Clinical Confidence Research Articles

Implementation of the psycho-existential symptom assessment scale in palliative care: Qualitative analysis of stakeholders perspectives

ObjectivesTo explore 1) perspectives of feasibility, acceptability, integration and sustainability of the Psycho-existential Symptom Assessment Scale (PeSAS); 2) barriers and benefits of PeSAS in its real-world performance; and 3) clinician confidence and perceived competency in using PeSAS. MethodsThirty-one key stakeholders from nine palliative care services who participated in the implementation of the PeSAS were purposefully sampled and participated in semi-structured interviews. Data was managed using the Determinants Framework. ResultsBenefits of PeSAS were a common language enhancing communication, identifying symptoms of psycho-existential distress, initiating referral, providing acknowledgement for previously unrecognised distress and enhancing patient agency. Key barriers were the availability of skilled clinicians, patient characteristics such as delirium and phase of illness, avoidance of confronting end-of-life conversations, information technology resourcing, and reduced engagement due to language, culture and health literacy. ConclusionScreening using the PeSAS is feasible and acceptable once clinicians are adequately trained to administer it. Our study highlights the benefits of qualitative enquiry in developing and implementing new interventions. Practice ImplicationsThe identification and management of psycho-existential symptoms should be part of routine practice in palliative care. However, adequate staff training, resourcing, referral pathways and implementation process and outcome assessments are important to ensure sustainability.

Introducing simulation-based education to Genitourinary Medicine specialty training in the North West of England: A quality improvement project exploring trainee perspectives and impact.

Simulation-based education (SBE) provides enactive experiences for learners. This project explores the utility of SBE in GUM training. Phase 1 was a qualitative survey of GUM trainees across the UK exploring their views on SBE. Phase 2 involved roll-out of SBE to new GUM trainees. Feedback was subsequently obtained. Twenty-three participants were surveyed in phase 1. When asked to rate the relevance of SBE to curriculum competencies on a scale of 1 to 5 (1 = not relevant, 5 = highly relevant), the highest ratings (score ≥4) were for proctoscopy (4.1), IUD insertion (4.1), SDI removal (4.1), SDI insertion (4.0), and punch biopsy (4.0). All curriculum items scored ≥3. Eighty-three percent (n = 19) felt SBE will improve clinician confidence and competence. Following introduction of SBE, participants fed back on the relevance of the session. All 5 respondents rated the session ≥4 for addressing their clinical and curriculum goals. All respondents rated the session ≥4 for improving clinician confidence and competence. The session received an overall rating of 5, and respondents similarly rated 5 for more sessions. Trainees recognise the value of simulated learning experiences and its role in improving procedural competence and addressing bespoke human factor skills relevant to GUM.

Advancing Nurse Practitioner proficiency and confidence: An evaluation of postgraduate training in rural and medically underserved communities.

Nurse practitioners (NPs) are critical in delivering primary health care, especially in underserved and rural areas. Transitioning from academic training to practical application poses challenges, highlighting the need for structured post-licensure training (PLT). To address the knowledge gap regarding the impact of PLT programs on the clinical development, confidence, and care delivery of NPs using an innovative evaluative approach. Using a mixed-methods approach, this study engaged 19 NP fellows in quantitative and qualitative evaluations. Assessments of clinical skills and feedback were collected using the REDCap platform, focusing on mentorship and the practical application of skills. Quantitative analysis showed improvements in several domains: patient-centered care (median score increase from 8 to 10, p = .005), knowledge of evidence-based practice (median score from 8 to 9, p = .028), and health systems (median score from 8 to 9, p = .014). Qualitative feedback underscored the benefits of the program's structured support and practical learning experiences while revealing the need for improvements in mentor preparedness. The PLT program effectively advanced NP proficiency across various domains, particularly in patient-centered care and evidence-based practice. However, it also highlighted a crucial need for focused mentorship in developing leadership skills. The study's limited scope, dependence on self-reported measures, and specific statistical methods constrain the broader applicability of its findings. Future research should aim to validate these results across diverse settings and explore long-term outcomes. This study provides new perspectives on NP workforce development, emphasizing the importance of structured mentorship and training, especially in medically underserved communities.

