus more on pharmacological treatments. This best practice implementation project aimed to integrate the best evidence on non-pharmacological interventions for elderly patients with constipation in clinical care practice and to promote the use of non-pharmacological interventions for such patients in the hospital setting. This project is based on the JBI Evidence Implementation Framework, which follows three stages. The first stage involved a baseline audit using two audit criteria derived from the best available evidence. This audit evaluated current clinical scenarios, guided by the i-PARIHS framework. The second stage involved analyzing the results of the baseline audit, identifying barriers to compliance, and developing and implementing strategies to overcome those barriers. Strategies included nursing education, development of constipation information booklets for nurses and patients, establishment of a nursing workflow, and modification of the department environment. In the third stage, a follow-up audit was conducted to evaluate the implementation, using the same data collection indicators and methods as in the baseline audit. Sixty patients participated in the project. Compliance for Criterion 1 (patient education) increased from 0% to 60% (P < 0.001), while compliance for Criterion 2 (monitoring patients' bowel health) increased from 0% to 100% (p < 0.001). The results indicate that this evidence-based implementation project facilitated the application of non-pharmacological interventions for elderly patients with constipation. Nurses played a significant role in developing regular defecation habits in patients and monitoring their defecation. http://links.lww.com/IJEBH/A284.

Physical Activity and Acute Care Utilization Among Older Adults With Mild Cognitive Impairment and Dementia.

People living with dementia have high rates of hospitalizations. Identifying factors that influence hospitalization is important. This study examines the influence of physical activity levels on risk of hospitalization and emergency department (ED) use among older people living with mild cognitive impairment (MCI) or dementia followed in our primary care practice in Rochester, Minnesota, United States. We included those age 55 years and older, who had a clinic visit between June 1, 2019 and June 30, 2021 and completed a social determinants of health questionnaire about physical activity levels (n = 3090). Physical activity was classified as sufficiently active, insufficiently active, or physically inactive. Risk of hospitalization and ED visits by physical activity levels were examined. People who were physically inactive were at higher risk of hospitalization and ED visits (p < .001) compared with those who were sufficiently active. This highlights an area for health promotion in people living with MCI and dementia.

Rethinking Intergenerational Living as the Ideal Form of Senior Care: Life Course Research with Immigrant Families in Toronto

Canada’s care systems are ill-equipped to support its aging population, and this crisis intertwines with an acute shortage of affordable housing. Immigrants to Canada have a higher propensity to cohabitate multi-generationally, an arrangement that is sometimes romanticized as an ideal form of senior care. This article contributes to scholarship exploring intergenerational cohabitation as a practice of care, using life course research to consider how class and migration timing shape experiences of intergenerational living and senior care. Based on 19 in-depth interviews with immigrant seniors from Latin America and the Caribbean (n=10) and family caregivers (n=9) living in the Greater Toronto Area, this study uncovers two central findings. First, intergenerational living should not be viewed as an ideal form of senior care since (1a) some seniors resist intergenerational living, preferring independence and downtown residence nearer to culturally relevant communities and (1b) cohabitation does not always provide sufficient or better care. Second, access to smooth multigenerational cohabitation is inequitable, as housing arrangements are structured by class and migration timing, with middle-class families who have been in Canada longer facing fewer barriers to positive experiences of intergenerational living, compared to more recent migrants with lower incomes. This article challenges culturally essentializing assumptions about immigrant intergenerational cohabitation and argues that access to affordable housing is a senior care issue.

