Care Decisions Research Articles

A Nationwide Study to Evaluate Accessibility to Specialized Pediatric Palliative Care in Italy-Patients, Needs, and Critical Issues: The PalliPed Study.

Background: PalliPed is the first Italian nationwide project aimed at describing the characteristics of patients accessing specialized pediatric palliative care (PPC) and their families, in the main care settings (hospice, home care, and hospital). The project's secondary aim is to assess the extent and quality of regional PPC networks/facilities and the number of dedicated resources. In this article, we present the results of the first part of the project. Methods: All Italian PPC centers/facilities were invited to participate in the project. Children and young adults in the care of the specialized PPC networks/structures as of 24 October, 2022, including prenatal care, were involved. Children's eligibility for specialized PPC was assessed according to the Assessment Form for Complex Clinical Needs in Pediatrics (ACCAPED Scale) and after a multidisciplinary assessment by the healthcare team. Data were collected through an online survey. Results: A total of 867 patients were described. The lack of adequate specialized PPC service emerged, according to the available estimate of specialized PPC needs, as well as the need for improved referral to PPC by pediatricians or territorial services, particularly for infants and oncological patients. More family support measures also seem necessary, particularly for the mothers. Healthcare providers' communication skills should be improved to ensure greater involvement of patients and families in care decisions. Conclusions: This analysis represents the first step toward defining a constantly updated database for the census and monitoring of specialized PPC activities at the national level. This research model can be extended to other realities in different countries, allowing comparison of different care models.

Sinonasal Tumors: What the Multidisciplinary Cancer Care Board Wants to Know.

Sinonasal neoplasms are a remarkably heterogeneous group, reflecting the numerous tissue types present in the nasal cavity and paranasal sinuses. These entities can be relatively benign (ie, respiratory epithelial adenomatoid hamartoma) or can be exceedingly aggressive (ie, NUT carcinoma). Certain sinonasal tumors have a propensity to spread through local invasion and destruction, while others have a high likelihood of perineural spread. The genetic and molecular mechanisms underlying sinonasal tumor behavior have recently become better understood, and new tumor types have been described using these genetic and molecular data. This has prompted an expansion in the number of tumors included in the World Health Organization fifth edition classification system for head and neck tumors, along with a new classification structure. Radiologists' familiarity with this classification structure is crucial to understanding the expected behavior of these tumors and to collaboration with the multidisciplinary cancer care board in making decisions for optimal patient care. ©RSNA, 2024.

Racial and ethnic disparities in prior authorizations for patients with cancer.

Prior authorization is used to ensure providers treat patients with medically accepted treatments. Our objective was to evaluate prior authorization decisions in cancer care by race/ethnicity for commercially insuredpatients. Retrospective study of 18,041 patients diagnosed with cancer between January 1, 2017, andApril1,2020. Using commercial longitudinal data from a large national insurer, we described the racial and ethnic composition in terms of prior authorization process outcomes for individuals diagnosed with cancer. We then used linear regression models to evaluate whether disparities by race or ethnicity emerged in prior authorization process outcomes. The self-identified composition of the sample was 85% White, 3% Asian, 10% Black, and 1% Hispanic; 64% were female, and the mean age was 53 years. The average prior authorization denial rate was 10%, and the denial rate specifically due to no medical necessity was 5%. Hispanic patients had the highest prior authorization denial rate (12%), and Black patients had the lowest prior authorization denial rate (8%). Regressions results did not identify racial or ethnic disparities in prior authorization outcomes for Black and Hispanic patients compared with White patients. We observed that Asian patients had lower rates of prior authorization denials compared with White patients. We observed no differences in the prior authorization process for Black and Hispanic patients with cancer and higher rates of prior authorization approvals for Asian patients compared with White patients.

Association between systemic inflammatory markers and all-cause mortality in patients with stroke: A prospective study using data from the UK Biobank

