Individual Care Research Articles

A Roadmap for Disaster Risk Reduction and Management in Kidney Care

Background: Natural, technological and other disasters cause significant human suffering, and kidney patients are uniquely vulnerable. The safe provision of kidney replacement therapies necessitates the consistent provision of resources. Robust disaster risk reduction and management (DRRM) can mitigate risks associated with resource disruption. Individual kidney care programs may benefit from an organized approach to developing context-specific protocols. We aimed to synthesize contemporary literature in kidney care to create a roadmap in DRRM. Methods: We conducted a scoping review followed by a content analysis using the Framework Method. Literature that focused on lessons learned and proposed strategies or recommendations in DRRM was eligible. We contextualized this roadmap within the domains of disaster preparedness, response, and recovery. Results: Of 3,973 titles and abstracts screened, 52 articles were included. We developed the following roadmap: 1) the ‘ABC4s’ of disaster preparedness: Assess needs, risks, and vulnerabilities (regional risks, patients at risk); Build a task force network; Capacity building (tangible resources, intangible resources, monetary considerations, transportation); Communication (network and protocol, patients’ medical and dialysis information, contact information of all stakeholders, inclusive approach, reliable medium); Coaching (patients, caregivers, healthcare personnel, reinforce and repeat); Contingency planning (surge capacity, rationing care, resource distribution); and Strategic partnerships. 2) the ‘DIAL’ response: Damage and scope assessment; Initiate action plan (choose the plan, apply preparedness tenets, implications for receiving facilities); Appraise the action plan regularly (reassess, maintain ethical standards, address psychosocial needs); and Liaise, engage and update. 3) the ‘ARC’ to recovery: Assess damage; Return to the (new) norm; and Collect data to evaluate, improve, and share. Conclusions: We propose a roadmap to disaster preparedness, response and recovery that can guide individual kidney care programs globally to develop context-specific protocols aimed at building capacities and facilitating processes toward DRRM.

Integrated Care in Atrial Fibrillation: A Multidisciplinary Approach to Improve Clinical Outcomes and Quality of Life

Background: Atrial fibrillation (AF) is the most common arrhythmia globally, associated with serious complications such as stroke and heart failure, as well as significant impacts on patients’ quality of life. Objectives: This theoretical article explores the role of integrated care in the management of AF, highlighting the need for a multidisciplinary approach that goes beyond rhythm and heart rate control. Methods: Through a review of the literature, this article explores the prevalence of AF, the challenges of diagnosis, the socioeconomic and psychological impact, as well as the benefits of integrating medical, psychological, and social interventions, drawing on insights from studies about integrative care in AF. Results: The findings highlight the challenges of managing AF, including its high prevalence, complex diagnosis, and significant socioeconomic and psychological impacts on patients. Integrated care models, combining medical, psychological, and social interventions, improve treatment adherence, reduce complications like stroke and heart failure, and enhance patient quality of life. Conclusions: Integrated care models hold significant promise in improving outcomes in AF patients through structured, multidisciplinary approaches. Evidence supports reductions in cardiovascular events, hospitalizations, and mortality when adhering to clinical guidelines, emphasizing patient education, and implementing individualized care strategies. Despite challenges, like regional disparities and suboptimal implementation, the integration of multidisciplinary teams and emerging technologies offers a way to enhance care delivery and accessibility. Future efforts should focus on personalizing care, promoting professional collaboration, and taking advantage of technological advances to optimize AF management and promote sustainable health systems.

Artificial intelligence-based clinical decision support in the emergency department: A scoping review.

