Care Preferences Research Articles

Comparative effectiveness of delivering early palliative care via video versus in-person on end-of-life outcomes in patients with advanced lung cancer.

1649 Background: Findings from our prior large-scale comparative effectiveness trial showed the equivalent effect of delivering early palliative care via video versus in-person on quality of life among patients with advanced non-small cell lung cancer (NSCLC). We now report on whether the two care delivery modalities were equivalent with respect to patient-reported communication with clinicians about their end-of-life (EOL) care preferences and hospice utilization. Methods: Between 6/14/2018 and 5/4/2023, we enrolled 1250 patients with newly diagnosed advanced NSCLC in a randomized trial of early palliative care across 22 US cancer centers. Patients were randomly assigned to meet with a palliative care clinician every 4 weeks from enrollment through the course of the disease, either via video or in the outpatient clinic. Participants completed self-report surveys at baseline and weeks 12, 24, 36, and 48, including an item asking if they had discussed with their clinicians the care they would want to receive if dying (yes/no); patients’ final assessments prior to death or last follow up were analyzed. We reviewed patients’ health records to collect data on hospice referral and length of stay. To test the equivalence in these outcomes, we used a binomial generalized linear model with the identity link function (pre-specified equivalence margin of ±8% for patient-reported communication about EOL care) and linear regression (pre-specified equivalence margin of ±6 days for mean length of stay in hospice). P-values were adjusted for multiplicity using a Bonferroni correction. Results: Of the 1250 enrolled participants, 888 (71.0%) completed at least one survey post baseline regarding whether they communicated with clinicians about EOL care preferences. Among those, 29.1% of the video group and 26.0% of the in-person group reported “yes,” indicating that they recalled such EOL care discussions (difference = 3.1%, 95% CI: -1.8%, 8.1%; p = 0.26 for equivalence). During the course of the trial, 733/1250 (58.6%) patients died, of whom 537/733 (73.3%) were referred to hospice. Mean lengths of hospice stay were 25.3 days for the video group versus 25.1 days for the in-person group (difference = 0.2, 95% CI: -7.0, 7.4; p = 0.46 for equivalence). When excluding outlying patients receiving hospice services > 180 days (n = 13), the mean lengths of hospice stay were 19.1 (video group) versus 19.7 (in-person group) days (difference = -0.6, 95% CI: -4.6, 3.3; p = 0.06 for equivalence). Conclusions: Although thresholds were not met to confirm equivalence statistically, the two modalities for delivering early palliative care demonstrate very similar outcomes with respect to patient-clinician communication about EOL care and hospice utilization. These findings provide further evidence of the utility of video visits for providing high quality palliative and EOL care. Clinical trial information: ClinicalTrials.gov Identifier ( NCT03375489 ) .

Pilot study of an enhanced telehealth program for patients with prostate cancer.