Background and aimsThe systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are novel inflammatory biomarkers used to determine various disease prognoses. However, the effects of these systemic inflammatory markers on all-cause mortality in patients with stroke remain unclear. MethodsWe used data from the UK Biobank for this prospective analysis. Overall, 6,020 eligible individuals were included. Over a median follow-up of 13.4 years, 1,233 participants died. We examined the effects of systemic inflammatory markers on all-cause mortality using random survival forest (RSF) and Cox proportional hazards models. Covariate adjustments in the Cox model, selected by RSF, included age, sex, body mass index (BMI), Townsend deprivation index, smoking status, alcohol intake frequency, sleep duration, diabetes, and malignant neoplasms. ResultsIn the marginal effect plots and restricted cubic spline analysis for systemic inflammatory markers, LMR exhibited a linear negative correlation, NLR showed a linear positive correlation, and SII and PLR demonstrated a U-shaped association. After covariates were adjusted, the all-cause mortality risk increased by 14 % for LMR <4 (hazards ratio [HR]: 1.14, 95 % confidence interval [CI]: 1.01–1.29; p= 0.03), by 26 % for NLR ≥2 (HR: 1.26; 95 % CI: 1.11–1.43; p < 0.001),by 26 % for PLR ≥175 (HR: 1.26; 95 % CI: 1.07–1.47; p < 0.001), and by 31 % for SII ≥526 (HR: 1.31; 95 % CI, 1.16–1.47; p= 0.014). In addition, sensitivity analyses, excluding participants who had been followed-up for <2 years and those with malignant neoplasms, yielded results consistent with those of previous research. ConclusionSII, NLR, PLR, and LMR significantly correlate with all-cause mortality in stroke patients. Thresholds established by the RSF model could potentially refine prognostic decision-making in stroke care.

Shared Decision-Making in Patient Care: Advantages, Barriers and Potential Solutions

Shared Decision-Making (SDM) is a collaborative process where physicians integrate scientific evidence with patients’ goals, preferences, and values to make healthcare decisions. This approach contrasts with traditional methods, enhancing patient involvement and understanding. The BRAN questions (Benefits, Risks, Alternatives, Nothing) effectively facilitate SDM across various clinical settings, promoting patient safety. While time constraints and low health literacy pose barriers, strategies like visual aids, extended appointments, and cognitive assessments can mitigate these challenges. Training for physicians in SDM skills has been shown to improve patient outcomes and satisfaction, underscoring the importance of personalized care in outpatient and inpatient contexts.

Prospectively investigating the impact of AI on shared decision-making in post kidney transplant care (PRIMA-AI): protocol for a longitudinal qualitative study among patients, their support persons and treating physicians at a tertiary care centre

IntroductionAs healthcare is shifting from a paternalistic to a patient-centred approach, medical decision making becomes more collaborative involving patients, their support persons (SPs) and physicians. Implementing shared decision-making (SDM) into...

SY8-2 Communication and decision-making in cancer care

SY8-2 Communication and decision-making in cancer care

Utilization of genomic tumor testing (GTT) among community oncologists participating in SWOG S2108CD.

320 Background: As targeted therapy options increase in oncology, GTT use is also increasing; however, the strategies and barriers to ordering GTT can vary across clinics. S2108CD is a cluster randomized trial comparing an educationally enhanced genomic tumor board intervention to usual practice to increase evidence-based genome-informed therapy based on GTT results. This analysis seeks to understand the utilization of GTT by physicians in rural and community oncology clinics. Methods: Physicians at sites enrolled on S2108CD completed baseline questionnaires collecting demographics, practice characteristics, and physicians’ experience with and use of GTT in practice. We also conducted semi-structured interviews at baseline and mid-study with select physicians in both arms to understand how and when physicians are ordering GTT and how it guides treatment decision making. Descriptive statistics were generated for survey data. Interviews were analyzed using conventional content analysis to identify recurring themes. Results: Surveys were completed by 117 physicians across 18 Recruitment Centers, with 57 from the usual practice and 60 from the intervention arm. Interviews were conducted with 10 physicians at baseline and 10 within 12-18 months of start of the study. Physicians reported feeling confident in determining whether GTT is clinically appropriate for a patient (42% moderately confident, 50% very confident). Some physicians utilize GTT from multiple vendors, with the following vendors used most frequently: Tempus (50% of physicians), Caris Life Sciences (61%), Foundation Medicine (62%) and Guardant Health (69%). Over two-thirds of physicians reported that professional guidelines were “very important” in the decision to utilize GTT. Reasons for not ordering GTT included “not relevant for the patient” (36%) and “difficulty in obtaining sufficient tissue” (20%) as “often” reasons. Notably, lack of access and cost/insurance coverage were “never” or “rarely” a reason for not ordering GTT in 80% physicians. Long waits to receive GTT results reportedly caused a delay in making patient care decisions (47% sometimes and 26% often). Physicians rely on the following sources to learn about new GTT panels: scientific meetings (91%), peer-reviewed literature (92%), and professional societies (90%). Interview data confirmed that physicians are generally confident ordering GTT but there is variability in the processes for ordering GTT and receipt of GTT results amongst clinics. Conclusions: Physicians enrolled on S2108CD self-reported high genomic confidence in ordering GTT. Access to GTT and coverage of GTT do not appear to be barriers to utilization. However, physicians did report delays in decision-making due to result turn-around times, which were sometimes attributed to length of time to tissue sendout and receipt of results into health record. Funding : NIH/NCI/NCORP grant UG1CA189974. Clinical trial information: NCT05455606 .