Artificial intelligence (AI)-based clinical decision support (CDS) has the potential to augment high-stakes clinical decisions in the emergency department (ED). However, its current usage and translation to implementation remains poorly understood. We asked: (1) What is the current landscape of AI-CDS for individual patient care in the ED? and (2) What phases of development have AI-CDS tools achieved? We performed a scoping review of AI for prognostic, diagnostic, and treatment decisions regarding individual ED patient care. We searched five databases (MEDLINE, EMBASE, Cochrane Central, Scopus, Web of Science) and gray literature sources from January 1, 2010, to December 11, 2023. We adhered to guidelines from the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. We published our protocol on Open Science Framework (DOI 10.17605/OSF.IO/FDZ3Y). Of 5168 unique records identified, we selected 605 studies for inclusion. The majority (369, 61%) were published in 2021-2023. The studies ranged over a variety of clinical applications, patient populations, and AI model types. Prognostic outcomes were most commonly assessed (270, 44.6%), followed by diagnostic (193, 31.9%) and disposition (115, 19%). Most studies remained in the earliest phase of preclinical development (572, 94.5%) with few advancing to later phases (33, 5.5%). By thoroughly mapping the landscape of AI-CDS in the ED, we demonstrate a rapidly increasing volume of studies covering a breadth of clinical applications, yet few have achieved advanced phases of testing or implementation. A more granular understanding of the barriers and facilitators to implementing AI-CDS in the ED is needed.

Addressing the "Black Hole" of Low Back Pain Care With Clinical Decision Support: User-Centered Design and Initial Usability Study.

Low back pain (LBP) is a highly prevalent problem causing substantial personal and societal burden. Although there are specific types of LBP, each with evidence-based treatment recommendations, most patients receive a nonspecific diagnosis that does not facilitate evidence-based and individualized care. We designed, developed, and initially tested the usability of a LBP diagnosis and treatment decision support tool based on the available evidence for use by clinicians who treat LBP, with an initial focus on chiropractic care. Our 3-step user-centered design approach consisted of identifying clinical requirements through the analysis of evidence reviews, iteratively identifying task-based user requirements and developing a working web-based prototype, and evaluating usability through scenario-based interviews and the System Usability Scale. The 5 participating users had an average of 18.5 years of practicing chiropractic medicine. Clinical requirements included 44 patient interview and examination items. Of these, 13 interview items were enabled for all patients and 13 were enabled conditional on other input items. One examination item was enabled for all patients and 16 were enabled conditional on other items. One item was a synthesis of interview and examination items. These items provided evidence of 12 possible working diagnoses of which 3 were macrodiagnoses and 9 were microdiagnoses. Each diagnosis had relevant treatment recommendations and corresponding patient educational materials. User requirements focused on tasks related to inputting data, and reviewing and selecting working diagnoses, treatments, and patient education. User input led to key refinements in the design, such as organizing the input questions by microdiagnosis, adding a patient summary screen that persists during data input and when reviewing output, adding more information buttons and graphics to input questions, and providing traceability by highlighting the input items used by the clinical logic to suggest a working diagnosis. Users believed that it would be important to have the tool accessible from within an electronic health record for adoption within their workflows. The System Usability Scale score for the prototype was 84.75 (range: 67.5-95), considered as the top 10th percentile. Users believed that the tool was easy to use although it would require training and practice on the clinical content to use it effectively. With such training and practice, users believed that it would improve care and shed light on the "black hole" of LBP diagnosis and treatment. Our systematic process of defining clinical requirements and eliciting user requirements to inform a clinician-facing decision support tool produced a prototype application that was viewed positively and with enthusiasm by clinical users. With further planned development, this tool has the potential to guide clinical evaluation, inform more specific diagnosis, and encourage patient education and individualized treatment planning for patients with LBP through the application of evidence at the point of care.

A Qualitative Study of the Lived Treatment Experiences of Women With an Eating Disorder and Comorbid Borderline Personality Disorder.

Having both an eating disorder (ED) and borderline personality disorder (BPD) is associated with heightened clinical complexity, high levels of distress, and challenges in treatment. This study sought to qualitatively investigate the experiences of women with an ED and comorbid BPD as they undergo ED treatment, aiming to better understand factors that shape their perceptions of care. Fourteen women with both an ED and BPD in treatment at a public-sector ED clinic were recruited to participate in an open-ended qualitative interview about their lived treatment experiences. Five overarching themes (with seven subthemes) emerged from the qualitative analysis: (1) Difficulties with emotions as a key factor underlying both ED and BPD; (2) Perceptions of BPD in ED maintenance and treatment; (3) Relational dynamics in treatment; (4) Treatment is "never enough"; and (5) The importance of treating the ED and BPD together. This study highlights the lived experiences of women with both an ED and BPD. Patients expressed the need for ED treatment to target emotion dysregulation, interpersonal difficulties, and their attachment to their therapists and to treatment. This study provides insights into the experiences of patients with BPD of ED treatment that may help guide the approach to care in such individuals.