Community Health Workers Linking Clinics and Schools and Asthma Control

Childhood asthma is characterized by pervasive disparities, including 3-fold higher hospitalization rates and 7-fold higher death rates for Black children compared with White children. To address asthma disparities, one must intervene in all lived environments. To determine if a community health worker (CHW) intervention to connect the primary care, home, and school for low-income minoritized school-aged children with asthma and their caregivers improves asthma control. This study was a hybrid effectiveness/implementation trial using a 2 × 2 factorial, cluster randomized clinical trial design of 36 schools crossed with participant-level randomization into a clinic-based CHW intervention. The study was conducted from May 2018 to June 2022. The intervention took place in primary care offices, homes, and 36 West Philadelphia, Pennsylvania, public and charter schools. Children aged 5 to 13 years with uncontrolled asthma were recruited from local primary care practices. Asthma management, trigger remediation, and care coordination occurred in school, home, and primary care settings. Children were followed up for 12 months. The Yes We Can Children's Asthma Program, Open Airways For Schools Plus, and school-based asthma therapy were implemented. Improvement in asthma control, as measured by the Asthma Control Questionnaire, comparing the mean difference between groups 1 year after randomization with their baseline (difference in differences). Both primary care and school interventions were dramatically disrupted by the COVID-19 pandemic; therefore, stratified analyses were performed to assess per-protocol intervention efficacy before the pandemic disruptions. A total of 1875 participants were approached, 1248 were excluded, and 1 was withdrawn. The 626 analyzed study participants (mean [SD] age, 8.7 [2.4] years; 363 male [58%]) self-identified as Black race (96%) and non-Hispanic ethnicity (98%). Although all groups had statistically significant improvements in asthma control from baseline to 12 months (P- group: -0.46; 95% CI, -0.58 to -0.33; P+ group: -0.57; 95% CI, -0.74 to -0.44; S- group: -0.47; 95% CI, -0.58 to -0.35; S+ group: -0.59; 95% CI, -0.74 to -0.44), none of the difference-in-differences estimates from the primary prespecified models showed a clinically meaningful improvement in asthma control. Analysis from the prepandemic interval, however, demonstrated that children in the combined clinic-school intervention had a statistically significant improvement in asthma control scores compared with control (-0.79; 95% CI, -1.40 to -0.18). This randomized clinical trial provides preliminary evidence that connecting all lived environments for care of children can be accomplished through linkages with CHWs.

Active Choice Nudge to Increase Screening for Primary Aldosteronism in At-Risk Patients.

Primary aldosteronism (PA) is the most common cause of secondary hypertension, yet screening remains startlingly infrequent. We describe: 1) PA screening practices in a large, diverse health system, 2) the development of a computable phenotype for PA screening, and 3) the design and pilot deployment of an electronic health record (EHR)-based active choice nudge to recommend PA screening. A multidisciplinary team developed a multi-pronged intervention to improve PA screening informed by guidelines, expertise, and multivariable analyses of factors associated with screening. The intervention included EHR-based tools to automatically identify screen-eligible patients, an active choice nudge recommending screening for these patients, and screening result interpretation. The intervention was piloted across two primary care practices for seven months. Screening frequencies were compared to clinics not receiving the intervention. The baseline frequency of screening of eligible patients within one year was 1.4%. Higher mean systolic blood pressure (OR=1.4; p<0.001), more antihypertensive medications (OR=1.3; p=0.002), lower minimum serum potassium (OR=2.0; p=0.001), specialist care (OR=3.0; p<0.001), and Black race (OR=1.5; p=0.001) were associated with a higher likelihood of screening. The refined computable phenotype identified a subcohort with a higher frequency of positive screening (8.6% versus 4.1%; p=0.03). In a pilot study of an active choice nudge, a greater proportion of eligible patients were screened in the intervention clinics (16.4%) than in the non-intervention clinics (1.8%; p<0.001). PA screening rates are low. This pilot study suggests an EHR-based nudge leveraging a precise computable phenotype can dramatically increase appropriate PA screening.

Nurse-Led Medication Management for Older People in Home Care: A Systematic Review of Evolving Nurse Responsibilities in Technology-assisted Care

Technology-assisted care is transforming the home care landscape for older people requiring medication management. With evolving roles and responsibilities, nurse-led interventions are shaping the future of nursing practice in home care. This review aimed to identify and describe nurse-led roles in medication management in home care for older people within the context of technology-assisted care. A systematic review employing an integrative approach was conducted on the PubMed (covering MEDLINE), Scopus, CINAHL, ProQuest, and Embase, targeting studies published in English over the past decade, from 2014 to 2024. The initial database search identified 1629 studies, which were subsequently narrowed down to 20 studies selected for data analysis and narrative research synthesis. The review findings were classified into 3 categories: “fundamental principles,” “nurses and their role identities,” and “enhanced care quality and medication safety.” Given the effectiveness of nurses as leaders in technology-assisted home care for enhancing medication management safety, it is essential to implement policies that support and improve their involvement in multidisciplinary healthcare teams. Additionally, continuous education and training focused on technology-assisted care competencies are necessary to ensure nurses are well-prepared to enhance patient safety in home care.

