Clinician Focus Groups Research Articles

Facilitators and Barriers to Integrating Patient-Generated Blood Pressure Data into Primary Care EHR Workflows.

Evidence supports using patient-generated blood pressure data for better outcomes in hypertension management. However, obstacles like dealing with home-generated paper data sets and questions of validity slowed the meaningful incorporation of home blood pressure into clinical care. As clinicians value patient data more, reliance on digital health solutions for data collection and shared decision-making grows. The purpose of this study is to evaluate the design and early implementation of an electronic health record (EHR)-based data visualization tool and explore the barriers or facilitators to integrating) patients' home blood pressure data into the electronic workflow in the clinical setting. Findings can inform potential next steps for implementation and provide recommendations for leveraging patient-generated health data (PGHD) in hypertension management. We qualitatively explored pre- and early-implementation factors for integrating PGHD into clinicians' EHR interfaces intended to support shared decision-making using the Consolidated Framework for Implementation Research (CFIR). We collected data in the form of notes and transcripts from clinician focus groups, administrative leadership feedback sessions, research team observations, and recurring team meetings. This study took place at a midwestern academic health center. We identify implementation facilitating factors, adoption considerations, and next steps across CFIR domains focusing on large-scale implementation. Key recommendations include aligning internal and external priorities, empowering champions to facilitate uptake, using intuitive design, and anticipating and planning for unintended consequences. These findings can guide future efforts to include PGHD in workflows, thus enhancing shared decision-making and laying the groundwork for larger implementations. Understanding the implementation barriers and facilitators to connect PGHD to clinician apps in the EHR workspace can promote their adoption and maintenance.

Abstract B163: Researcher, Clinician, and Community Focus Groups to Inform an Understanding of Cancer Disparities in the Transgender and Gender Diverse

Abstract Background: A growing number of Americans identify as transgender or gender diverse (TGD). This population experiences barriers and challenges across to socio-ecological spectrum including healthcare. Simultaneously, there is limited data on cancer in TGD persons. While advances in data-capture provide promising opportunity for future research, a comprehensive understanding of cancer disparities for the TGD community is needed to inform clinically and socially relevant research questions – particularly on cancer prevention, risk, screening, and treatment. Our study aimed to develop a transdisciplinary (TDS) academic-community team to create a shared understanding of factors associated with cancer disparities in the TGD population with aid from discussion sessions and interviews with researchers, clinicians, and community members. Methods: The TDS team engaged in literature reviews and discussion to ground their collective understanding. The team also conducted focus groups and interviews with researchers, clinicians, and community members (N=55) to enrich the team’s understanding of factors associated with cancer disparities. Data were summarized and thematized and groups were compared. Results: Community organizations/members noted systemic issues such as insufficient training of healthcare providers and staff, individual mistrust, and not believing they would live long enough to worry about cancer development. Providers identified personal uncertainty working with TGD patients, knowledge of appropriate recommendations for cancer screening, and individual risk behaviors (i.e. tobacco and alcohol use) as potential causes for cancer disparities. Researchers indicated they had not considered including TGD individuals as a specific subject population, were unsure how to study given lack of mouse models for early-stage research and acknowledged the opportunity for future study inclusion. Further, community members discussed the persistent stress of existing as a TGD person during a time of increasingly aggressive anti-TNB legislation and social attitudes. Healthcare providers and researchers reflected on the behavioral and physiological impact of stress on an individual’s health and cancer risk. Conclusion: The findings from our focus groups elucidated areas of shared understanding between the three different audiences; however, they also highlighted concepts that were not shared which offer opportunities for further collaboration and learning by key stakeholders. Through our TDS and collaborative approach, we will continue deep learning between team members to identify specific research questions to address the root causes of TGD cancer disparities through TDS collaboration and innovative research. Citation Format: Tobi Cawthra, Chandler Cortina, laura Pinsoneault, Michael Munson, Andrew Petroll, Melinda Stolley. Researcher, Clinician, and Community Focus Groups to Inform an Understanding of Cancer Disparities in the Transgender and Gender Diverse [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B163.