The Oregis Dashboard: Web-based Ophthalmic Research Benchmarking in Germany.

The oregis registry operated by the German Ophthalmological Society (DOG) serves as a central digital platform for collecting and analysing ophthalmological healthcare data in Germany. The aim of oregis is to provide a comprehensive picture of the current healthcare situation and promote healthcare research using real-world-data from inpatient and outpatient facilities. Since its launch in 2020, oregis has continuously expanded its database to enable scientific analyses on a wide range of topics. This paper presents the new dashboard feature allowing participating centres to compare their own patient data with aggregated data in real time while also covering privacy aspects of the system. The oregis steering committee opted to implement the oregis dashboard based on existing medical registries. First, forty-nine national and international registries were analysed to identify common features such as benchmarking functionality. This was followed by technical realisation and implementation. Each centre connected to oregis has secure access to the oregis dashboard, which displays key indicators for patients, diagnoses, and treatments. Dynamic filtering options allow targeted data analysis, comparing each centre's results anonymously with aggregated data from other centres. The dashboard uses Apache Superset data visualisation software [! etwas informativer]. Data is synchronised using an integrated oregis Konnektor module to anonymise patient data according to defined standards. Extensive security and privacy measures ensure data security, including server-side encryption, transport encryption, and two-factor authentication. The dashboard is part of a comprehensive privacy policy developed and validated for oregis by privacy experts. The number of centres connected to oregis is still growing. The new web-based dashboard allows flexible analysis of data and comparison with other centres without allowing conclusions to be drawn about any individual care centre; this ensures data privacy and independence in each centre. More features can be added to provide a more thorough overview of eye care in Germany as oregis grows.

Evaluation of care and clinical outcomes after the implementation of an electronic medical record system for type 1 diabetes management in Rwanda

ABSTRACT Background Electronic medical record (EMR) systems are increasingly used to improve disease management. However, the impact on data quality, quality of care and clinical outcomes for type 1 diabetes (T1D) in sub-Saharan Africa (SSA) has not yet been explored. Objective The aim was to evaluate the effect of implementing an EMR system on the quality of care and clinical outcomes for T1D individuals in Rwanda. Methods The Rwanda Diabetes Association collected data during quarterly district hospital visits. We evaluated the effect of a newly developed and implemented EMR system by assessing differences in clinical attendance and outcomes 2 years before (pre-EMR: February 2020-February 2022) and after (post-EMR: February 2022–February 2024) the deployment of the EMR system. Results We found an increase in the number of individuals examined and the number of consultations conducted post-EMR. There was an increase in data completeness on all parameters; however, we also found that more people did not monitor their blood glucose post-EMR. We found a significant increase in clinical attendance, and a reduction in median HbA1c levels from 81.4 mmol/mol pre-EMR to 63.9 mmol/mol post-EMR (p < 0.001). Conclusion Several quality and clinical indicators improved after the integration of the EMR system in T1D management. To the best of our knowledge, this is the first study evaluating the impact of using an EMR system on the quality of care and clinical outcomes for T1D individuals in an SSA context. The long-term effect and implications are yet to be explored.

A socio-ecological model of the management of leprosy reactions in Indonesia and India using the experiences of affected individuals, family members and healthcare providers

