Clinician Perspectives Research Articles

Clinician perspectives on adolescent contraceptive counseling following Dobbs v. Jackson: Implications for young people's contraceptive autonomy

Clinician perspectives on adolescent contraceptive counseling following Dobbs v. Jackson: Implications for young people's contraceptive autonomy

PARP inhibitors and maintenance treatment decision-making in advanced ovarian cancer: Patient and clinician perspectives

PARP inhibitors and maintenance treatment decision-making in advanced ovarian cancer: Patient and clinician perspectives

Clinician and Patient Perspectives on the Exchange of Sensitive Social Determinants of Health Information

Social determinant of health (SDOH) data are essential to individualized care and reducing health disparities. However, there is little standardization in the way that SDOH data are collected, and barriers to increasing the collection of such data exist at both the patient and clinician levels. To evaluate clinician, patient, and care partner perspectives on the barriers to and facilitators of patients sharing SDOH information with their clinicians. This qualitative study included clinicians, patients, and care partners across the United States. Focus groups were conducted between September 2022 and February 2023 to understand the experience of collecting, documenting, and exchanging SDOH data. Rapid assessment procedures were used to analyze focus group transcripts, creating summaries, codes, and themes mapped directly to the project research questions. A total of 235 individuals participated, including 109 (46.4%) clinicians (60 [55.0%] male; 25 [22.9%] Asian, 2 [1.8%] Black, and 74 [67.9%] White) and 126 (53.6%) patients and care partners (45 [35.7%] male; 1 [0.8%] Asian, 48 [38.1%] Black, and 64 [50.8%] White). Clinicians and patients agreed that SDOH data are important for clinicians to know. Both clinicians and patients wanted a structured, standardized way to collect SDOH data in the future, accompanied by time for more in-depth discussion during the visit. However, they highlighted numerous issues that impact collecting these data, including beliefs about how the information will be used, the clinician-patient relationship, having enough of the right staff, time needed to collect SDOH information, and technology used to collect the data (eg, usability, standardization). This qualitative study of the experience of collecting, documenting, and exchanging SDOH data underscores the ongoing barriers to widespread adoption of uniform approaches to SDOH data documentation as well as factors that may help lower those barriers, such as trusting patient-clinician relationships, greater transparency in how the data will be used, and targeted resources. A multifaceted approach to addressing the concerns raised by clinicians, patients, and care partners is required to ensure that such data can be captured in a way that improves care and allows for progress toward an equitable health care system.

Prospective evaluation of the store-and-forward teledermatology service (eConsult) delivery at Townsville Hospital: A pilot study.

The shortage of dermatologists in rural and regional Australia is acutely felt in north Queensland where the population experiences a leading burden of skin cancer and tropical dermatoses. Store-and-forward teledermatology (SAFT) is recognised as a potential solution to improve accessibility of dermatology specialist care in rural communities. eConsult (a SAFT service) was piloted for the broader Townsville community in 2022. Evaluation was necessary to ensure wider implementation would meet stakeholder needs and improve patient care. To evaluate clinician perspectives and use of eConsult within the Townsville Hospital and Health service catchment over the pilot period (up to 9 months). Pre-engagement interviews with clinicians assessed their management of dermatoses and service expectations prior to eConsult usage. eConsult referrals identified case characteristics, outcomes and uptake of the service amongst clinicians. Post-engagement interviews assessed clinician perceptions and their suggestions for the service at the conclusion of the pilot period. In total, 24 and 17 clinicians participated in the pre- and post-engagement interviews respectively, and 38 referrals were submitted by clinicians. The service assisted diagnosis and management of non-urgent skin conditions for any age group. Clinicians generally had positive perceptions and appreciated timely access to local specialist advice. This study suggests a SAFT service can improve access to dermatology specialist opinion and increase management of dermatoses in primary care. Establishing sustainable teledermatology services with strong engagement from users is important for accessible care. Future research may investigate similar SAFT models involving more specialists and assess long-term cost-effectiveness.