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane

BackgroundThe National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital’s anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector.MethodsWe conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method.ResultsParticipants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA’s potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions.ConclusionsThe evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Building sustainable local training capacity for maternal and newborn health within the public health system: A training intervention in Palghar District, India

Continuing professional development for the health workforce is of paramount importance and can be implemented using locally available, competent trainers. However, guidelines for the selection, development, and mentorship of such trainers are lacking. Training intervention research conducted in Western Maharashtra, India, aimed to address these gaps by focusing on skills for maternal and newborn health (MNH). In this study, selected trainers from a pilot project in the Pune district received advanced training to become core trainers (CTs) for a scale-up project in Palghar district (2019 – 2022). The CTs trained master trainers (MTs) in Palghar (n = 32) with support from the United Kingdom-based technical partners, following a six-step approach: selection of trainers, training of trainers (ToT) (including knowledge and skills assessment), staggered induction as trainers, continuous support, regular quality assessment, and virtual refresher training. The process and outcomes of this six-step approach were evaluated using mixed-methods research. The skills of local trainers were augmented through hands-on training and further supported by long-term mentorship to develop training excellence. The CTs’ competency as mentors improved due to appreciative feedback. Regular assessments conducted by the expert team also contributed to maintaining quality control. Online learning has emerged as an effective method for refresher training. There was considerable improvement in the clinical knowledge and skills of the health providers from Palghar (n = 505), which attests to the quality of the training delivered by the Palghar MTs. This intervention enhanced both clinical competency and confidence. The approach demonstrated the importance of recruiting suitable participants who could consciously shift their teaching style to become more adult-learner-centric facilitators. However, there is a need for a systematic, long-term evaluation of this model, its application to MNH care, and its institutionalization within the public health system.

Simulation training improves resident physicians’ confidence in managing first trimester bleeding in the emergency department

First trimester bleeding is commonly encountered in pregnancy and can be potentially life-threatening. Simulation training provides an ideal opportunity for resident medical learners to improve clinical knowledge and gain confidence in managing life-threatening causes of first trimester bleeding in a realistic but safe clinical environment. The objective of this study was to assess the effectiveness of simulation in improving family medicine residents’ confidence and knowledge in identifying and managing first trimester bleeding in the emergency department (ED). The intervention was a two-hour educational simulation focusing on management of unstable first trimester bleeding. Twenty-one family medicine residents (67% female) at the University of Toronto participated in the simulation and completed pre- and post-simulation questionnaires assessing their confidence and knowledge in management of first trimester bleeding. This study demonstrates that simulation training improves resident physicians’ confidence in managing first trimester bleeding in the ED. Additionally, it improves their objective history taking skills. Post-graduate medical programs should consider developing structured simulation, particularly for high-yield clinical cases residents may not otherwise have acute exposure to and are required to be competent in managing.

Clinicians' confidence in diagnosing atypical anorexia nervosa: An experimental study of the role of patient and clinician characteristics.

This experimental study investigated the weight loss parameters and resulting end weight that influence clinician confidence in diagnosing atypical anorexia nervosa (AAN). Clinicians (N=67) read a series of vignettes where patient weight loss and end weight varied, then rated their confidence in an AAN diagnosis and alternatives. Using repeated measures ANOVAs, we examined patient (weight loss, end weight) and the possible relationship between clinician (e.g., age, profession) characteristics and confidence in diagnosing AAN. Clinicians were most confident in an AAN diagnosis when patients had lost 10% or 15% of their body weight, leaving them at a high or normal weight. Clinicians considered 5% as significant weight loss for AAN, but only when the patient ended at a high or normal weight. However, they did not clearly differentiate AAN from unspecified feeding and eating disorder (UFED) when there was a 5% weight loss resulting in high or normal end weight. Clinician characteristics did not impact on confidence in diagnoses. The DSM's 'significant weight loss' criterion leaves room for clinicians to interpret it idiosyncratically. The lack of a clear pattern of UFED and AAN diagnosis has important clinical implications, as UFED tends to be dismissed as being less serious.

Safety in spinal surgery-Empowering clinicians to report concerns in motor function.

Timely identification of neurological deterioration in patients with spinal disorders, through spinal motor assessment, is paramount in achieving early intervention to reduce the risk of permanent deficits. This project was initiated to meet the requirement for safe, timely spinal motor assessment through establishing and addressing clinician's educational needs. Mixed methods study conducted through online survey and concurrent focus groups June 2022-April 2023. Pre-intervention online survey and focus groups identified insufficient provision of education targeted at identifying changes in motor function and as a result, clinicians lacked confidence and competence in completing assessments and caring for patients with spinal disorders. An e-learning package was created and shared widely along with additional interventions to support assessment completion. To establish the success of the project a post-intervention online survey was distributed. Survey respondents reported that the e-learning package has influenced their practice to either some extent or to a great extent with 91% reporting increased confidence in completing a spinal motor assessment. Post-intervention results also demonstrated an increase in confidence in caring for spinal surgery patients. Through engaging with clinicians to establish and address educational needs, this quality improvement project has successfully increased competence and confidence in this area of spinal care. This study highlights the importance of targeted education to ensure that clinicians are appropriately skilled to identify neurological deterioration and demonstrates the effectiveness of digital education in providing this. This study addressed concerns around timely identification of deterioration of spinal patients. Study findings were the success in utilizing digital education to increase clinician's confidence and competence and thus enhance patient safety. This research will have an impact on clinical areas caring for patients with spinal disorders. SQUIRE guidelines. No patient or public contribution.