1647 Background: The time required for cancer treatment is considerable. Telehealth (TH) with home monitoring can minimize travel burden but patients’ perceptions regarding tradeoffs of clinic visits versus enhanced telehealth (ET) are uncertain. We piloted an ET intervention offering patients on androgen deprivation therapy (ADT) for prostate cancer up to four components of care at home. Methods: Prostate cancer patients on ADT were offered participation in 4 at home services: 1) TH oncologist visits; 2) remote BP monitoring (BP); 3) home phlebotomy (HP); and 4) self-injection of ADT or denosumab at home with RN support via TH as needed. Clinicians referred eligible patients and specified frequency of each service. Completion rates were evaluated for each component. Patient perspectives, preferences for subsequent care, and assessments of the feasibility, acceptability, and appropriateness of each component were collected after participation in eligible services at least once over the course of the pilot. Feasibility, acceptability, and appropriateness were measured by validated measures (scores from 1-5). Patient satisfaction with ET was measured using a net promoter score. All results are based on the last completed patient survey. Results: Between 6/2023 and 6/2024, 39 patients enrolled in the pilot, the median age was 70 (IQR: 61.5-76.7), 62% were white, and 69% (N = 27) lived with family or a partner. Table 1 shows the %/(N) of patients who chose to participate in each at home component with completion rates at the patient and visit level. 73% (145/198) of remote monitoring failures were due to patient inability to execute the at home task. > 75% of patients reported that each service was convenient and saved time. Most patients reported no problems with completing the visit (TH 89%, BP 89%, HP 91%, injections 67%). Patients were either very likely or somewhat likely to participate again (TH 97%, BP 100%, HP 96%, injections 100%) and the majority preferred ET for future care (TH 79%, BP 79%, HP 87%, injections 100%). 62% (24/39) of patients found at-home visits to be equally or less stressful than in-person care. Patients found each service to be feasible, acceptable, and appropriate (mean score > 4.7 for all services) and gave ET a net promotor score of 79. Conclusions: Patients found ET for the management of prostate cancer on ADT to be feasible, acceptable, and appropriate, providing a more patient-centered and convenient alternative to traditional clinic-based care. Future studies will explore scalability and applicability across diverse patient populations and treatment regimens. % (N) Patients opting in for each component % (N) Patients completing each component (at least once) % (N) Total episodes completed TH visits 100% (39) 59% (23) 90% (53/59) Remote BP monitoring 92% (36) 94% (34) 60% (296/494) Home phlebotomy 69% (27) 100% (27) 97% (143/148) Home injections 28% (11) 73% (8) 90% (9/10) All 4 components 18% (7) 29% (2) 70% (501/771)

Broadening the gates: Analysis of potentially modifiable screen failures in pancreatic and biliary tract cancer trials.

e23011 Background: Eligibility criteria for clinical trials are crucial for maintaining safety and study integrity. However, they often exclude patients due to medical conditions that are not relevant, leading to gaps in understanding the real-world effectiveness of treatments. Addressing potentially modifiable exclusions (PMEs) could enhance accessibility and participation in trials without compromising safety, particularly given the low rates of enrollment. Methods: We retrospectively analyzed ‘screen-failed’ patients (those who were excluded after providing consent because they did not meet the eligibility criteria or other protocol requirements) with biliary tract (BTC) or pancreatic cancer (PDAC) between August 2019 and November 2024. Screening logs and electronic health records provided clinical data. PMEs were identified and validated by two independent medical oncologists. Results: Of 585 screen-failed patients from 18 trials, 76 were excluded due to incomplete data. Among the 509 patients analyzed (367-PDAC, 142-BTC), the leading causes of screen failure were declined participation (99, 19%), comorbidities (59, 12%), suboptimal organ function (56, 11%), absence of biomarker (49, 10%), and insufficient biospecimens (36, 7%). Among patients declining participation, reasons included preference for standard care (23%), travel (22%), competing trials (5%), adverse event concerns (4%), financial issues (3%), and unknown reasons (43%). Of the 509 patients deemed ineligible for study entry at screening, we identified 69 patients (13.6%) with PMEs, primarily related to borderline laboratory abnormalities: liver function (16, 23%), kidney function (14, 20%), platelet count (8, 12%), hemoglobin (5, 7%), and white blood cell count (4, 6%). Other PMEs included previous or concurrent malignancies (6, 9%) and viral hepatitis (3, 4%). PMEs were evenly distributed across trials. Notably, all screen-failed patients proceeded to receive standard therapy. Conclusions: This analysis underscores the potential for rigid eligibility criteria to exclude stable patients who might benefit from investigational treatments. Easing specific criteria, particularly those related to laboratory abnormalities, could broaden trial accessibility. Furthermore, examining the reasons for declined participation and addressing PMEs could help develop strategies to enhance trial enrollment.