A Comprehensive Review of Thyroid Eye Disease Pathogenesis: From Immune Dysregulations to Novel Diagnostic and Therapeutic Approaches

Thyroid eye disease is a complex inflammatory disorder of the orbit that has gained tremendous interest over the past years, and numerous scientific efforts have been deployed to elucidate its pathophysiology for novel drug development. Our manuscript will delve into the molecular dysregulations involved in the pathogenesis of thyroid eye disease that led to its clinical manifestations. Abnormalities within the apoptotic pathway, inflammatory cascade, and autoimmune regulatory systems will be covered. We will further discuss the challenges involved in its diagnosis and management and provide a summary of the current diagnostic tools (i.e., molecular biomarkers, diagnostic scores) from the perspective of clinicians. Finally, our comprehensive literature review will provide a thorough summary of most recent preclinical and clinical studies around the topic of thyroid eye disease, with an emphasis on the manuscripts published within the last five years. We believe our manuscript will bring novelty within the field by bridging the fundamental sciences with the clinical aspect of this disease. This review will be a great tool for clinicians in better understanding the pathogenesis of thyroid eye disease while providing an outlook on future perspectives (i.e., liquid biopsies, artificial intelligence).

Exploring treatment decision-making at diagnosis for children with advanced cancer in low- and middle-income countries

PurposeGlobal childhood cancer survival outcomes correlate with regional contextual factors, yet upfront treatment decision-making for children with advanced or poor prognosis cancer in low- and middle-income countries (LMICs) is not well understood. This study aimed to (1) characterize the landscape of contextual factors that shape physician decision-making at diagnosis for these children in LMICs and (2) describe physician rationales for if/when to offer treatment with non-curative intent, including how they define “poor prognosis” during treatment decision-making.MethodsAn international panel of pediatric oncologists practicing in LMICs participated in two focus groups structured for the collaborative generation of factors influencing treatment decision-making, including consideration of non-curative treatment pathways at diagnosis. Thematic analysis of qualitative data was conducted, followed by member checking.ResultsEleven pediatric oncologists participated, representing all global regions defined by the World Health Organization. Participants identified a broad range of factors influencing decision-making across multiple levels, including the individual, hospital, health system, community, and country levels. All participants agreed that treatment with non-curative intent could be offered at diagnosis in certain contexts, and diverse definitions for poor prognosis were described.ConclusionsUpfront treatment decision-making for children with advanced or poor prognosis cancer in LMICs is variable and challenging. Difficulties with decision-making in LMICs may be amplified by inconsistent definitions of poor prognosis and underrepresentation of the factors that influence treatment decision-making within existing decision-making frameworks or childhood cancer treatment guidelines. Future research should explore decision-making approaches, preferences, and challenges in depth from the perspectives of pediatric cancer patients, families, and multidisciplinary clinicians.

Relugolix (Orgovyx)

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec. This review assesses relugolix, (Orgovyx), 120 mg, oral tablets. Indication: For the treatment of adult patients with advanced prostate cancer.

Antithrombotic therapy decision making in advanced cancer: Patients and clinicians' views, perspectives, and experiences

Abstract Background Decision-making regarding antithrombotic therapy (ATT) for patients with advanced cancer is highly challenging, given the competing risks and benefits of this treatment near the end of life. SERENITY is a Pan-European study aiming to develop and evaluate a shared decision-making support tool (SDMST), to facilitate ATT management with patients with advanced cancer, at the end of life (1). Purpose To explore patients’ and clinicians’ views, perspectives and experiences of ATT treatment and decision making. These data will form part of the evidence base to develop and evaluate a SDMST to support decision-making with patients with advanced cancer receiving ATT. Methods Semi-structured interviews were conducted with patients and clinicians involved in ATT treatment and management in the UK, Denmark, France and Spain. Data were analysed using Framework Analysis; the thematic framework was informed by concomitant SERENITY work packages, interview transcripts/summaries and patient and public representatives. Results Fifty-nine patients and 77 clinicians were interviewed across the four countries. Some patients expressed a preference not to be involved or informed, while others felt they should have the ultimate authority over ATT prescribing decisions. For many, there was little distinction between being informed about the decision and being involved in the decision regarding ATT; ultimately, many patients expressed the doctor should make the final decision. However, many patients did not perceive there to be a decision to make, either due to the complexities of the choice to be made, or that there are circumstances in which they should discontinue ATT. Similarly, while patients relied heavily on the doctors’ expertise, clinicians described significant reliance upon the patient perspective, due to the complexity of competing risks and benefits, and the context of advanced cancer/multi-comorbidities. Some patients reported being highly concerned about the risks of ATT deprescription, while others did not have a strong opinion on this treatment, deferring to their clinicians’ expertise. Thus, a discordance in decision-making perceptions between patients and clinicians was evident. Moreover, the decision is multifaceted in nature; the context of advanced cancer, coupled with the possibility that the clinician prescribing ATT may not serve as the primary clinician during the time when ATT decisions must be made, further complicated both the decision-making process and the opportunity for shared decision making. Conclusion There appears to be discordance in decision-making perceptions between patients and clinicians, which could negatively influence the co-decision making regarding ATT, contributing to prescribing inertia, and potentially impacting patient outcomes. A SDMST may help support the complexity around the decision, ensuring informed choices are made, and patients’ wishes and values are incorporated into the decision.