Assessing the feasibility of the GOTT (Gabapentinoid and Opioid Tapering Toolkit) in a primary care setting in North-East England

Objective To assess the feasibility and possible impacts of implementation of systematic non-pharmacological interventions to reduce the level of prescribing of opioid and gabapentinoid analgesics for chronic non-cancer pain (CNCP), particularly high-dose prescriptions, through a proof-of-concept study in a deprived area (second lowest decile) primary care practice in North-East England. Participant Twenty-five primary care staff (clinical and non-clinical) of which 18 clinicians received the intervention. Intervention used in this study practice known as GOTT (Gabapentinoid and Opioid Toolkit) All clinicians received an educational skills programme to support patient pain self-management, tailored on the clinicians’ self-assessment of their learning needs, embedding both clinician skill learning and patient self-care resources for rapid access within consultations into a GP clinical management computer system. Outcome measures Clinical staff completed questionnaires before and after the GOTT intervention to assess levels of knowledge and confidence in their own skills to support chronic pain self-management across several domains. Prescription data were used to measure changes in opioid and gabapentinoid prescribing at the practice across the 12-month intervention and 30-month follow-up period. Results Prescribing of opioid and gabapentinoid/pregabalin decreased substantially in the practice across the intervention period (c. 90% in high-dose opioid [ p = .0118], and 15% gabapentin/pregabalin prescriptions, respectively), over a one-year period during the COVID-19 pandemic. Follow-up analysis showed 100% and c.50% reductions, respectively, in December 2022. The questionnaire data showed an increase in clinician confidence in skills to enable self-management over the intervention period, overall ( p = .044) and, specifically across three of the five domains measured: supporting behavioural change ( p = .028), supporting self-care ( p = .008), and managing difficult consultations ( p = .011). Conclusion The GOTT intervention program provided some initial evidence of a proof-of-concept for the implementation of a systematic non-pharmacological pain management skills and resources programme addressing lack of confidence in skills to introduce and support self-management and reduce use of strong opioids and gabapentinoids.

Antenatal care practices for gestational weight gain: a cross sectional survey of antenatal care providers reported provision and barriers to providing recommended care.

Implementation of recommended gestational weight gain (GWG) care by antenatal care providers is poor. It is unclear whether practice implementation and barriers differ between antenatal care provider profession or experience. This study aimed to assesses the provision of and barriers to guideline care for GWG and examine associations with professional discipline and years of experience. A cross sectional survey was conducted with antenatal care providers working in three public maternity services in a regional city in Australia. Data were collected on the provision of and barriers (informed by the Theoretical Domains Framework) to recommended GWG care. Data were summarised using descriptive statistics. Associations between health profession characteristics (professional discipline and years providing antenatal care) and GWG care practices and barrier outcomes were assessed using multivariate logistic regression. 117 antenatal care providers completed the survey (75% participation rate). One quarter (25%) reported that they routinely provided recommended GWG assessment at the first antenatal visit, and 9% at subsequent visits. Only 7% routinely provided recommended advice on GWG, healthy eating and physical activity. Professional discipline or years of experience were not associated with higher odds of GWG practices. Skills, belief about capabilities, belief about consequences and environmental context and resources were barriers to providing care. Medical professionals had higher odds of agreeing that they have been adequately trained to address GWG (OR = 9.14, 95%CI:3.10-26.90) and feel competent in having sensitive conversations with pregnant women about GWG (OR = 8.60, 95%CI:2.29-32.28) than midwives. Midwives had higher odds of agreeing that there are services they can refer pregnant women to for further support (OR = 2.80, 95%CI:1.13-6.91). The provision of antenatal care for GWG was low, inconsistently provided and did not differ by professional discipline or years of experience. Antenatal care providers report numerous barriers including skills, belief about capabilities, belief about consequences, and environmental context and resources. Barriers to GWG care provision differed by professional discipline, but not years of providing care. The findings demonstrate that the type and prioritisation of practice-change implementation strategies may need to be tailored to address the differential barriers faced by professional groups.