Awareness and attitudes towards ear health in classical music students—advancing education and care for professional ear users

Background and aimClassical music students, as a key group of professional ear users (PEUs), rely heavily on their auditory perception, making ear health critical to their education and careers. However, significant gaps in their knowledge of hearing health and protection have been previously identified, while data on non-noise-related risk factors and broader aspects of ear health remain scarce. This study aimed to evaluate classical music students’ knowledge of ear health, including ear anatomy, common ear disorders, and non-noise-related risk factors such as ototoxic medications and cardiovascular risk factors, as well as attitudes toward specialized ear health care. The goal was to inform the development of tailored educational programs and evaluate the need for specialized ear health care in performing arts medicine.MethodsA questionnaire specifically designed for the purpose of the present study (Professional Ear User Questionnaire) was distributed to classical music students at music schools in Switzerland and Germany, as well as to medical and general students at a Swiss university. Statistical analyses, including Fisher’s exact test and principal component analysis, explored response patterns and identified factors influencing ear health knowledge and behavior.ResultsData were collected from 209 music students and two control groups of 65 medical students and 40 general students. Significant gaps in ear health knowledge were identified, with only 37.8% familiar with common ear disorders. A total of 52.4% rarely or never used hearing protection, despite 84.4% expressing concerns about potential hearing deterioration. Many were unaware of non-noise-related risk factors, such as ototoxic medications. Only 27.4% knew of an ear specialist for PEUs, yet 72.1% preferred a hearing exam at a specialized clinic.ConclusionThe study highlights the need for comprehensive ear health education tailored to the unique needs of classical music students and other PEUs. Educational programs should cover both noise and non-noise-related risk factors and promote early hearing protection. The preference for specialized care underscores the importance of establishing dedicated ear health clinics for PEUs. Collaborations between (university) music schools, healthcare providers, and policymakers is crucial to protect the ear health of music students, musicians, and other PEUs, ensuring their ability to perform without preventable ear disorders.

Informal Carers' Perceived Needs and Preferences in Implementing WHO iSupport for Dementia Program: A Cross-Sectional Study.

This study explored the needs and preferences of informal carers in implementing the Chinese iSupport program. 101 Chinese-Australian and 134 Chinese informal carers of people living with dementia were recruited in this cross-sectional design from July to December 2022 via dual-channel strategies (paper-based/online in China; community centers in Australia). A purpose-designed questionnaire was utilized to assess the carers' preferences. Between-country comparisons of sociodemographic variables and iSupport preferences were analyzed using descriptive statistics, the standard Chi-square test, and the Mann-Whitney U test for non-parametric data. Chinese carers were younger and more educated and received more support from family members than Chinese-Australian carers. Chinese carers demonstrated a greater willingness to utilize iSupport, participate in web-based iSupport, and study iSupport with family members. Both groups preferred paper-based and audio formats for iSupport manuals, desired a facilitator for the program, favored peer support groups, and were willing to pay for facilitated iSupport. This study highlights the similarities and differences in sociodemographic characteristics, needs, and preferences between Chinese and Chinese-Australian carers, providing insights for tailoring strategies to address these needs in varying socio-cultural contexts.

"It's Like Having a Map": An Exploration of Participating Pet Owners' Expectations of Using Telemedicine to Access Emergency Veterinary Care.

(1) Background: Telemedicine is increasingly recognized as a potential way to help overcome barriers to accessing veterinary care. This study explored pet owners' perspectives on telemedicine services in situation they viewed as veterinary emergencies, focusing on both their access-to-care challenges and their expectations of such services. (2) Methods: Semi-structured, one-on-one interviews were conducted with 18 pet owners in Ontario, Canada. All participants were unable to access in-person care, leading them to a veterinary telemedicine service. Interviews were supplemented by an online questionnaire to collect demographic information. Thematic analysis was conducted on all interview transcripts. (3) Results: Participants' expectations of telemedicine were largely informed by their uncertainty about their pets' health in emergency situations. Anxiety was common, leading them to seek telemedicine for reassurance. Participants expected advice and guidance, viewing the process as collaborative. While acknowledging the benefits of telemedicine in their situation, participants also acknowledged the inherent limitations of this type of service, articulating a general preference for in-person veterinary care. (4) Conclusions: When in-person care is unavailable, telemedicine can offer pet owners valuable guidance, clarity, and comfort, although many pet owners may continue to prefer face-to-face consultations for comprehensive care.