BackgroundLeprosy reactions (LR) are immune-mediated complications of leprosy that may be associated with severe and irreversible nerve damage. Non-medical aspects, such as financing, service provision, and healthcare resources in the management of LR are generally overlooked as studies tend to concentrate on clinical features and treatment. Barriers to accessing care and services are a major cause of suboptimal care for people with leprosy. This study aims to explore the barriers to and facilitators of high-quality care and management of LR in two leprosy-endemic countries with different health care models – Indonesia and India – and identify areas for improvement.MethodsA socio-ecological model was adopted. Data were obtained from 66 interviews with individuals who experienced LR and were seeking care at the two study sites. In addition, immediate family members of individuals with LR and healthcare workers attending to people with leprosy participated in seven focus group discussions (FGDs).ResultsThis study highlights the significant impact of public health insurance regulations and uptake at the macrosystem level on the provision of healthcare services, clinical decision-making, care expenditure, and the psychological well-being of individuals with LR in Indonesia and India. Lack of specialized health professionals and communication challenges were identified in both study populations. Indonesian participants encounter additional challenges due to a fragmented information system and drug shortages. This study identifies key facilitators in providing high-quality care for LR-affected individuals, including financial assistance, availability of corticosteroid alternatives, timely provision of care, and counselling. It found that the high coverage of public health insurance cards in the Indonesian model has increased access to care among individuals affected by LR, despite the challenges. Conversely, the Indian model of care offers treatment subsidies. The advantage of the Indonesian model is its ability to provide wider access to high-quality care, whereas the Indian model focuses on those in most need. This study emphasizes the importance of addressing these challenges through improved communication strategies, education aimed at the affected individuals, and accessible medical care. Furthermore, variations in care-seeking behaviour and self-care practices were observed in both sites, underscoring the need for culturally sensitive and comprehensive approaches to the management of LR.ConclusionThe study findings demonstrate that the factors identified at the four systemic levels are interrelated and have an impact on the access, acceptability, and management of LR services. Despite its accessibility and wider coverage of public health insurance, the integrated service model in Indonesia faces challenges associated with complex regulations and the availability of medication. India’s care model offers intensive, specialised care but has difficulties in ensuring sufficient health personnel, resources, and public health insurance coverage. These findings highlight the need to address these challenges to ensure timely, effective, and comprehensive care for individuals with LR.

The Role of Stratified Cumulative Antibiograms in the (Choice of Appropriate Antibiotics in Urinary Tract Infection) Management of Urinary Tract Infections

Urinary tract infections (UTIs) are one of the most common bacterial diseases both in communities and in hospitalized patients, and at the same, time they are one of the most common indications for the use of antibiotics. UTI guidelines are generally available nationally or internationally, but they do not address all aspects of UTI treatment for different patient cohorts, age, gender, or comorbidities. The aim of the study was to point out the importance of stratified cumulative antibiograms at the level of individual health care facilities and the significant differences between epidemiological data, not only at the national level, but also at the local level. Our study analyses data from 383 patients with UTIs from a hospital department, General University Hospital (GUH), and 272 patients from an outpatient medical facility, Urocentrum (UC). This analysis focuses on the most common UTI causative agent, Escherichia coli, its representation as the causative agent of UTI in patients with complicated acute cystitis (N30), and its representation in complicated acute cystitis in patients with prostate cancer (C61). In addition to the frequency of occurrence, a sub-analysis of the incidence of resistance of E. coli to commonly used antibiotics by age, gender, diagnosis, and medical facility was performed. Results: The most common causative agent of UTI was E. coli. In patients with N30, it was 70% in GUH and 54% in UC, but in oncological patients with UTI, it was only 39% and 35%, respectively. In patients with UTI in C61, there was a significant difference in susceptibility of E. coli between individual health care facilities. Lower resistance was found in UC opposite to GUH isolates in ampicillin, with 29.8% vs. 65%, p = 0.001; amoxicillin/clavulanic acid, with 8.5% vs. 30%, p = 0.01; with 2.1% vs. 17.5% in pivmecillinam, p = 0.01; with 10.6% vs. 37.5% in co-trimoxazole, p = 0.003; and ciprofloxacin, with 10.6% vs. 30%, p = 0.04. The study shows significant differences in the sensitivity of urinary E. coli isolates in patients in relation to age, gender, medical devices, and the presence of comorbidities.