Using the RE-AIM and TDF frameworks to evaluate the implementation of a standardized cognitive assessment protocol in outpatient rehabilitation.

Impairments in cognition significantly affect patient functioning and rehabilitation outcomes. Assessment is essential to identifying at-risk individuals and guiding care plans. A cognitive assessment protocol was implemented in occupational therapy (OT) and speech-language pathology (SLP) outpatient practice. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Domains Framework (TDF), this study (1) measured the reach and adoption of the cognitive assessment protocol and (2) explored determinants and strategies that may affect adoption. Sequential mixed methods. Two outpatient rehabilitation clinics (A and B) within a health care network. Medical records from 220 adult patients with neurologic diagnosis and 15 OT and SLP clinicians. Cognitive assessment protocol. Reach of the assessment protocol across patient characteristics and adoption across clinical sites were measured quantitatively via retrospective electronic medical records review. Qualitative data on effectiveness and the implementation process were collected via clinician focus groups. Protocol adoption rates were 71% and 54% at clinics A and B, respectively. Site B OT was more likely to be noncompliant with protocol adoption compared to Site A, when controlling for patient characteristics, (81% vs. 16%, respectively; odds ratio = 11.4, 95% confidence interval [3.36-38.64], p ≤ .001). Patient age was a significant factor for protocol reach; older age was associated with noncompliance of the SLP protocol adoption, p < .05. Both sites employed implementation strategies targeting the provider level (eg, education/training); Site A additionally included organization-level strategies (eg, leadership engagement). In the absence of organization-level strategies, OT and SLP clinicians at Site B identified barriers related to leadership support, resources, and workflow. Standardized practice protocols are feasible to implement within the rehabilitation setting, though multilevel implementation strategies may be needed to promote adoption. Aligning practices with the needs, values and priorities of the organization, providers, and patients and families is imperative.

"Sustaining NSW Families" as a hybrid face-to-face/virtual program: Experiences of clients and clinicians.

To explore clients' and clinicians' perspectives about the acceptability and perceived outcomes of the Sustaining New South Wales (NSW) Families (SNF) program shifted to a hybrid service delivery model during the COVID-19 pandemic. Mixed methods design comprising cross-sectional online surveys and a focus group. Eighty clients who accessed the SNF service and 12 SNF clinicians. Anonymous client survey comprising questions about perceived benefits and impacts of the hybrid SNF program model, and suggestions for change. Clinician focus group discussion about perceived benefits and challenges of the hybrid SNF model. The hybrid SNF program is a child and family health nursing home visitation program for families with moderate level psychosocial risks. It comprises a mix of face-to-face and virtual telehealth/telephone appointments, delivered during pregnancy and up to 2 years postpartum. Clients reported high levels of satisfaction with the program, and improvements in confidence and decision-making. Clinicians spoke of increased efficiency and flexibility, and capacity for ongoing service provision during the COVID-19 period. Technology access issues were identified as a barrier. Overall, however, both clients and clinicians expressed a preference for face-to-face SNF service provision. While further studies are required to test clinical outcomes, the hybrid SNF model is acceptable to clients and clinicians.

Pharmacogenetic educational needs and the role of pharmacogenetics in primary care: a focus group study with multiple perspectives.

Pharmacogenomics (PGx) is a well-established concept of how genes impact medication response, with many studies demonstrating reductions in medication side effects, improved efficacy and cost effectiveness. Despite these benefits, implementation of PGx in daily practice remains limited. Studies on the implementation of PGx in clinical practice have previously found that inadequate knowledge is one of the main barriers. Details regarding specifically which educational needs exist among family medicine clinicians requires further study. The aim of this study was to identify both the perceived role that pharmacogenomics (PGx) could play in primary care practice, the knowledge gaps that family medicine clinicians experience, and the skills they require to use PGx in their daily practice. To achieve this aim, the attitudes, knowledge, barriers, skills needed, and preferred educational program were explored in a family medicine clinician focus group study via a semi-structured interview and knowledge quiz. Second, multidisciplinary focus groups provided information on the level of knowledge and necessary skills to use PGx in patient care. After gathering key recorded information from both focus groups, the perceived role pharmacogenomics could possibly play in primary care, the predominant knowledge gaps, and the most appropriate educational program was determined by qualitative analysis. Four themes emerged regarding the PGx educational needs and the role of PGx in family medicine: 1) need for PGx competences, 2) insight into the roles and responsibilities of PGx services, 3) optimization of PGx workflow through artificial intelligence integrated in the electronic health record, and 4) the ethical dilemmas and psychological effects related to PGx. These themes reflect a shift in the role of PGx in family medicine with implications for education. The results obtained from this study will help improve the implementation of PGx in daily practice, and consequently, may result in increased utilization of PGx, thereby resulting in improved medication efficacy and reduced side effects.