Utilization and consequences of CRP point-of-care-testing in primary care practices: a real-world multicentre observational study with 1,740 patient cases in Germany.

Point-of-care tests (POCTs) for C-reactive protein can support clinical decision-making of general practitioners (GPs) but are not widely used in German general practices. To investigate the utilization of semi-quantitative CRP-POCTs in routine primary care. Prospective observational study in 49 general practices in Germany (Nov/2022 to Apr/2023). GPs were provided with CRP-POCTs and collected data for each CRP-POCT use using standardized data collection sheets. Data from 1,740 CRP-POCT uses were recorded. GPs employed CRP-POCTs mainly for patients with respiratory tract infections (RTIs, 70.9% of all cases) and to a lesser extent for gastrointestinal infections (GIs, 10.3%). In RTIs, CRP-POCTs were frequently used to distinguish between bacterial and viral aetiology (60.8%) and to guide decisions on antibiotic prescribing (62.8%). In GIs, CRP-POCTs were mainly used to rule out severe disease progressions (53.2%) and for decisions on further diagnostic procedures (45.6%). In RTIs, CRP-POCTs influenced antibiotic prescribing in 77.5 % of the cases (32.3% in favour vs. 45.2% waiver). In GIs, CRP levels mainly affected decisions on further diagnostic procedures. GPs reported that CRP-POCTs were helpful in 88.6% of all cases. When available, German GPs predominantly use semi-quantitative CRP-POCTs to guide decisions on antibiotic prescribing in patients with RTI. CRP-POCT use improves clinical decision-making and increases the GPs' clinical confidence.

What influences ambulance clinician decisions to pre-alert emergency departments: a qualitative exploration of pre-alert practice in UK ambulance services and emergency departments

BackgroundAmbulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical...

Evaluation of telehealth in delivering diagnostic developmental assessments for children in South Western Sydney during the COVID-19 pandemic: Clinician and family perspectives.

Children with neuro-developmental disorders faced significant challenges in accessing services during the COVID-19 pandemic. Telehealth has been adopted by health services globally to facilitate access to clinical services. Our aims were to evaluate the utility of the telehealth modality for providing developmental assessment services and explore enablers and barriers to using telehealth, in a culturally diverse and socioeconomically disadvantaged population in Sydney. We reviewed telehealth developmental assessments in South Western Sydney conducted between 1 April and 30 June 2020. Data were collated on demographics; telehealth modality; diagnostic formulation; recommendations; and requested follow up. We conducted retrospective semi-structured telephone interviews with 79 families and 11 clinicians about their telehealth experience. Thematic analysis was carried out on the open text responses. Of 205 children assessed across six sites, median age was 48 months; 45% were assessed with video and 55% with telephone only. Diagnostic formulation and therapeutic recommendations were provided for 203 (99%) children and 138 (67%) were asked to come for face-to-face follow-up. The majority of families (76%) were satisfied or extremely satisfied with telehealth. Median clinician satisfaction was 3.5 out of 5, whilst clinician confidence with diagnostic formulation was 4 out of 5. Qualitative data revealed a range of barriers and enablers. Telehealth was a successful modality for contributing to the assessment journey for children with neuro-developmental disorders in our culturally, linguistically and socioeconomically diverse clinical population in the context of a pandemic lockdown. We discuss the potential for telehealth modalities in child developmental assessments beyond the pandemic.

Effectiveness of a pediatric critical care pilot preceptor program: Improved confidence and competency outcomes among a cohort of professional nurses in Blantyre, Malawi

BackgroundAvailability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists. AimEvaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence. DesignA 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months). SettingBlantyre, Malawi. ParticipantsNurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers. MethodsQuantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests. ResultsParticipants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041). ConclusionThis pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings.

Telesimulation for Training in Infant Feeding: A Randomized Controlled Trial.