The effect of individual education and care provided in living spaces to pregnant women in the earthquake region on prenatal distress, risk perception, and labour anxiety

BackgroundThe purpose of this study was to evaluate the effect of individual education and care given to pregnant women in their living spaces on prenatal distress, risk perception, and labour anxiety.MethodThe study was conducted with 60 pregnant women primiparous pregnant women over 20 weeks of gestation. Data for this quasi-experimental, pretest-posttest designed randomised control group study were collected using the Prenatal Distress Scale, the Perception of Pregnancy Risk Questionnaire, and the Oxford Worries about Labour Scale. Education and care were provided in four 30-minute sessions, scheduled on mutually agreed-upon days and times in the living spaces of the pregnant women in the intervention group. These sessions were based on modules prepared by the researchers according to the women’s trimesters. Pregnant women in the control group received routine pregnancy follow-ups concurrently with the intervention group.ResultsThe mean posttest score of the pregnant women was 33.5 ± 4.1 in the intervention group and 23.6 ± 4.9 in the control group (p = 0.001). The mean posttest score for the Risk Perception Scale was 3 ± 0.9 in the intervention group and 5.6 ± 2.2 in the control group. For Prenatal Distress, the mean post-test score was 1.4 ± 2.2 in the intervention group and 13.2 ± 9.1 in the control group (p = 0.001).ConclusionThe results of this study show that providing education to pregnant women in their living spaces following a disaster effectively reduces their risk perceptions, prenatal distress, and labour anxiety.Date of registration26.10.2023 (NCT06110819).

The mediating role of thyroid-related hormones between thyroid dysfunction diseases and osteoporosis: a mediation mendelian randomization study

The links between Thyroid dysfunction diseases (TDFDs) and osteoporosis (OP) has received widespread attention, but the causal relationships and mediating factors have not been systematically studied. We used two-sample Mendelian randomization (MR) analysis to elucidate the causal relationship between TDFDs and OP. Moreover, we performed mediation MR analyses to explore the role of thyroid-related hormones and OP risk factors in the association between TDFDs and OP. Two sample MR analyses showed that hyperthyroidism increased OP (OR = 1.080, 95% CI 1.026 to 1.137; P = 0.0032) risk. Hypothyroidism increases OP (OR = 1.183, 95% CI 1.125 to 1.244; P < 0.0001) risk. Furthermore, mediation analysis revealed that TSH mediated 5.314% of the relationship between hypothyroidism and OP. In contrast, FT4 mediated 9.670% of the relationship between hyperthyroidism and OP. In European populations, TDFDs may increase OP risk. TSH mediates in the causal association between hypothyroidism and OP, and similarly, FT4 mediates in the causal link between hyperthyroidism and OP. Our findings underscore the significance of improving integrative care for individuals with TDFDs to mitigate the risk of OP. It is essential to maintain stable levels of thyroid hormones and closely monitor bone health to effectively mitigate and prevent OP.

Further Education in the Care of Individuals with Intellectual Disabilities: Findings from a Nationwide Online Survey in Germany

This paper presents key findings from the study "Further Education in the Care of Individuals with Intellectual Disabilities," conducted at Philipps University of Marburg, Germany, between early 2023 and 2024. The research explored various aspects of professional development in this field, with a particular focus on a nationwide online survey. The survey included 254 participants in management roles at institutions serving individuals with disabilities across Germany. A primary objective was to evaluate the demand for further education within these organizations.

"Anybody who can clarify or humanize the experience would be such a help": An interpretive description of perceptions of genomic health and nursing care in individuals with cancer predisposition syndromes.

There is increased use of genomic testing in oncology care. Yet, individuals with hereditary cancer predisposition syndromes (CPS) experience challenges when navigating the lifelong CPS healthcare considerations. The purpose of this study is to describe the healthcare experiences of individuals living with CPS and their perceptions of genomic-informed nursing care. Interpretive description (ID) was the qualitative approach used in this patient-oriented research study, conducted in partnership with two individuals with lived experience of CPS. Participants were recruited to participate in an interview using a variety of public and provider/patient network sampling sources. Inductive data analysis was guided by general steps for ID analysis as described by Sally Thorne. Thirty-seven individuals who self-reported a CPS participated in interviews between April and August 2023. Two primary themes were identified: 1), When genomic knowledge is power, and 2), Perceived acceptability of nursing roles in CPS care. Participants described genomic knowledge as a form of personal and family empowerment, but many reported that CPS-related knowledge is inaccessible in the healthcare system. This often resulted in healthcare experiences that were insufficient and fragmented. Although participants reported minimal nursing involvement in their CPS care, there was a consensus that enhanced nursing contributions could be beneficial. They particularly endorsed the potential value of a dedicated oncology genomic nursing role. Findings highlight patient-endorsed opportunities for nurses at the generalized and specialized levels to contribute to improved cancer genomic care. Findings can be used to inform novel models of clinical care for individuals with CPS.