Telemedicine and time management in primary care.

Information and communication technologies (ICTs) can enable workers to structure work in novel ways, allow for better time management, and increase work scheduling autonomy. Time management and work scheduling are important factors in the field of clinical practice in primary care. Time limits on consultation are a key constraint on the delivery of good care since the length of patient-physician consultation impacts its quality. This research aimed to examine the experiences of primary care physicians (PCPs) when using telemedicine technologies (TTs), a type of ICT, in their communication with patients. During 2023 in-depth interviews were conducted with 20 Israeli PCPs: family physicians and pediatricians. Perception and management of time emerged as a focal subject in the interviews. The PCPs interviewed described several effects of TTs on time management in primary care. They portrayed TTs as saving time for patients and having a mixed effect on the healthcare organization: both saving and wasting their work time. TTs were described as impacting their time management in the context of work-life balance, allowing them to manage their time during and between appointments. For PCPs, TTs can be beneficial for managing time in the clinic, which can contribute to better healthcare. This article, concerning TTs as a type of ICT, contributes to the existing literature which suggests that ICTs can allow for better time management and increase work scheduling autonomy. It also presents several recommendations for better implementation of TTs in healthcare organizations.

Manual Hair Removal for Intraoral Flaps: a Simple Practice for Professional Education and Patient Cancer Care.

After resection of malignant tumors of the head and neck, reconstructions are commonly performed using surgical free flaps. In non-irradiated patients, hair may continue to grow at the reconstruction site after surgery, causing undesirable effects such as difficult to maintain oral hygiene, food and saliva accumulation, halitosis, dysphagia, moral distress, and impact on intimacy and sexuality. Until a standardized laser therapy protocol is available, manual depilation isan option that should not be underestimated to improve the patient's quality of life and available to every oral healthcare team. This case illustrates a simple practice that contributes to improving patients' quality of life and oral health in an interprofessional way.

Mother of All Labour: Vulnerability and Immunity in Times of Ebola

Wonkifong Ebola treatment unit was unique at the time of the outbreak that hit the Guinea in 2014. Contrary to other infrastructures run by Western workers, Wonkifong mainly employed personnel from Guinea, the Democratic Republic of Congo, and Cuba. Even so, the unit constituted a racialised landscape where proximity to white agencies granted privileges to certain groups of racialised people while excluding others. In a humanitarian infrastructure aimed at empowering knowledge of epidemics in the Global South, Black children were quarantined without their parents and left mostly unattended. After many months, former patients were hired as nannies to remedy the infrastructure’s blind spot. These women were employed to care for the children thanks to their immunity to the virus. Building on the concept of a ‘politics of life’ and exploring how these women were exploited as ‘medical superbodies’, my article sheds light on how the humanitarian infrastructure produced a gendered labour that mirrors other economies exploiting female Black bodies such as the colony or the plantation. Relying on an ethnography of practices of care and mobility within the unit, this piece underlines how the postcolonial segregation at play during the outbreak operated not strictly in terms of skin colour, but in terms of gender and closeness to white power.

Patient Perceptions on the Follow-Up of Abnormal Cancer Screening Test Results.

Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results. Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results. Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results. Patients from 44 participating practices in three primary care practice networks. Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results. Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations. Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result. ClinicalTrials.gov NCT03979495.

Foster care breakdown in adolescence: A retrospective view of young individuals on their experiences

Summary Placement with a foster family is one of the care arrangements available for children who cannot live at home. Many of those in foster care are teenagers. The complexity of the development during adolescence poses major challenges and may ultimately lead to what is known in the literature as “foster breakdown.” Most of the research in this area focuses on the point of view of social workers or foster parents. The current study examines this experience through a retrospective view of those who were teenagers at the time of foster care breakdown. To this end, semi-structured interviews were conducted with 14 Israeli young individuals (16–30 years old) who had experienced foster breakdown at various stages of adolescence. Findings The findings paint a complex and multidimensional picture of breakdown. While most of the interviewees described it as a sudden, unexpected event, closer examination revealed a dynamic process of collapse. This process comprised various factors, including those associated with the welfare system, the foster family, and characteristics related to the developmental stage of adolescence of the research participants. The combination of these factors led to the premature termination of the foster arrangement. Applications This study opens a window to the complex experience of foster breakdown in adolescence, an issue that has received very little research attention thus far. Understanding the dynamics of foster breakdown from the perspective of young individuals can improve professional foster care practices and policy and can benefit social workers in their work with foster families.