An Intervention to Increase Advance Care Planning Among Older Adults With Advanced Cancer

Many older adults with advanced cancer never communicate goals of care or treatment preferences to their clinicians, raising the risk that care received will not match their values. Scalable models of care may help surmount this barrier. To test whether a combined patient and clinician intervention increased the rate of advance care planning (ACP) documentation in large health care systems. This stepped-wedge cluster randomized clinical trial using an open cohort design included patients aged 65 years or older with advanced cancer seen at oncology clinics in 3 health care systems located in the US South, Midwest, and Mid-Atlantic regions from April 1, 2020, to November 30, 2022. Data collection ended in 2024. The intervention involved delivering brief evidence-based patient-facing video decision aids available in 25 languages as well as goals-of-care communication training to oncology clinicians. Patients in the control period received usual care. The primary outcome was ACP documentation, which included any electronic health record documentation of a goals-of-care conversation, palliative care, hospice, or limitation of life-sustaining treatments, identified via a validated natural language processing program. Analysis was performed on an intention-to-treat basis. Twenty-nine practices, comprising 13 800 unique eligible patients with a total of 29 357 repeated measurements, were included (mean [SD] age, 74.5 [6.6] years; 52.3% men [15 344 of 29 357 measurements]). The proportion of patients with ACP documentation was greater in the intervention phase compared with the usual care phase (adjusted rate difference, 6.8% [95% CI, 2.8%-10.8%]; P < .001). ACP documentation in the intervention phase occurred among 3980 of 15 754 patients (25.3%) (goals-of-care conversation, 21.4% [3377 of 15 754]; palliative care, 9.6% [1517 of 15 754]; hospice, 5.4% [847 of 15 754]; and limitation of life-sustaining treatments, 7.2% [1128 of 15 754]). In comparison, ACP documentation in the usual care phase occurred among 2834 of 13 603 patients (20.8%) (goals-of-care conversation, 16.8% [2281 of 13 603]; palliative care, 9.5% [1287 of 13 603]; hospice, 5.3% [724 of 13 603]; and limitation of life-sustaining treatments, 8.4% [1149 of 13 603]). In this stepped-wedge cluster randomized clinical trial for older adults with advanced cancer, a bundled evidence-based decision aid and communication training intervention increased the proportion of older patients with ACP documentation. This approach offers an innovative paradigm with a clinically meaningful increase in ACP documentation, a widely used quality metric that reflects high-quality patient-centered care delivery. ClinicalTrials.gov Identifier: NCT03609177.

Quality of clinical practice guidelines on the COVID-19 management in pregnancy during the pandemic: a systematic review.

The Coronavirus Disease 2019 (COVID-19) pandemic disrupted maternity care, highlighting the need for rapid, high-quality clinical practice guidelines (CPGs) to ensure safe care for pregnant women. We assessed the quality and recommendations of CPGs related to COVID-19 in pregnancy. Following prospective registration (PROSPERO number: CRD42022346031) we searched Medline, Web of Science, and UpToDate from inception until July 2024. The methodological quality was appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II). A total of 27 CPGs were included. High scores were achieved in scope and purpose (21/27, 78%) and clarity (17/27, 63%). The most poorly addressed domains were rigour of development and applicability to clinical practice (18/27, 67% and 19/27, 70% scored low quality, respectively). Overall, only four (15%) guidelines were recommended. Most CPGs (25/27, 93%) addressed COVID-19 screening and transmission prevention, but few covered psychological care (3/27, 11%) or maternal delivery preferences (4/21, 19%). Consensus was found on timing and mode of delivery (16/17, 94%), but there was disagreement on delayed cord clamping and virus transmission interventions. Evidence-based practice requires health care providers, patients and stakeholders to be aware of variations in both the quality and recommendations of CPGs, especially during times of uncertainty.