Frontline professionals' experiences of navigating boundaries in a layered care and support system for individuals with complex care needs in the Netherlands.

Fragmented care systems, characterized by horizontal and vertical boundaries, hinder interprofessional collaboration for individuals with complex care needs. This study explores how frontline professionals navigate these boundaries to foster collaboration within a national program promoting integrated care for individuals with 'misunderstood behaviour' in the Netherlands. Using a boundary work lens, we analysed 44 semi-structured interviews with frontline professionals from the social, care, and safety domains. Our findings reveal that frontline professionals employ a multifaceted repertoire of collaborative boundary work strategies. These strategies include adjusting boundaries (expanding roles and tasks to address individuals' needs), spanning boundaries (creating boundary spanners, co-locations, and boundary objects), and working around boundaries (finding creative solutions to overcome financial and legislative limitations). The choice of strategy deployed depended on the agency professionals experienced in relation to specific types of boundaries. Professionals' limited agency regularly constrained the effectiveness of strategies. In these cases, professionals relied on interventions of higher-level actors. This reliance involved both direct interventions by managers and administrators to rearrange boundaries and indirect support, empowering frontline professionals with the flexibility and autonomy to navigate boundaries themselves. These findings introduce a power dimension to the conceptualization of boundary work and underscore the importance of addressing the interconnectedness of different types of boundaries at various levels.

The Cascade of Care for Individuals With Opioid Use Disorder in Los Angeles County

The Cascade of Care for Individuals With Opioid Use Disorder in Los Angeles County

Role of psychologists in enhancing care quality for individuals with serious mental illnesses: Introduction to a special section.

This special section underscores the importance of psychologists in improving and enhancing care for individuals with serious mental illnesses (SMIs). People with diagnoses typically included in the category of SMIs-schizophrenia, schizoaffective disorder, bipolar disorder, and other diagnoses with symptoms severely impacting functioning-typically have layered marginalities and experience significant social stigma in addition to mental health symptoms. The complexity of challenges commonly experienced by individuals with SMI requires that treatment providers have specialized knowledge, training, and skills to provide specialty care needed to support mental health recovery. The included articles illustrate the breadth of the impact of psychologists on care for this population to date as well as the need to address growing care gaps for people with SMI through specialized training support to increase the provision of evidence-based practices and high-quality care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Assessment tools and factors associated with relapse among patients with alcohol use disorders: A narrative review

Alcohol is a highly addictive substance, and long-term alcohol consumption can lead to mental disorders. Many patients with alcohol use disorders (AUDs) often relapse shortly after receiving treatment following a brief period of abstinence. Identifying the factors influencing relapse is crucial for follow-up treatment and nursing. At present, academic research on AUD and relapse primarily focuses on summarizing clinical symptoms and drug and non-drug treatment methods, with limited analysis of the factors that contribute to relapse. This paper reviews the current understanding of AUD and relapse, along with the assessment tools used, and examines the factors influencing relapse. The aims are to identify key relapse factors in patients with AUD after abstinence and to provide guidance for relevant research, as well as for developing individualized treatment and care plans.

Evaluation of a transdiagnostic mental health intervention in German primary care: study protocol for a parallel-group, two-arm, cluster randomised controlled pilot study