Mindful Night-to-Day: A Pilot Feasibility Trial of a Mindfulness-Based Insomnia and Symptom Management Intervention for Patients with Hematologic Cancer

ABSTRACT Objectives Patients with hematologic cancer experience severe symptoms (i.e. insomnia, fatigue, pain, distress). Few interventions addressing insomnia and other symptoms exist for this population. Mindfulness-Based Therapy for Insomnia (MBTI) may be appropriate but has only been tested in healthy outpatients. This study aimed to develop and test an adapted MBTI protocol for hematologic cancer patients. Methods Patient (n = 3) and clinician (n = 1) focus groups, and user-testing (N = 5) informed adaptation of Mindful Night-to-Day (MBTI+). A single-arm pilot trial (N = 32) evaluated feasibility (accrual, attrition, adherence), acceptability (intervention satisfaction), and changes to insomnia symptom severity (Insomnia Severity Index; primary outcome) and secondary outcomes (fatigue, pain, distress, pre-sleep arousal, mindfulness, symptom management self-efficacy) at baseline, post-intervention, and 1-month post-intervention. Descriptive statistics and paired sample t-tests were conducted. Results Qualitative feedback informed MBTI+ content, format, and delivery. Mindfulness was used to increase symptom awareness (sleepiness vs. fatigue). Meditations and behavioral skills were applied to inpatient treatment. MBTI+ met feasibility (N = 32/12 months; 8.1% attrition; 83.8% adherence) and acceptability (M = 3.52/4.00) benchmarks. Insomnia symptom severity decreased (d = 1.20) from baseline to post-intervention, as did most secondary outcomes. Conclusions MBTI+ was feasible, acceptable, and showed promise for benefits throughout inpatient and outpatient treatment. Findings warrant further evaluation in a randomized trial.

Clinician Needs for Electronic Health Record Pediatric and Adolescent Weight Management Tools: A Mixed-Methods Study.

Clinicians play an important role in addressing pediatric and adolescent obesity, but their effectiveness is restricted by time constraints, competing clinical demands, and the lack of effective electronic health record (EHR) tools. EHR tools are rarely developed with provider input. We conducted a mixed method study of clinicians who provide weight management care to children and adolescents to determine current barriers for effective care and explore the role of EHR weight management tools to overcome these barriers. In this mixed-methods study, we conducted three 1-hour long virtual focus groups at one medium-sized academic health center in Missouri and analyzed the focus group scripts using thematic analysis. We sequentially conducted a descriptive statistical analysis of a survey emailed to pediatric and family medicine primary care clinicians (n = 52) at two private and two academic health centers in Missouri. Surveyed clinicians reported that they effectively provided health behavior lifestyle counseling at well-child visits (mean of 60 on a scale of 1-100) and child obesity visits (63); however, most felt the current health care system (27) and EHR tools (41) do not adequately support pediatric weight management. Major themes from the clinician focus groups were that EHR weight management tools should display data in a way that (1) improves clinical efficiency, (2) supports patient-centered communication, (3) improves patient continuity between visits, and (4) reduces documentation burdens. An additional theme was (5) clinicians trust patient data entered in real time over patient recalled data. Study participants report that the health care system status quo and currently available EHR tools do not sufficiently support clinicians working to manage pediatric or adolescent obesity and provide health behavior counseling. Clinician input in the development and testing of EHR weight management tools provides opportunities to address barriers, inform content, and improve efficiencies of EHR use.