Assessing the Content of Goals of Care Documentation for Hospitalized Patients With Alzheimer's Disease and Related Dementias

ABSTRACTBackgroundGoals of care (GOC) conversations are an evidence‐based practice that help clarify and align patient values and preferences for medical care with treatment options. Little is known about how clinicians document the content of GOC conversations for patients with Alzheimer's disease and related dementias (AD/ADRD) in the electronic health record (EHR) and whether this may differ across hospitals. We aimed to assess the content of GOC documentation for hospitalized patients with and without AD/ADRD.MethodsWe performed a retrospective cross‐sectional study to assess documented content within a standardized GOC note written for seriously ill hospitalized adult patients admitted to 21 hospitals between 2021 and 2023. Seriously ill patients had a predicted 90‐day mortality greater than 30% as determined by an artificial intelligence mortality prediction score. Patients with AD/ADRD were identified using diagnostic codes placed by clinicians in the EHR.ResultsOur review of GOC documentation across 21 hospitals identified 5475 patients with GOC notes. The study sample had a median age of 76 years and was 52% male, 13% nonwhite, 81% with Medicare insurance, and 14% with AD/ADRD. Compared to patients without AD/ADRD, patients with AD/ADRD were more likely to have documentation of family presence at the GOC conversation (93% vs. 76%, p = &lt; 0.001), a surrogate decision‐maker (60% vs. 54%, p = 0.003), and patient prognosis (84% vs. 78%, p = &lt; 0.001). Patients with AD/ADRD were less likely to have documentation of patient presence at the GOC conversation (28% vs. 64%, p = &lt; 0.001) and patient values and preferences for medical care (65% vs. 69%, p = &lt; 0.05).ConclusionsHospitalized patients with AD/ADRD are infrequently present in GOC conversations and less likely to have their values and preferences for medical care documented within a GOC note. Further research is needed to explore the reasons for these findings.

Factors Influencing Participation in Physiotherapy Services Following a Total Shoulder Replacement Surgery: A Cross-Sectional Survey.

When designing appropriate rehabilitation programs after a shoulder replacement, it is critical to consider the multitude of factors that can influence a patient's participation. Therefore, this study aims to quantitively understand the factors that affect access and participation to physiotherapy services after a shoulder replacement in older adults. Our research team created an online of 58 questions, focusing on personal characteristics, geographic accessibility, socioeconomic status, preferences for care, social support, and cultural beliefs to understand potential barriers and facilitators to accessing services. Using a mixed-methods approach, data was analyzed through quantitative descriptive statistics and interpretive descriptive methodology. Data was stratified by gender. Data collection took place in 2020-2022. A total of 51 (53% women) people participated in this survey; with the average age of 64.6 (9.4) years old. Gender heavily influenced patients' preferences on accessing care and physiotherapy services. Social factors, economic factors and personal factors emerged as potential barriers to participation in physiotherapy for women. Patient expectations differed by gender, as women prioritize return to daily activities (93%), whereas men prioritized sport/recreational activities (85%). Finally, preferences for delivery of physiotherapy differed based on gender, as men prefer in person (77%) and women prefer virtual. This survey was able to investigate trends that influence participation to rehabilitation after a shoulder replacement, both quantitatively and qualitatively. This study is a starting point for future research to explore how factors such as gender roles and social expectations may affect individuals' participation in rehabilitation.

Factors Associated with Cancer Patients' Preferences for Telemedicine or In-Person Palliative Care.

Factors Associated with Cancer Patients' Preferences for Telemedicine or In-Person Palliative Care.

Patient Preferences for Provider Specialization for Induced Abortion and Miscarriage Care.