Claimant and clinician perspectives on sources of claimant distress in interactions with Australian compensation schemes: a qualitative study

Purpose Recovering from compensable injuries can be influenced by a variety of factors including the claimant’s experience of distress during the claims process. In order to develop cross-scheme, nation-wide strategies to improve claimants’ interactions with the compensation system, reduce claimant distress, and improve claimant outcomes, it is important to understand sources of claims-related distress from the perspective of both claimants and clinicians. Methods An exploratory qualitative design was undertaken using semi-structured interviews with 13 claimants and 26 clinicians from four injury compensation schemes in five Australian states. A collaborative and reflexive thematic analysis was undertaken with an inductive approach to coding, and themes were constructed for claimants and clinicians across compensation schemes. Results Claimants and clinicians interviews revealed four main sources of distress, including (1) complexity and delays in administrative processes, (2) interruptions to recovery caused by treatment delays, (3) non-individualised approaches to care, and (4) a lack of support for navigating the claims process. Conclusion Sources of claims-related distress identified by claimants and clinicians in the present study point to the urgent need for nationwide systems level changes to reduce claimant distress in the pursuit of better claimant outcomes.

Primary Care Clinician Perspectives on Team-Based Welcome Video Visits.

Synchronous virtual visits aid in longitudinal primary care and fulfill unmet needs for patients and clinicians. Virtual visits are widely accepted for specialty consultation and follow-up; however, novel systems-based programs and processes may support earlier engagement. Evaluate primary care clinician attitudes and perspectives on patient information obtained team-based, nurse-led virtual visits ahead of face to face visits. Study occurred in a large, regional, multispecialty group practice in Eastern Pennsylvania. Participants included primary care physicians, nurse practitioners, and physician assistants. Virtual visits are a component of a large, unified network strategy called the Patient Partnership Model which incorporates technology and remote care to achieve improved access and patient satisfaction. Survey of participating primary care clinicians assessing impact of at-hand medical history, social history, and medications on delivering face to face primary care. Weighted mean of satisfied participants was 3.61 on a 5-point Likert scale. Participants reported satisfaction and acceptability of team-based virtual visits, noting high satisfaction with information exchange and actionability of notes. Participants reported ongoing opportunities to enhance medication reconciliation. Virtual visits continue to evolve and may serve varying roles in primary care.

The 2024 European Society of Cardiology Guidelines for Diagnosis and Management of Atrial Fibrillation: A Viewpoint from a Practicing Clinician's Perspective.

Atrial fibrillation (AF) is a complex disease requiring a multidomain and (usually) long-term management, thus posing a significant burden to patients with AF, practitioners, and health care system. Unlike cardiovascular conditions with a narrow referral pathway (e.g., acute coronary syndrome), AF may be first detected by a wide range of specialties (often noncardiology) or a general practitioner. Since timely initiated optimal management is essential for the prevention of AF-related complications, a concise and simple guidance is essential for practitioners managing AF patients, regardless of their specialty. Guideline-adherent management of patients with AF has been shown to translate to improved patient outcomes compared with guideline-nonadherent treatment. To facilitate guideline implementation in routine clinical practice, a good guideline document on AF should introduce only evidence-based new recommendations, while avoiding arbitrary changes, which may be confusing to practitioners. Herein, we discuss the main changes in the 2024 European Society of Cardiology (ESC) AF Guidelines relative to the previous 2020 ESC document. Whether the updates and new recommendations issued by the new guidelines will translate in high adherence in clinical practice (and hence improved prognosis of patients with AF) will need to be addressed in upcoming years.

Positive behaviour support in Irish residential services: Perspectives of frontline staff, management and clinicians on implementation challenges

ABSTRACT Background The current study explored the perspectives of staff working with adults with intellectual disabilities and behaviours that challenge. We sought insight into their understanding of procedural fidelity and challenges faced when implementing behaviour support. Method We interviewed 15 staff members supporting adults with intellectual disabilities in residential settings. Participants included five front-line staff, five residential managers, and five clinicians. Interviews were transcribed and thematic analysis conducted. Results Issues identified by the participants related to four main themes: (1) Organisational and environmental constraints; (2) Understanding and monitoring of procedural fidelity; (3) Theory versus practice; (4) There's nothing positive about behaviour support. Conclusion Across staff groups, lack of understanding of fidelity emerged, as well as minimal accountability regarding behaviour support. Front-line staff felt isolated and under pressure. Greater emphasis on partnership, practice leadership, and positive feedback may give front-line staff the support needed to use behavioural interventions with high fidelity.