Developing the Form and Content of Implementation Strategies to Prevent Venous Thromboembolism for Ambulatory Patients with Cancer

Introduction To prevent venous thromboembolism (VTE) in people with cancer, guidelines recommend risk-assessment for those receiving systemic therapy and anticoagulation (AC) prophylaxis for those at high risk of VTE. However, these recommendations are significantly underused in clinical practice. Our prior work demonstrated barriers and facilitators contributing to this underuse and identified potential implementation strategies to address these barriers. The objective of this study was to develop the form and content of targeted implementation strategies promoting the uptake in clinical practice of guideline-recommendations for VTE prevention for ambulatory patients with cancer. Methods We conducted multidisciplinary stakeholder focus group discussions and semi-structured patient interviews to iteratively design the form and content of five implementation strategies (Table 1): (1) Conduct clinician education and training on risk-assessment models and anticoagulation thromboprophylaxis; (2) Adapt electronic health records (EHR) to provide interactive assistance; (3) Develop and distribute educational materials for clinicians about the Khorana score, VTE risk, and AC counseling; (4) Develop and distribute educational materials for patients; and (5) Audit and feedback. Stakeholders included oncologists, classical hematologists, an oncology clinical pharmacist, oncology advanced practice providers, and oncology patients, in academic and community-based settings within a single health care system. We conducted the clinician focus groups iteratively: in the first session we reviewed guidelines and evidence to support the use of risk assessment and AC prophylaxis in patients with cancer and shared barriers and facilitators identified in our earlier work. During subsequent sessions, we iteratively designed the form and content of the implementation strategies. In the final session, clinicians were presented a finalized prototype of the implementation strategies and asked to perform exploratory usability testing through simulated patient care encounters. Individual semi-structured interviews were conducted with patients to obtain feedback on the design of the implementation strategies and patient-education resources. Results A workflow for integration of risk-assessment and relevant prophylaxis in clinical practice was created based on participant feedback. Details for selected implementation strategies are shown in Table 1. For EHR support, stakeholders recommended the risk-assessment component be integrated within chemotherapy order sets. In addition, they recommended incorporating aid for AC management within the EHR, including a method to assess bleeding risk, pre-populated options for AC thromboprophylaxis, provision of easily accessible links to resources for peri-operative/procedure AC management, and a list of interactions between anticoagulants and common drugs used in oncology practice. Clinician stakeholders also recommended - and subsequently approved - standard phrases available to incorporate into the EHR documentation, both to guide decision-making and to serve as a reminder to re-assess in future visits. For education resources (clinician and patient), clinicians wanted education resources to be concise, and for the patient-facing resource, to be provided to patients both in existing “chemotherapy education” booklets and sent in after-visit appointment instructions. Regarding audit and feedback, clinicians recommended a personalized report card comparing their use of appropriate VTE prevention to their peers. After reviewing the patient-facing education documents, patients recommended simpler, straightforward language and clarifications for the VTE and AC patient education resources based on their past experiences. Conclusions With multidisciplinary stakeholder input from clinicians and patients, we developed a set of implementation strategies designed to address barriers to uptake of VTE prevention recommendations in oncology clinics. Next steps are to test the implementation strategies in clinical practice to measure impact on increasing these evidence-based interventions.

Clinician Perspectives on Opioid Treatment Agreements: A Qualitative Analysis of Focus Groups