Advancing quality of care using a knowledge transfer approach to foster the use of single-fraction radiation therapy.

288 Background: There are significant barriers between the publication of scientific evidence and its adoption in clinical practice. Research in bone metastasis has demonstrated the effectiveness of single-fraction radiation therapy for uncomplicated cases. A persistent reluctance to adopt this approach in favor of multi-treatment courses remain. The aim of this project was to advocate for a better treatment method by employing a knowledge transfer approach to disseminate information, gather clinician feedback, and change practices. Methods: Initially, experts were invited to share best practices and raise awareness about the issue. Quality measures were developed with help from a consortium-wide working group and were introduced in 2020. The performance metric was steadily increased from 20% to a consortium-wide rate of ≥45% in 2023. The knowledge transfer project involved using video presentations to educate clinicians on the benefits of single-fraction treatment, a post-session survey to assess the impact of the information provided, and a 30-minute virtual discussion that followed days after the presentation. The 30-minute recorded video presentation by a radiation oncologist with expertise in palliative care presented evidence in support of the treatment and dispelled myths surrounding single-fraction treatment. This was first piloted at four sites before being rolled out consortium wide. Results: The project was effective. Physicians at 22 radiation oncology centers reported an increased awareness of single-fraction treatment and a willingness to try it. The table shows: 100% reported the topic was relevant, 94% were prompted to reflect on their current practice, 63% reported their thoughts about fractionation changed and 84% acknowledged an increase in their knowledge of the evidence supporting single-fraction treatment. Annual rates of single-fraction use increased over time. The consortium wide target promoting the use of single fraction for uncomplicated patients was met in 2023– single fraction was used 46% of the time for the treatment of uncomplicated bone metastases patients as compared to about 37% in 2021. Conclusions: Patient care can be enhanced by supporting providers who make health care decisions daily. Quality care can be encouraged by conveying evidence-based knowledge to providers, who are responsible for making healthcare treatment decisions. This project illustrates that sustained efforts in knowledge transfer can effectively change clinical practice patterns to align with evidence-based recommendations. Knowledge transfer project. Physician participation vs. those invited to participate 22/24 (91.67%) Survey Responses: a. Relevant to Practice 100% b. Usefulness to practice and reflection on current practice 94% c. Thoughts changed about fractionation treatment 63% d. Knowledge of evidence supporting treatment increased 84%

Should I Stay or Should I go? Resilience, Intention to Quit and Job Satisfaction among Nurses in Intensive Care Units

Addressing the global nursing shortage is crucial to both national and international public health efforts. This paper aims to highlight the importance of resilience and its impact on primary care nurses' job satisfaction and intentions to quit, especially in the face of current challenges. The study utilized a mixed methods design involving nurses in intensive care units of a university hospital in Austria. In the first phase of data collection, qualitative focus group interviews were conducted to gather insights on the current challenges and stressors faced by nursing professionals. Building on relevant literature, a quantitative survey was then administered to all nurses, using scales measuring resilience, intention to quit, and job satisfaction in order to examine the relationships between these variables. In addition, a data structuring of the resilience scale by factors was achieved with the help of confirmatory factor analysis. Subsequently, the correlations of the resilience factors with the other variables were examined by means of an additional correlation, regression and mediation analysis. The results showed negative correlations with regard to resilience and intention to quit as well as with regard to job satisfaction and intention to quit. In contrast, job satisfaction and resilience correlated significantly positively with each other. The negative correlation between resilience and the intention to quit was confirmed, but only for the factors "goal focus" and "pride and commitment". A closer examination of the two factors and their associated items revealed a connection to both professional identity and organizational identity. This study provides valuable insights for health care leaders and health care decision makers to effectively lead, develop, and thereby retain primary care nurses. The authors argue that improving resilience and strengthening organizational identity are important influencing factors in increasing job satisfaction and reducing nurses' intention to quit.

Males discriminate between substrate-borne cues of conspecific females based on age and mating status in the jumping spider, Habronattus brunneus.