Simulation is an education modality known to support clinical skill development. Unfortunately, access to simulation has been challenging, both prior to and during the pandemic. Simulation via telepractice, i.e., "telesimulation", has emerged, but little is known about whether outcomes are comparable to in-person simulation. This study compared in-person versus telesimulation learner outcomes in an infant feeding scenario. The secondary aim was to compare outcomes between novice and experienced participants.This pragmatic randomized controlled trial included speech pathologists who could attend if randomized to the in-person modality. Block randomization matched participants with < 6 months' infant feeding experience to those with > 6 months experience (2:1 ratio) into telesimulation or in-person simulation. Measures of clinical reasoning, confidence/anxiety, and satisfaction were collected, pre-, post-, and 4-weeks post-simulation.Overall, 39 clinicians completed either in-person simulation (n = 17) or telesimulation training (n = 22), including 16 experienced and 23 novice learners. Both in-person and telesimulation groups achieved significant improvements across time in clinical reasoning, self-reported confidence, and anxiety. The extent of change in clinical reasoning, confidence and anxiety was comparable between the telesimulation and in-person simulation groups. Comparing by experience, novice-level participants reported significantly greater changes in confidence and anxiety than experienced participants. Satisfaction levels were high regardless of simulation modality or experience.Participants in telesimulation and in-person simulation achieved similar improvements in the primary outcome measure of clinical reasoning, had comparable improvements in self-perceived confidence and anxiety, and demonstrated high satisfaction levels. Telesimulation is a promising means to improve clinician access to simulation training in infant feeding.

Preparedness and Anxiety of Dental Students in the Transition from Preclinical to Clinical Practice

Aim: This study aimed to investigate the preparedness and anxiety levels of dental students transitioning to clinical practice and to examine the effects of sex, university, and observations. Material and Method: A total of 182 students (58 male, 124 female) transitioning from preclinical to clinic participated in the study. The survey consisted of sections covering socio-demographic data, students' opinions on their preparedness for clinical practice, anxiety levels measured by the State-Trait Anxiety Inventory (STAI), and confidence levels in various skill areas. Spearman's Rank correlation test was used for correlation analysis, while the Mann Whitney-U test for pairwise group comparisons. Results: No differences were found in preparedness between sexes, but males exhibited significantly higher confidence in various dental skills. Conversely, females reported significantly higher levels of state and trait anxiety. State university students (n=48) reported heightened workload expectations and elevated levels of state and trait anxiety. Conversely, private university students (n=134) demonstrated increased confidence and preparedness in dental practice-related knowledge and skills. Students who participated in observations (n=96) had lower preparedness and confidence levels in several dental areas, coupled with higher trait anxiety levels, compared to their peers who did not participate in observations (n=86). Finally, STAI scores were positively correlated with workload, negatively correlated with knowledge, skills, and confidence. Conclusion: Sex, school, and observation status have an impact on students' preparedness for clinical education, anxiety, and confidence in their professional abilities. Therefore, assessments and orientation programs that take these aspects into account can benefit students at this time of change.

Paternal Exposure: Two patients' perspectives in an evolving landscape of therapeutics. Can we now provide reassurance?

There is now substantial evidence of safety in pregnancy for several newer medications, particularly biologic disease-modifying antirheumatic drugs, although clinician confidence varies. There is much less information available regarding paternal exposure. This article provides insight from two patients who describe the impact of family planning on their therapeutic decision making.

Evaluation of postgraduate foundation training for dental therapists: does participation enhance career prospects?

Objectives This study explored the value of dental therapy foundation training (DTFT) in the UK and how participation influenced career prospects.Aims To examine the efficacy of postgraduate foundation training for dental therapists (DTs) and evaluate whether participation increased clinical confidence. To investigate whether participation in the scheme enhanced career prospects and to determine barriers encountered by DTs in securing suitable positions, inclusive of COVID-19 restrictions.Methods The study used a survey incorporating open, closed, Likert-scale and multiple-choice questions. Quantitative data were analysed with IBM SPSS Statistics v26. Analysis of qualitative data was undertaken by two researchers. Final themes and subthemes were confirmed following round table discussions.Results A total of 94 survey responses were received: 61 from DTs who had not undertaken DTFT (Group A) and 33 who had undertaken DTFT (Group B). Most respondents were female (95%) with a mean age of 33.8 and 32.9 years, respectively. In total, 58.3% of Group A respondents did not believe that completing DTFT would have enhanced their career prospects, whereas 63.6% of Group B said that they gained a position as a result of completing DTFT. Participation in DTFT increased perceived clinical confidence in Group B and 81.8% were likely to recommend DTFT to their peers. A total of 12 major themes and 13 subthemes were identified.Conclusions DTFT schemes were considered a valuable educational experience which increased clinical confidence. Participation may have enhanced career prospects. Barriers were encountered by DTs when seeking work, regardless of participation in DTFT.