Background Patients with chronic pain face significant barriers in finding clinicians to manage long-term opioid therapy (LTOT). For patients on LTOT, it is increasingly common to have them sign opioid treatment agreements (OTAs). OTAs enumerate the risks of opioids, as informed consent documents would, but also the requirements that patients must meet to receive LTOT. While there has been an ongoing scholarly discussion about the practical and ethical implications of OTA use in the abstract, little is known about how clinicians use them and if OTAs themselves modify clinician prescribing practices. Objective To determine how clinicians use OTAs and the potential impacts of OTAs on opioid prescribing. Design We conducted qualitative analysis of four focus groups of clinicians from a large Midwestern academic medical center. Groups were organized according to self-identified prescribing patterns: two groups for clinicians who identified as prescribers of LTOT, and two who did not. Participants 17 clinicians from General Internal Medicine, Family Medicine, and Palliative Care were recruited using purposive, convenience sampling. Approach Discussions were recorded, transcribed, and analyzed for themes using reflexive thematic analysis by a multidisciplinary team. Key Results Our analysis identified three main themes: (1) OTAs did not influence clinicians’ decisions whether to use LTOT generally but did shape clinical decision-making for individual patients; (2) clinicians feel OTAs intensify the power they have over patients, though this was not uniformly judged as harmful; (3) there is a potential misalignment between the intended purposes of OTAs and their implementation. Conclusion This study reveals a complicated relationship between OTAs and access to pain management. While OTAs seem not to impact the clinicians’ decisions about whether to use LTOT generally, they do sometimes influence prescribing decisions for individual patients. Clinicians shared complex views about OTAs’ purposes, which shows the need for more clarity about how OTAs could be used to promote shared decision-making, joint accountability, informed consent, and patient education.

Harmonization of patient-reported outcome measurement across four academic medical centers: Multi-site clinician focus group results from the Carolinas Collaborative Initiative.

336 Background: Use of patient-reported outcomes (PROs) to monitor symptoms in cancer care demonstrates clinical benefit, but implementation of PROs across healthcare settings remains low. We conducted focus groups (FGs) with stakeholders from four academic medical centers (AMCs) to identify perceived barriers and facilitators to implementing PROs in routine care. Methods: Stakeholders were recruited to participate in FGs and asked to identify barriers and facilitators of future PRO implementation in their respective healthcare setting. Transcripts were coded and synthesized via thematic content analysis. Results: Seventy stakeholders participated in one of 14 FGs (leadership groups, n = 5; nurse groups, n = 4; physician groups, n = 5) stratified by role and site. The mean FG size was 5 (range = 2 to 14). Three overarching domains were identified: Workflow, Training and Implementation, and Data-Driven Action. Table 1 shows the relative frequency of notable codes associated with each domain across FGs aggregated by stakeholder role. Themes within each domain are: Workflow: current workflow dynamics inhibit PRO implementation (code = Workflow, Table 1); more resources are necessary to adjust clinical workflow and the EMR to facilitate administration and clinicians’ ability to respond to concerning symptoms (code = Resources needed, Table 1). Training and Implementation: clinicians may be unaware of the utility of PROs; training about the clinical relevance of PROs may help facilitate integration (code = Training needs, Table 1). Data-Driven Action: data derived from PROs must be interpretable and actionable to promote sustained utility (code = How to display PROs, Table 1). Tailored measures for specific clinical populations are needed, along with information on clinically significant scores, meaningful change thresholds, predictive value, and whether integration of PROs improves healthcare quality. Conclusions: Similar barriers to PRO implementation were identified across four AMCs. Infrastructure is needed in each AMC to help clinics integrate PROs. Resources to address workflow inefficiencies, EMR integration, clinician training, and follow-up support may help facilitate integration. Academic medical centers must also ensure that data derived from PROs are relevant and actionable.[Table: see text]

B-137 Development of a Novel Software System for Providing Real-Time Laboratory Test Information to Clinicians at Point of Order Entry

Abstract Background Clinicians depend on an increasingly complex set of laboratory tests to aid in the diagnosis and monitoring of patients. Staying informed about the proper usage of these tests requires active effort, especially as test offerings continually evolve. To aid in test decision making, institutions often implement some form of decision support, including: grouping of common “order sets”, “best practice alert” popups, and web-based “lab catalogs”. For many institutions, lab catalogs provide the most comprehensive information on available tests, but typically exist separate from the interface used to place test orders, and thus suffer from underutilization in actual clinical practice. Methods We developed a novel, open-source software to closely integrate our institution’s lab catalog at the point of order entry within our electronic medical record (EMR) system. The software provides an immediate pop-up window anytime a clinician needs additional information while placing orders. The software also provides an independent, customizable search function that helps steer clinicians away from commonly mis-ordered tests. Both functions are immediately available at the point of order entry, without requiring the user to leave the EMR or otherwise interrupt their normal workflow. We conducted a small usability pilot with a focus group of clinicians, using the System Usability Scale (SUS) (1). Results Our software reduced the number of clicks and keystrokes needed to access detailed lab information from 27 to 2. The focus group (n = 6) rated the product favorably on the SUS, with average rating 89 ± 9 out of 100. Conclusion This study demonstrates proof-of-concept for a novel software decision support tool that provides instant access to lab information at the point of order entry. Future work will focus on evaluating utility in a real-world clinical pilot.