Objectives: Most induced abortions are provided by abortion specialists, despite knowledge and skills overlap with other disciplines, particularly general obstetrics and gynecology (OB/GYN). We evaluated patient preferences for abortion and miscarriage care from a family planning specialist versus other providers, and perceptions of a general OB/GYN's ability to provide safe miscarriage and abortion care. Materials and Methods: We conducted a cross-sectional survey among individuals aged 18-44 receiving induced abortion (n = 54) or nonabortion gynecological care (n = 111) in North Carolina hospital-based gynecology or family planning clinics between April and October 2023. The primary predictor was appointment type. The primary outcome was preference for induced abortion from a family planning specialist versus other providers; secondary outcomes were provider specialty preference for miscarriage care and patient perceptions of a general OB/GYN's scope of practice. We evaluated associations between appointment type, outcomes, and participant characteristics. Results: This was a racially diverse population with half (50.3%) using public health insurance. Most (73.0%) felt abortion is "morally acceptable and should be legal." Over half (53.1%) preferred induced abortion from a specialist provider, compared with one-third (32.7%) for miscarriage (p < 0.001), with no differences by appointment type. Educational attainment (p = 0.03) and Democratic party affiliation (p = 0.02) were independently associated with abortion specialist preference, but not significant in multivariable analysis. More participants believed a general OB/GYN can provide medications for miscarriage management compared with induced abortion (94.5% versus 86.6%, p = 0.01). Both medical and surgical first trimester induced abortions were more often identified as within-scope for a general OB/GYN than the ability to perform a hysterectomy (69.8%, p < 0.01). Most (78.8%) believed OB/GYNs should be required to train in abortion care. Conclusions: Participants were more likely to prefer a family planning specialist for induced abortion care versus miscarriage; however, nearly half preferred nonspecialist care. Incorporation of induced abortion into general practice settings may meet patient preferences while expanding access.

Eliciting and Honoring Prognostic Communication Preferences in Pediatric Cancer Care

Eliciting and Honoring Prognostic Communication Preferences in Pediatric Cancer Care

Preferences of patients in advance care directives provide key steps for concordance of end-of-life care.

Preferences of patients in advance care directives provide key steps for concordance of end-of-life care.

The influence of perceived neighborhood disorder on HIV care-related decisions: A qualitative study.

The study used a qualitative approach to explore how perceived neighborhood disorder influences health-related decisions among people living with HIV. Recognizing the crucial role environmental factors play in health behaviors, this research seeks to bridge a gap in understanding how neighborhood dynamics affect individuals with HIV. A qualitative research design with interpretive qualitative analysis was used. The interview guide and analysis were guided by the Broken Windows Theory and Social Cognitive Theory, enabling an exploration of the intersection between environmental perceptions and healthcare behaviors. Data were collected through telephonic in-depth interviews with 18 participants from two HIV clinics from June 2022 to February 2023. Interviews were analyzed using the Dedoose software 9.0.17 and narratives were enriched using their survey data from a cross-sectional study with a validated scale to measure perceived neighborhood disorder. Our findings show that perceived neighborhood disorder influences HIV care-related decisions through a diminished sense of control pathway. Also, healthcare settings emerge as a mitigator of the influence of perceived neighborhood disorder on HIV care-related decisions by offering a sense of control. Perception of lower neighborhood disorder correlates with a strong sense of control and a preference for specialized care. As the perception of neighborhood disorder increases, there is a shift toward care settings that balance specialized services with a supportive care environment. A higher perception of neighborhood disorder leads to prioritized care settings that provide a sense of community support, and discretion, reflecting adaptations to a compromised sense of control. This research underscores the influence of neighborhood disorder on health-related decisions through the pathway of self-control, emphasizing the role that healthcare environments play as mitigators. For chronic disease management, such as with HIV, the development of healthcare settings that reinforce patient autonomy and control, alongside community efforts to diminish signs of disorder, and their underlying causes is crucial.