60 Exploring clinician perspectives on the utility and impact of psychosocial assessment on the management of hospitalized paediatric patients

Abstract Background A substantial number of paediatric inpatient, medical admissions may involve underlying psychosocial challenges. However, patients’ in-hospital care will focus on patients’ acute medical needs, despite growing evidence that holistic care incorporating patients’ broader psychosocial needs could improve physical health outcomes and health-related quality of life. Psychosocial assessment tools may facilitate clinicians’ ability to identify and address underlying mental health needs. Nonetheless, it remains unclear whether clinicians perceive these tools, and the clinical information they generate, as adding value to patient care planning. Objectives This study determines to explore the clinician-perceived views on the MyHEARTSMAP tool report and whether this report has impacted their patient care, and if so, how. Design/Methods We conducted a cross-sectional survey sub-study, within a larger randomized control trial at BC Children’s Hospital, sampling from nine inpatient specialties: general paediatrics, cardiology, nephrology, neurology, endocrinology, gastroenterology, orthopaedic surgery, urology, and general surgery. The survey was designed, validated, and administered using the Modified Dillman’s approach. Automated reminders were sent to participants if they did not respond to the survey after completing the consent form. . Eligible clinicians were asked to provide their perceptions towards the MyHEARTSMAP report through an online survey. Eligibility screening and consent retrieval were obtained prior to clinicians completing the survey. Qualitative and quantitative analyses of survey responses were conducted, summarizing proportions and counts of closed-ended responses and a content analysis of open-ended items. Results A total of 65 clinicians enrolled into our study (88% women, 85% nurses). Most clinicians (92%) found that patient-reported psychosocial assessment was beneficial for establishing patient-clinician relationships and providing information about the patient’s mental health that may not have been previously queried about. Of the clinicians who had read and used the MyHEARTSMAP screening report in their practice, a majority (84%) found it helpful for their patient care. Most clinicians felt that the MyHEARTSMAP screening report facilitated clinician-patient communication (87%) and patient involvement in the care process (90%). About half of the clinicians (52%) felt the screening report’s interface and design could be improved to allow for ease of use. Currently, the paper screening report is placed in the patients’ physical chart for clinicians to assess, but they would prefer it to be implemented onto the digital charting system used at BC Children’s Hospital. Conclusion Clinicians' perceptions towards the MyHEARTSMAP report showed acceptability amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.

Towards 'Formalising' WhatsApp Teledermatology Practice in KZ-N District Hospitals: Key Informant Interviews.

District hospitals in KwaZulu-Natal Province, South Africa, do not have onsite specialist dermatology services. Doctors at these hospitals use WhatsApp instant messaging to informally seek advice from dermatologists and colleagues before possible referral. They have expressed the need to formalise WhatsApp teledermatology. To determine the views and perspectives of clinicians on the feasibility and practicality of formalising the current WhatsApp-based teledermatology activities within the KwaZulu-Natal Department of Health Dermatology Service. Key informant interviews with 12 purposively selected doctors at district hospitals and all 14 dermatologists in the KwaZulu-Natal dermatology service. Their views and perspectives on formalising the current informal use of WhatsApp for teledermatology were recorded, transcribed, and thematically analysed. Five primary themes (communication, usability, utility, process, and poor understanding of legal, regulatory, and ethical issues) and 22 sub-themes were identified. Clinicians wanted WhatsApp teledermatology to continue, be formalised, and be incorporated within the KwaZulu-Natal Department of Health, facilitated by the provision of practical guidelines addressing legal, regulatory, and ethical issues. These findings will be used to develop a policy brief, providing recommendations and proposed guidelines for formalising the teledermatology service. The findings and methods will be relevant to similar circumstances in other countries.

Predictive accuracy of clinicians estimates of death and recovery after acute intracerebral hemorrhage: pre-specified analysis in INTERACT3 study.