P08.08.A EXPLORATION OF SURVIVORSHIP ISSUES AND QUALITY OF LIFE IN A COHORT OF IDH MUTATED HIGH GRADE GLIOMA 5 YEARS FOLLOWING DEFINITIVE TREATMENT

Abstract BACKGROUND Approximately 2000 people are diagnosed with brain cancer in Australia each year. Compared to glioblastoma patients, the IDH-mutated high-grade glioma (IDHmHGG) is a more favourable diagnosis; better prognosis and survival outcomes. Coupled with improved treatments, the IDHmHGG cohort is living longer which means treatment side effects (eg. fatigue, cognitive deficits, physical limitations etc.) can significantly impact their quality of life in the survivorship years. Hence there is a need to identify and determine the survivorship issues most pertinent for the IDHmHGG cohort. MATERIAL AND METHODS A mixed- METHODS cross-sectional study was conducted to investigate the relationship between socio-demographic, clinical factors and quality of life in the IDHmHGG cohort. Qualitative data collection consisted of a neuro-oncology clinician focus group (n=11) regarding survivorship issues and was contrasted with semi-structured patient interviews (n=27). Quantitative data collection (n=41) involved socio-demographic questions, the Functional Assessment of Cancer Therapy - Brain (FACT-Br) tool and The Hospital Anxiety and Depression Scale (HADS). RESULTS The results indicate that marital status, employment status, and treatment complications are strongly associated with quality of life in IDHmHGG patients. Being single and unemployed is associated with lower quality of life (p&amp;lt;0.05). Similarly, our findings show that psychological distress, specifically the presence of anxiety and depressive symptoms, is a major factor that can negatively impact the QoL in an IDHmHGG cohort. The order of ranking between clinician and patient identified issues only matched for physical limitations (ranked 3rd). Although not matched in ranking, both groups identified cognitive function, employment, social function, isolation and mental health as commonly experienced in the survivorship years. CONCLUSION This study highlights the importance of considering socio-demographic and clinical factors in the care and support of brain cancer patients. The most important finding of this study was that being single and unemployed negatively predicted QoL. Additionally, it is notable that our results show a discrepancy between clinician identified issues and patient identified issues. This finding suggests that in order to deliver patient-centred and meaningful care, there is a need to incorporate a more patient focused perspective. Future survivorship models of care for the IDHmHGG cohort should be co-designed with patients.

“You're just on your own”: Exploring bowel symptom management needs after rectal cancer surgery through patient and clinician focus groups

PurposeCurrently cancer survivorship often leaves the needs of patients unidentified and unmet. The study aims to establish the views of experts on managing bowel symptoms following rectal cancer surgery. MethodPeople living with bowel symptoms as well as clinicians with expertise in rectal cancer and subsequent bowel changes were invited to participate in online focus groups. Focus groups were recorded, transcribed verbatim and analysed using a modified framework analysis. Results were presented narratively with interpretations and quotations. ResultsFourteen patients following rectal cancer treatment attended one of two focus groups. Sixteen clinicians attended one of four groups. Participants described their opinions about bowel symptom management. Three themes were described by both patients and clinicians: expectations of bodily changes, supported self-repair and knowledgeable self-repair. Data from participants frequently concurred; all recognised clinicians needed to support and empower patients to independently manage their cancer consequences. ConclusionWell-managed expectations enable patients to set realistic goals and make plans. Clinicians need to support patients to understand potential bowel changes that might occur after rectal cancer surgery, providing support, information and signposting to other relevant information and colleagues. Effective communication through avoidance of jargon and rapport building as well as providing a point of contact help prevent patients feeling alone with their symptoms. Education is needed by both clinicians and patients to ensure consistent and useful advice is provided and understood. A recommendation from the focus groups is to create opportunities for patients to access information with clinician support and signposting.