Sexual selection is often studied with a focus on female mate choice, wherein females evaluate male signals to select an optimal mate. However, in some systems, males should also make careful decisions about the females they choose to court, particularly when faced with the risk of precopulatory sexual cannibalism. Here, we explore the idea that male jumping spiders (Habronattus brunneus) may mitigate this risk by responding to female cues probably associated with female aggression and/or receptivity. We tested mature male spiders' ability to discriminate between substrate-borne cues (i.e. silk and excreta) produced by conspecific females of different ages and mating statuses. We found that males spent more time exploring cues produced by mature, non-mated females compared with either immature females or mated females. Heightened interest in cues produced by females that are sexually mature but not yet mated may allow males to reduce cannibalism risk, reduce wasted courtship effort and increase their reproductive success. The use of chemical and/or tactile cues in jumping spider courtship behaviour has been vastly understudied compared with the ways they use vision; this study provides the groundwork for understanding how these sensory modalities interact.

Dog owners' perceptions and veterinary-related decisions pertaining to changes in their dog's behavior that could indicate pain.

Assess dog owners' concern levels and veterinary care decisions pertaining to behaviors that might signify pain before and after receiving brief pain-related educational information. Additionally, evaluate dog owners' perceptions of a modified version of the Colorado State University Canine Acute Pain Scale to identify their dog's pain level, determine whether they should take their dog to the veterinarian, and describe their dog's pain to their veterinarian. 367 survey respondents who resided in the US and were the primary caretaker of at least 1 dog. An electronic survey was created in Qualtrics and distributed via Prolific. Data were analyzed. When assessing differences between participants' concern levels before and after educational pain-related information, significant differences were found for 2 of the 3 scenarios. Significant differences were also found between participants' veterinary-related behaviors before and after educational pain-related information for all 3 scenarios. The most common reasons for not seeking immediate veterinary care included elements related to cost, convenience, and dog-related stress during veterinary visits. Most participants reported finding the Canine Acute Pain Scale useful for identifying their dog's pain level (89%), determining whether they should take their dog to the veterinarian (84%), and describing their dog's pain to their veterinarian (89%). Owners' interpretations of and subsequent actions (or inactions) to behaviors that might suggest pain carry great implications for companion animals' overall well-being. Following exposure to brief educational material about signs and symptoms of canine pain, owners in our study reported significant increases in stated concern related to their dog's change in behavior and intention to seek veterinary care. These findings suggest that even very brief pain-related educational material can have a positive impact on owners' perceptions of canine behavioral changes and increase the possibility that they will seek veterinary care.

Ethical Implications in AI-Based Health Care Decision Making: A Critical Analysis

Ethical Implications in AI-Based Health Care Decision Making: A Critical Analysis

Behaviors suggestive of pain: the perceptions and veterinary-related decisions of cat guardians in the USA.

The aim of the study was to assess cat guardians' concern levels and veterinary care decisions pertaining to behaviors that might signify pain before and after receiving brief pain-related educational information. The secondary aims were to evaluate cat guardians' perceptions of the usefulness of a modified version of the Colorado State University Feline Acute Pain Scale (CSU-FAPS) in identifying their cat's pain level, determining if they should take their cat to the veterinarian and describing their cat's pain to their veterinarian. Participants were recruited through Prolific. An electronic survey was created in Qualtrics and distributed via a link offered in Prolific. A total of 362 surveys were completed by participants who resided in the USA and were the primary caretaker of at least one cat. Significant differences between participants' concern levels before and after pain-related educational information were found for two of the three scenarios. Significant differences were found between participants' veterinary-related behavior choices before and after pain-related educational information for all three scenarios. The most common reasons for not seeking immediate veterinary care included elements related to cost and stress for guardian and cat during veterinary visits. The majority of participants reported finding the CSU-FAPS useful for identifying their cat's pain level (90%), determining if they should take their cat to the veterinarian (86%) and describing their cat's pain to their veterinarian (92%). Guardians' interpretations of and subsequent actions to behaviors that might suggest pain carry great implications for feline health and wellbeing. After exposure to brief pain-related educational material, guardians in our study reported significant increases in stated concern related to their cat's change in behavior and intention to seek veterinary care. These findings suggest that even very brief pain-related educational material can have a positive impact on cat guardians' perceptions of feline behavior changes and increase the possibility they obtain appropriate veterinary care.

Integration of lung function data: turning snapshots into stories.

Missing or inaccessible lung function measurements, gathered over time, have the potential to stagnate or impair clinical care decisions being made. This jeopardises patient safety and often contributes to excessive resource utilisation. Data integration is fundamental to clinical decision-making and entails amalgamating lung function data from multiple sources in a user-friendly format. Despite this, current systems for recording lung function data are suboptimal, with copious gaps in the clinical picture arising from missing or inaccessible lung function measurements. This article discusses the importance of data integration for lung function, with a call to action for key stakeholders involved in the performance, management and interpretation of such tests.