Postpartum Care Recommendations from Parents of Premature Infants Requiring Intensive Care.

To describe postpartum care preferences and experiences among individuals who deliver a premature infant requiring neonatal intensive care. In this qualitative description study, we recruited patients 2 to 8 weeks after delivery of a premature infant requiring neonatal intensive care to participate in semi-structured interviews. We asked participants to share their postpartum care experiences including their expectations and preferences regarding what is addressed during postpartum visits, their decision-making process in attending scheduled postpartum visits, and their suggestions for how to optimize postpartum care to serve their needs. We used thematic analysis to generate codes and identify themes. Of 26 participants, 8 (31%) had attended a postpartum visit, 4 (15%) had missed their appointment, and 14 (54%) had a visit scheduled to occur after the time of the study interview. We found that participants weigh the perceived benefits of attending a postpartum visit against barriers to care, such as insurance restrictions, competing responsibilities and priorities when deciding whether to attend their postpartum visit. At their postpartum visit, participants preferred when clinicians centered the visits around the participants' goals and tailored the encounter to their specific concerns. Lastly, participants recognize that screening for postpartum mood disorders is important; however, the current screening tools do not differentiate between mood disorders and expected responses to a stressful neonatal intensive care experience. Postpartum visits tailored to patient preferences for care in the early postpartum period are needed alongside system-level interventions to address barriers to accessing postpartum care for patients who deliver premature infants.

Proactive end-of-life conversations in residential care homes: a qualitative interview study exploring residents’ and family members’ experiences

BackgroundDue to population aging, residential care homes are increasingly providing end-of-life care for residents with multiple chronic illnesses and cognitive decline. Proactive end-of-life communication, a component of Advance Care Planning, has been suggested as a means of providing high-quality care aligned with residents’ preferences and supporting involved family members. Despite growing knowledge about the benefits of early communication concerning end-of-life care preferences, such conversations are still rare in the context of residential care homes, and little is known about how they are perceived by residents and family members. The aim of this study is to explore the outcomes experienced by residents and family members who have participated in proactive end-of-life conversations in residential care homes.MethodsThis qualitative study is embedded within a participatory action research project implementing proactive end-of-life conversations in five Swedish residential care homes, using a conversation tool. In this study we performed 18 interviews with eleven residents and eight family members after they had participated in staff initiated proactive end-of-life conversations. Data were analyzed using interpretive description.ResultsResidents and family members experienced several outcomes of proactive end-of-life conversations presented in three closely interconnected themes: (1) Enabling open communication, (2) Creating space for knowledge exchange, and (3) Contributing to feelings of confidence and relationship building.ConclusionsProactive end-of-life conversations generated several beneficial outcomes for residents and family members, including those with cognitive decline. The study demonstrated that the conversations may strengthen person-centered care and family support in this context. Based on these findings, proactive end-of-life conversations have the potential for use by residential care home staff.

Preference for palliative care among low-income advanced cancer patients in Mainland China: a qualitative study

BackgroundPrevious studies have highlighted the significant impact of income on access to palliative care. However, few studies have explored the treatment preferences of low-income patients with advanced cancer. These individuals require additional support in terms of palliative care, including financial psychological, spiritual, and social assistance. Therefore, it is essential to conduct more qualitative research with a particular emphasis on the preferences of this population.AimTo explore the preference and influencing factors of palliative care among low-income advanced cancer patients in mainland China.DesignA qualitative study design with a hermeneutic phenomenological approach was used.MethodsSemi-structured interviews were conducted with a purposive sample of 23 low-income advanced cancer patients in mainland China. The collected data was analyzed thematically using Giorgi's methodology. The COREQ checklist was used.ResultsFour themes emerged from the analysis: (1) Economic status is crucial for palliative preference selection, which affects the patient’s choice of treatment, drugs and whether to continue with palliative care; (2) Family members and medical personnels’ support strengthens determination to receive palliative treatment; (3) The Chinese traditional culture of returning to one’s roots influences the choice of place of death, surgery and intubation; (4) Patients with advanced cancer tend to prefer the comfort care, refuse to be awakened and agree to sedation to reduce consciousness and thus relieve suffering.ConclusionsThe preferences of low-income patients with advanced cancer were influenced by economic status, social support, cultural beliefs, and the desire to alleviate suffering. Therefore, medical professionals should be patient with patients, respect them, and provide psychological support. And strengthen patients’ economic support by improving medical insurance policies and providing social assistance. At the same time, medical policymakers and clinical staff should respect patients’ cultural values and treatment preferences when developing treatment plans.