Effectiveness of telehealth in providing preventive oral health care: A pilot evaluation of patient, carer, and clinician experience.

This pilot study aimed to characterize the experience, satisfaction, and views on feasibility of an oral health primary prevention telehealth service at a public dental hospital's department of pediatric dentistry, from the viewpoint of patients, carers, and clinicians. Data were collected using an anonymous questionnaire for parents/guardians, a focus group for clinicians; and were summarized using descriptive statistics, chi-square tests, analysis of variance, and by thematic analysis for the qualitative data. Thirty-seven parents/guardians and four clinicians were included. The mean patient age was 5 years (SD = 3.3). Over half of the parents (51.4%) were aged 30-39 years. There was high satisfaction (97.3%) and acceptability (81.1%) of the telehealth service. Native English-speakers were significantly more likely to agree that telehealth was an acceptable mode of preventive care and that they would use it again (p = 0.033). Parents reporting difficulty traveling to dental appointments were significantly more likely to score favorably in categories of usefulness, technical quality, and satisfaction relating to telehealth (all p < 0.001). Important themes from the clinician focus group included specific benefits for patients with special needs or who live rurally, reduced stress on families, and an enhanced focus on prevention. The findings suggest ongoing benefits of providing preventive oral health services as an adjunct to face-to-face care, especially to the identified subset of patients who will benefit the most.

Clarifying misbeliefs about hydroxychloroquine (HCQ): developing the HCQ benefits versus harm decision aid (HCQ-SAFE) per low health literacy standards

BackgroundUp to 83% of patients with SLE stop taking hydroxychloroquine (HCQ) within the first year due to knowledge gaps regarding the survival benefits of HCQ versus inflated fears of rare...

A qualitative analysis of adolescent motherhood within the broader family context in Peru.

The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets. Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group. This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed. The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy. Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy. Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study.

Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people's preferences and calls for integration of these services, current mental health services rarely offer blended models of care. This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians' competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services.

Improving measurement-based care implementation in adult ambulatory psychiatry: a virtual focus group interview with multidisciplinary healthcare professionals

BackgroundMeasurement-Based Care (MBC) is an evidence-based practice shown to enhance patient care. Despite being efficacious, MBC is not commonly used in practice. While barriers and facilitators of MBC implementation have been described in the literature, the type of clinicians and populations studied vary widely, even within the same practice setting. The current study aims to improve MBC implementation in adult ambulatory psychiatry by conducting focus group interviews while utilizing a novel virtual brainwriting premortem method.MethodsSemi-structured focus group interviews were conducted with clinicians (n = 18) and staff (n = 7) to identify their current attitudes, facilitators, and barriers of MBC implementation in their healthcare setting. Virtual video-conferencing software was used to conduct focus groups, and based on transcribed verbatin, emergent barriers/facilitators and four themes were identified. Mixed methods approach was utilized for this study. Specifically, qualitative data was aggregated and re-coded separately by three doctoral-level coders. Quantitative analyses were conducted from a follow-up questionnaire surveying clinician attitudes and satisfaction with MBC.ResultsThe clinician and staff focus groups resulted in 291 and 91 unique codes, respectively. While clinicians identified a similar number of barriers (40.9%) and facilitators (44.3%), staff identified more barriers (67%) than facilitators (24.7%) for MBC. Four themes emerged from the analysis; (1) a description of current status/neutral opinion on MBC; (2) positive themes that include benefits of MBC, facilitators, enablers, or reasons on why they conduct MBC in their practice, (3) negative themes that include barriers or issues that hinder them from incorporating MBC into their practice, and (4) requests and suggestions for future MBC implementation. Both participant groups raised more negative themes highlighting critical challenges to MBC implementation than positive themes. The follow-up questionnaire regarding MBC attitudes showed the areas that clinicians emphasized the most and the least in their clinical practice.ConclusionThe virtual brainwriting premortem focus groups provided critical information on the shortcomings and strengths of MBC in adult ambulatory psychiatry. Our findings underscore implementation challenges in healthcare settings and provide insight for both research and clinical practice in mental health fields. The barriers and facilitators identified in this study can inform future training to increase sustainability and better integrate MBC with positive downstream outcomes in patient care.