Accurately predicting a patient's prognosis is an important component of decision-making in intracerebral hemorrhage (ICH). We aimed to determine clinicians' ability to predict survival, functional recovery, and return to premorbid activities in patients with ICH. Pre-specified secondary analysis of the third INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT3), an international, multicenter, stepped-wedge cluster randomized controlled trial. Clinician perspectives on prognosis were collected at hospital admission and Day 7 (or before discharge). Prognosis questions were the likelihood of (i) survival at 48 hours and 6 months, (ii) favorable functional outcome (recovery walking and self-care) and (iii) return to usual activities at 6 months. Clinician predictions were compared with actual outcomes. Most clinician participants were from neurosurgery (75%) with a median of 8 working years (IQR 5-14) of experience. Of the 6305 randomized patients who survived 48 hours, 213 (3.4%) were predicted to die (positive predictive value [PPV] 0.99, 95% confidence interval [CI] 0.99-0.99). Of 5435 patients who survived 6 months, 209 (3.8%) were predicted to die (PPV 0.93, 95% CI 0.92-0.93). Predictions on favorable functional outcome (PPV 0.54, 95% CI 0.52-0.56) and satisfied ability to return to usual activities (PPV 0.50, 95% CI 0.49-0.52) were poor. Prediction accuracy varied by working years and region of practice. In patients with ICH, clinician estimates of death are very good but conversely they are poor in predicting higher levels of functional recovery and activities.

Clinician perspectives on endings and discharges in community mental health work

Clinician perspectives on endings and discharges in community mental health work

Storytelling Games for General Anxiety: Clinician Perspectives on Walking Simulator Games as Intervention

General anxiety is a common mental health condition across the world, with many barriers preventing people from accessing treatments. A growing body of evidence suggests that serious games offer appealing and effective solutions for anxiety. Despite their potential, an understanding of game design qualities and contextual game mechanics in game-based interventions are significantly under-explored, especially for general anxiety. Alternative and emerging game genres may offer new intervention approaches previously overlooked in digital mental health research. We use story-led exploration games, particularly the environmental storytelling walking simulator game genre, as an analytical template to understand new game design strategies and features that can potentially enable engaging and efficacious serious games as interventions for general anxiety. Using semi-structured interviews and thematic analysis, we summarize input from expert clinical participants who identified and evaluated several game design qualities towards developing walking simulators as potential serious game interventions.

Counseling About Cannabis Use During Pregnancy and Lactation: A Qualitative Study of Patient and Clinician Perspectives.

Legalization in many jurisdictions has increased the prevalence of cannabis use, including during pregnancy and lactation. Accordingly, clinicians providing perinatal and infant care are increasingly required to counsel about this topic, even if they do not feel comfortable or prepared for this conversation. The aim of this research was to explore how prenatal clinicians and pregnant and lactating women interact with cannabis consumption. Using qualitative description, we conducted semi-structured interviews with 75 individuals in Canada: 23 clinicians who provide pregnancy and lactation care, and 52 individuals who made cannabis consumption decisions during pregnancy and/or lactation. Data were analyzed using inductive content analysis. Three phases of the clinical encounter influenced decision-making about cannabis consumption: initiation of a discussion about cannabis, sense-making, and the outcome of the encounter. Patients and clinicians described similar ideals for a counseling encounter about cannabis consumption during pregnancy or lactation: open, patient-centered conversation grounded in an informed decision-making model to explore the benefits, risks, and alternatives to cannabis. While clinicians described these values as reflecting real clinical interactions, patients reported that in their experience, actual interactions did not live up to these ideals. Clinicians and pregnant and lactating people report desiring the same things from a counseling interaction about cannabis: sharing of information, identification of values, and facilitation of a decision. Both groups endorse an open, nonjudgemental counseling approach that explores the reasons why a patient is considering cannabis consumption and reflects these reasons against available evidence and alternatives known to be safe.

Bimekizumab (Bimzelx)

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec. This review assesses bimekizumab (BIMZELX), 160 mg/mL, solution for injection, subcutaneous injection. Indication: The treatment of adult patients with active ankylosing spondylitis who have responded inadequately or are intolerant to conventional therapy.

Metreleptin (Myalepta)

Reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class. The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada’s federal, provincial, and territorial governments, with the exception of Quebec. This review assesses metreleptin (Myalepta), 3 mg, 5.8 mg, and 11.3 mg, powder for solution, subcutaneous injection. Indication: As an adjunct to diet as a replacement therapy to treat the complications of leptin deficiency in lipodystrophy patients: with confirmed congenital generalized lipodystrophy (Berardinelli-Seip syndrome) or acquired generalized lipodystrophy (Lawrence syndrome) in adults and children 2 years of age and above with confirmed familial partial lipodystrophy (PL) or acquired PL (Barraquer-Simons syndrome), in adults and children 12 years of age and above with persistent significant metabolic disease for whom standard treatments have failed to achieve adequate metabolic control.