BackgroundGeneral practitioners play an important role in the first-line care of individuals with mental health conditions. However, factors such as time constraints, limited experience in managing mental health conditions and high rates of comorbidity may hinder adequate treatment. To improve psychological care, adopting a transdiagnostic approach shows potential. Research on transdiagnostic interventions delivered by general practitioners is scarce. Thus, a transdiagnostic intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders was developed specifically for primary care. In a parallel-group, two-arm, cluster randomised controlled pilot study, the transdiagnostic intervention will be evaluated for feasibility, acceptability and potential effectiveness in German primary care.MethodsA total of 100 adult patients with a mental health condition will be recruited by general practitioners. In the intervention group, general practitioners will administer the transdiagnostic intervention, introducing patients to psychological concepts based on transdiagnostic factors (i.e., understanding emotions, cognitive flexibility, countering emotion-based avoidance). In the control group, general practitioners will provide improved treatment as usual oriented on official German treatment guidelines for depression, anxiety and somatoform disorders. In both study groups, treatment will be carried out in four 20-min sessions over 12-weeks. Self-report questionnaires will be completed before treatment initiation (only patients) and after treatment completion (patients and general practitioners) to assess feasibility and acceptability (i.e., treatment recruitment, delivery, response, effectiveness, unintended consequences and maintenance) as well as potential effectiveness (i.e., change in transdiagnostic factors).DiscussionThe pilot study will address the research gap concerning general practitioner-led psychological interventions in primary care and will give insights into whether the adoption of a transdiagnostic approach is of benefit to general practitioners and patients. Findings may inform the design of a main trial by identifying barriers to the transdiagnostic intervention’s feasibility and acceptability, whilst advancing treatment delivery protocols to support effectiveness.Trial registrationThe protocol for this study has been registered with the German Clinical Trials Register: DRKS00033386, Date of registration: 18th of March 2024, https://drks.de/search/en/trial/DRKS00033386.

Patient Acceptance of Death and Symptom Control/Quality of Care Among Terminal Cancer Patients Under Inpatient Hospice Care: A Multicenter Cross-Sectional Study.

Patient attitude to death is associated with outcomes in hospice care settings. This Korean study investigated the association between terminal cancer patient death acceptance and symptom control and quality of care (QoC) as perceived by family caregivers (FCs). A multicenter cross-sectional survey was conducted in nine inpatient hospice care units, and the data of 108 dyads (terminal cancer patients who responded to the revised Death Attitude Profile and their primary FCs) were analyzed. Dyads were dichotomized into high and low groups by death-acceptance level. Multivariate regression models were used to examine the association between death acceptance and symptom severity/QoC as perceived by FCs. Patients in the high acceptance group were younger, educated to a higher level, more religious, and had better-functioning families. Patients with severe shortness of breath were less likely to accept the inevitability of death. FCs of patients with high acceptance of death were more satisfied with QoC, particularly in domains of individualized care and family relationships. In addition, the positive association between patient acceptance and FC satisfaction with care was significant in dyads of young or female patients, patients with a low education level, and patients not cared for by a spouse. Terminal cancer patient death acceptance is associated with symptom control and FC perceived QoC.

2796 Improving physical health care in older people in mental health settings: the ImPreSs-care qualitative study

Abstract Background The overlap between physical and mental health is a common challenge for older adults, and many live with co-occurring physical and mental health disorders. Different service models have been adopted; however, the majority provide specialist mental health input to older adults with physical health needs in acute hospital trusts. Few service models are available providing comprehensive physical health input to older adults in secondary mental healthcare settings. Furthermore, little information is available regarding specific physical healthcare needs facing older people receiving specialist mental healthcare. The aim of this qualitative study was to determine the facilitators and barriers to delivering physical healthcare for older adult patients, their carers, and staff within specialist mental health settings (inpatients and community). Methods 54 semi-structured interviews (REC:22/IEC08/0022) were conducted with different stakeholders (staff (n = 28), patients (n = 7), carers (n = 19)) across two mental health trusts (Leicester, Nottingham). Interviews explored the facilitators and barriers to delivering physical healthcare to older people (aged &amp;gt;65 years) receiving secondary mental healthcare (dementia and functional disorders) with combined physical health needs. Interviews were audio recorded and transcribed verbatim. Data were analysed thematically, drawing on an underpinning framework of integrated care for individuals with multimorbidity (SELFIE). Results Three main themes were identified: 1) service delivery; focussing on care coordination and communication between services, 2) workforce; focussing on training and skills alongside support and availability of physical health expertise, 3) the individual with multimorbidity; focussing on mental-physical health interplay and patient experience. Conclusions The findings from this study can be used to inform service development to improve the provision of physical healthcare for older people receiving secondary mental healthcare in the UK, focussing on improving care coordination and communication between physical and mental health services, and upskilling and training mental health teams in physical health provision with appropriate support from physical health experts.