The Rory Morrison WMUK Registry for Waldenström macroglobulinaemia: The growth of a national registry for a rare disorder.

National registries are used globally to characterise patient demographics, treatment choices and mortality to inform and improve clinical management. Waldenström macroglobulinaemia (WM) is a rare, treatment-responsive B-cell lymphoproliferative disorder with diverse clinical features and variable outcomes. To prospectively chart changes in the management of WM in the UK, the Rory Morrison Registry (RMR) was developed to systematically collect real-world data. Here we describe the development of the RMR, demonstrate its feasibility and describe preliminary observations. The RMR was devised as a collaborative project between patients and clinicians, under the auspices of the UK Charity for WM in 2016. Patients may be registered after the point of diagnosis and those with historic diagnosis were also eligible. Data collection fields were compiled by focus groups of clinicians, patients, industry and commissioning partners. The RMR launched in November 2017 and as of March 2022, there were 22 participating centres and 1305 patients registered. Median follow-up was 6.4 years, five-year overall survival 90.7% (95% confidence interval [CI] 88.4%-92.5%) and 10-year overall survival 79.3% (95% CI 75.7%-82.4%). There has been a clear evolution in treatments including a rapid growth in the use of Bruton's tyrosine kinase inhibitors in relapsed disease since their availability in the UK.

Transition to a virtual model of physiotherapy and exercise physiology in response to COVID-19 for people in a rural Australia: Is it a viable solution to increase access to allied health for rural populations?

Virtual healthcare has the potential to increase access to allied health for people living in rural areas, but challenges in delivery of such models have been reported. The COVID-19 pandemic provided an opportunity for a rural practice of physiotherapists and exercise physiologists to transition service delivery to a virtual model of care which utilised a combination of phone, video, an exercise app and/or paper handouts. This study aimed to evaluate the uptake and outcomes from virtual delivery of allied health services, and to describe patient and clinician experiences of the virtual model of care. A parallel convergent mixed methods study was conducted. De-identified data from patients who were offered the virtual service between 15 March 2020 and 30 September 2020 were extracted from the database of the rural practice, as were data from patients attending the practice in-person during the same time in 2019 to serve as a historical comparison. De-identified data from a monthly survey tracking clinician experiences of delivering care virtually was also obtained from the practice. Quantitative data were presented descriptively. Between-group differences were compared using independent samples t-tests, and within-group longitudinal changes compared using paired t-tests. Semi-structured interviews were conducted among a purposive sample of patients using the virtual service, and focus groups conducted among clinicians providing this model of care. Qualitative data were recorded and transcribed verbatim, then thematic analysis conducted. During the study period, the practice delivered 4% (n = 242) consultations virtually. Thirty-seven of the 60 patients (62%) using the virtual service were new referrals. Patients attended fewer sessional appointments virtually and a smaller proportion of patients reported high satisfaction with virtual care, compared to those who received in-person care the previous year (p < .05). Clinician confidence in delivering virtual care did not change significantly over time (p>.05), though clinicians not providing virtual care in a given month perceived their lower confidence than those who did provide virtual care (p < .05). Five themes influencing the success of virtual allied health provision emerged from patient interviews and clinician focus groups: adaptation of program elements for virtual delivery, conduct of virtual treatment, clinician flexibility, patient complexity and communication. The theme of communication influenced all the other themes. Virtual healthcare is a potential solution to address lack of access to allied health practitioners in rural areas, but may not suit all patients. Establishing a therapeutic relationship and ensuring people have access to adequate resources prior to virtual care delivery will optimise successful adoption of virtual care models. A hybrid model incorporating limited in-person consultations with virtual consultations appears a more viable option.