Game Products: Innovative Pathways for Nursing Education and Clinical Training

To excel in their work, nurses must have specialized tools to support their tasks and professional development. Games, as a crucial pathway to achieving nursing education and clinical training goals, demonstrate significant potential and application value, making them an innovative product. Nursing education games come in various forms, including virtual reality, augmented reality, tabletop, and digital, and may be designed as needed for individual, two-player, or team play (Avşar et al., 2023; Bermejo et al., 2023; Tsai et al., 2024). These games, beyond their entertainment value, have clear educational objectives embedded in their design. Through levels, challenging tasks, and reward mechanisms, they stimulate learning enjoyment and promote nursing development. In this column, experts and scholars in the field of nursing engaged in game development share their experiences and achievements. Integrating games into nursing delivers a wealth of tools and resources for nursing education and clinical practice, offering immersive learning experiences, instant feedback, and individualized learning paths. For nursing students, gamified products offer safe and risk-free learning environments in which they can practice critical tasks and make decisions in simulated medical scenarios, increasing their clinical experience and confidence and enhancing their clinical judgment and decision-making skills (Wu et al., 2023). For patients, many therapeutic games have already been designed that use gameplay to improve health by facilitating user engagement in rehabilitation exercises, promoting healthy eating, and fostering social interactivity (Tsai et al., 2024). For nurses, various games are being used to promote continuous professional growth in an interactive and enjoyable learning environment, improving overall quality of care and job satisfaction (Hsieh et al., 2023). In summary, the application of game products in nursing education and clinical training has introduced new learning and training models that provide multifaceted benefits for nurses, nursing students, and patients. We hope that readers will gain a deeper understanding of related game products after reading this column and use games effectively to enhance nursing quality.

Evaluating Student Satisfaction and Self-Confidence in Simulation-Based Anesthesiology Training among Final-Year Medical Students.

Simulation-based training (SBT) is increasingly recognized in medical education for enhancing clinical skills and confidence. This study evaluated the impact of SBT on satisfaction and self-confidence among final-year medical students at Jazan University, Saudi Arabia. A total of 117 students participated in a cross-sectional study after attending SBT sessions focused on anesthesiology. Data were collected via a questionnaire assessing satisfaction and self-confidence. Statistical analyses included descriptive and inferential statistics. Results showed mean satisfaction and self-confidence scores of 3.64 ± 0.79 and 3.70 ± 0.90, respectively, with no significant differences by gender or age. A strong association was noted between the learning experience ratings and both satisfaction and self-confidence (p < 0.001). The highest satisfaction was with the instructor's teaching style, whereas the lowest was with the motivation provided by teaching materials. For self-confidence, the highest scores related to the instructor's guidance, while the lowest concerned the application of SBT to critical skills learning. A strong positive correlation was found between satisfaction and self-confidence (R = 0.847, p < 0.001). The study concludes that SBT significantly enhances student satisfaction and self-confidence, emphasizing the importance of learner-centered methods and interactive learning in medical education.

How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.

Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care. To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation. Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022. Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women. HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly. Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.

Association Between Clinician Confidence and Making Guideline-Recommended Decisions in the Management of Abnormal Cervical Cancer Screening Results.

Guidelines for managing abnormal cervical cancer screening results are complex and adherence is challenging for clinicians. Previous studies have identified gaps in knowledge as a possible cause; few have explored the confidence clinicians have in their management decisions. Confidence in decision-making may influence management practices, particularly when guidelines are complex and evolving. Assess whether confidence in decision-making is associated with making guideline-concordant recommendations for abnormal cervical cancer screening results. A clinician survey used vignettes to ask clinicians to make a management recommendation for different abnormal results and rate their level of confidence in their response. Physicians and advanced practice providers (APPs) at three diverse health systems in Washington, Texas, and Massachusetts. Correct response to each vignette based on either the 2012 or 2019 American Colposcopy and Cervical Pathology (ASCCP) management guidelines. In total, 501 clinicians completed the survey between October and December 2020 (response rate 53.7%). Overall, most clinicians made guideline-recommended management decisions for two vignettes (73.2 and 73.7%), but fewer were confident in their selection (48.3% and 46.6%, respectively). Clinicians who reported high levels of confidence were more often correct than those who reported lower levels of confidence (85.8% vs. 62.2% and 87.5% vs. 60.7%, both p<0.001). After adjusting for clinician and practice characteristics, confidence remained significantly associated with selecting the correct answer. Clinician confidence in management decisions for abnormal cervical cancer screening results was significantly associated with knowing guideline-concordant recommendations. Given the complexity of cervical cancer management guidelines, solutions to improve clinician confidence in decision-making are needed.