The TELEhealth Shared decision-making COaching and navigation in Primary carE (TELESCOPE) intervention: a study protocol for delivering shared decision-making for lung cancer screening by patient navigators.

Lung cancer screening (LCS) can reduce lung cancer mortality but has potential harms for patients. A shared decision-making (SDM) conversation about LCS is required by the Centers for Medicare & Medicaid Services (CMS) for LCS reimbursement. To overcome barriers to SDM in primary care, this protocol describes a telehealth decision coaching and navigationintervention for LCS in primary care clinics delivered by patient navigators. The objective of the study is to evaluate the effectiveness of the intervention and its implementation potential, compared with an enhanced usual care (EUC) arm. Patients (n = 420) of primary care clinicians (n = 120) are being recruited to a cluster randomized controlled trial. Clinicians are randomly assigned to 1) TELESCOPE intervention: prior to an upcoming non-acute clinic visit, patients participate in a telehealth decision coaching and navigationsession about LCS delivered by trained patient navigators and nurse navigators place a low-dose CT scan (LDCT) order for each TELESCOPE patient wanting LCS, or 2) EUC: patients receive enhanced usual care from a clinician. Usual care is enhanced by providing clinicians in both arms with access to a Continuing Medical Education (CME) webinar about LCS and an LCS discussion guide. Patients complete surveys at baseline and 1-week after the scheduled clinic visit to assess quality of the SDM process. Re-navigation is attempted with TELESCOPE patients who have not completed the LDCT within 3months. One month before being due for an annual screening, TELESCOPE patients whose initial LCS showed low-risk findings are randomly assigned to receive a telehealth decision coaching booster session with a navigator or no booster. Electronic health records are abstracted at 6, 12 and 18months after the initial decision coaching session (TELESCOPE) or clinic visit (EUC) to assess initial and annual LCS uptake, imaging results, follow-up testing for abnormal findings, cancer diagnoses, treatment, and tobacco treatment referrals. This study will evaluate factors that facilitate or interfere with program implementation using mixed methods. We will assess whether a decision coaching and patient navigation intervention can feasibly and effectivelysupport high-quality SDM for LCS and guideline-concordant LCS uptake for patients in busy primary care practices serving diverse patient populations. This study was registered at ClinicalTrials.gov (NCT05491213) on August 4, 2022. Version 1, April 10, 2024.

Beyond Treatment: A Narrative Review of Humanization Practices, Empathetic Communication, and Comprehensive Support in Oncology Patient Care in Brazil Over the Last Two Decades (2003-2023).

Humanization in oncology patient care represents a significant innovation in health care practice, shifting the traditional focus solely on treating physical conditions to encompass the emotional and psychosocial dimensions of patient experience. This study aimed to explore the importance of humanization in oncology and the application of practices that promote a patient-centered approach. Through a narrative review of the past 2 decades, the objective was to analyze the practices, benefits, and challenges of humanization in the oncology context. The methodology involved reviewing the relevant literature on empathetic communication, psychological support, and the integration of these aspects into oncology care. The results indicated that humanization significantly contributes to improving patients' quality of life, increasing treatment adherence, and fostering a more satisfying work environment for health care teams. However, effective implementation faces challenges, such as the need for ongoing training, resource limitations, and resistance to change. Despite these obstacles, humanization is essential to provide more comprehensive and patient-centered care. The adoption of humanized practices transforms the oncology care experience, making it more empathetic and holistic.

Integrated care for children and young people with special health and care needs: a systematic review

ContextThere is a dearth of high-quality evidence on integrated, coordinated and cost-effective care for children with special health and care needs (CSHCN).ObjectiveTo assess the effectiveness of integrated/coordinated care models for...