Lesbian, Gay, Bisexual, and Queer+ Patients’ Preferences for Contraceptive Counseling and Experiences of Coercion in Contraceptive Care

ABSTRACT Although one in three U.S. contraceptive clients identify as something other than heterosexual, research has overlooked associations between sexual identity and experiences of provider-based contraceptive coercion – that is, pressure from a healthcare provider to use or not use birth control. In 2023, we used the online Prolific panel to survey U.S. reproductive-age people assigned female at birth about their contraceptive care (N = 1,399; mean age = 32.6, SD = 8.24). We assessed differences in contraceptive care preferences and coercion across sexual identities and used open-ended survey responses to contextualize participants’ contraceptive coercion experiences. More than one-third (36%) of the sample identified as lesbian/gay, bisexual, asexual, pansexual, queer, questioning, or preferred to self-identify (hereafter LGBQ+). Compared to heterosexual participants, LGBQ+ participants were more likely to experience misalignment in how often they would like contraceptive counseling versus how often they received it. Among those who ever received contraceptive counseling (n = 1,197), LGBQ+ individuals were also more likely than heterosexuals to experience pressure to use contraception. Open-ended responses revealed LGBQ+ clients’ experiences with heteronormative assumptions during contraceptive care. Healthcare systems and providers must provide patient-centered contraceptive care to all individuals, with attention to how sexual identity can shape contraceptive needs.

Understanding patient priorities in teledermatology for psoriasis: A discrete choice experiment.

Despite supporting guidelines and evidence, teledermatology adoption in Germany is low, also possibly due to a lack of services that reflect patients' preferences. This study investigates these preferences in psoriasis care and the influence of sociodemographic, geographic and disease-related factors. A discrete choice experiment was conducted. The attributes included the two teledermatology modes (live-interactive, store-and-forward), treating physician, possibility to ask questions and acknowledgment of concerns. The opportunity to prefer the standard of care was given. Participants were randomly assigned to two scenarios: consultation for acute flare-ups or follow-up. Conditional logit models were used for analysis. Among 221 patients with psoriasis (mean age: 58.9 years, 39.8% female), a general preference for the standard of care was observed (acute: β = -0.86, p = 0.001; follow-up: β = -1.24, p = 0.001). Factors that positively influenced preference for teledermatology were medical care provided by the known physician (acute: β = 0.49, p < 0.001; follow-up: β = 0.51, p < 0.001), the possibility to ask questions (acute: β = 0.35, p < 0.001; follow-up: β = 0.52, p < 0.001) and a very good acknowledgment of patients' concerns (acute: β = 0.48, p < 0.001; follow-up: β = 0.50, p < 0.001). Immediate feedback (<24 h) was crucial in acute consultations (β = 0.51, p < 0.001). No preference for a teledermatology mode was noted in either scenario. In both scenarios, lower privacy concerns and higher technology acceptance positively influenced teledermatology preference. In acute care, current long waiting times, whereas in follow-up care, current regular blood sampling positively influenced the preference for teledermatology. Patients with psoriasis generally preferred standard-of-care over teledermatology. However, certain attributes positively influenced their preference for teledermatology, including consultations with their known treating physician, acknowledgment of patient concerns and prompt consultation during acute flare-ups. Adapting services to these preferences could increase the use of teledermatology.