Congenital diaphragmatic hernia and cleft lip and palate: looking for a common genetic etiology.

Congenital diaphragmatic hernia (CDH) and cleft lip and/or palate (CL/P) are inborn closure defects. Genetic factors in and outcomes for patients with both anomalies (CDH+CL/P) remain unclear. We aimed to investigate associated genetic aberrations, prevalence of, and outcomes for, CDH+CL/P. Data from Congenital Diaphragmatic Hernia Study Group (CDHSG) registry were collected. CL/P prevalence in CDH patients was determined. Genetic abnormalities and additional malformations in CDH+CL/P were explored. Patient characteristics and outcomes were compared between CDH+CL/P and isolated CDH (CDH-) using Fisher's Exact Test for categorical, and t-test or Mann-Whitney U-test for continuous, data. p < 0.05 was considered statistically significant. Genetic anomalies in CDH+CL/P included trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome (4p16.3 deletion). CL/P prevalence in CDH was 0.7%. CDH+CL/P had lower survival rates than CDH-, a nearly fourfold risk of death within 7days, were less supported with extracorporeal life support (ECLS), had higher non-repair rates, and survivors had longer length of hospital stay. Genetic anomalies, e.g. trisomy 13, 8p23.1 deletion, and Wolf-Hirschhorn syndrome, are seen in patients with the combination of CDH and orofacial clefts. CL/P in CDH patients is rare and associated with poorer outcomes compared to CDH-, influenced by goals of care decision-making.

Effect of patient gender on the decision of ceiling of care: an European study of emergency physicians' treatment decisions in simulated cases.

Gender bias in healthcare can significantly influence clinical decision-making, potentially leading to disparities in treatment outcomes. This study addresses the impact of patient gender on the decision-making process for establishing a ceiling of care in emergency medicine, particularly the decision to limit tracheal intubation. To determine whether patient gender influences emergency physicians' decisions regarding the recommendation for tracheal intubation in critically ill patients. A European survey-based study was conducted using a standardized clinical scenario to assess physicians' decisions in a controlled setting. The survey targeted European emergency physicians over a 2-week period in April 2024. A total of 3423 physicians participated, with a median age of 40 years and a distribution of 46% women. Physicians were presented with a clinical vignette of a 75-year-old patient in acute respiratory distress. The vignettes were randomized to vary only by the patient's gender (woman/man) and level of functional status: (1) can grocery shop alone, (2) cannot grocery shop alone but can bathe independently, or (3) cannot perform either task independently. The primary outcome was the recommendation for intubation, with secondary analyses exploring the influence of patient functional status levels. Multivariable logistic regression was used to adjust for potential confounders, including physician gender, age, experience, and practice setting. A total of 3423 physicians responded, mostly from France, Spain, Italy, and the UK (1,532, 494, 247, and 245 respectively). Women patients were less likely to be intubated compared to male patients [67.9% vs. 71.7%; difference 3.81%; 95% confidence interval (CI), 0.7-6.9%]. The likelihood of recommending intubation decreased with lower levels of patient functional status. Women physician gender was also associated with a reduced likelihood of recommending intubation. This study suggests a significant gender-based disparity in emergency care decision-making, with women patients being less likely to receive recommendations for intubation. However, these results should be interpreted with caution due to potential limitations in the representativity of respondents and the uncertain applicability of survey responses to real-life clinical practice.

-AI-assisted diagnostic potential of CT in bone oncology and its impact on clinical decision-making for intensive care

ObjectiveThis study evaluates the AI-assisted diagnostic potential of computed tomography (CT) for bone cancer and its influence on patient care during the pre- and post-treatment phases. It compares patient management approaches based on CT severity levels and identifies distinct CT phenotypes linked to disease severity. MethodologyWe retrospectively examined 50 patients diagnosed with bone cancer between December 2022 and June 2023. The CT scans were analyzed according to the Radiological Society of North America (RSNA) guidelines. This study was performed using the deep convolutional neutral network (DCNN) model to assist doctors in diagnosing bone tumors through CT scanning. Patients’ management approaches were compared based on the severity levels indicated by CT scans. ResultsFifty patients participated in this study, with a median age of 67.2 years, ranging from 32 to 89 years. Of them, 38 % were female and 62 % were male. In 2022, 19 individuals (13 males and 6 females, ages 32 to 84) were assessed, with a mean age of 59.9 years. In 2023, 31 individuals, aged 54 to 89 with a mean age of 71.6 years, were assessed; among them were 18 men and 13 women. SPECT scans revealed the following key diagnostic features: 85.9 % of patients exhibited bone lesions with ground-glass opacities, 88 % had multipolar involvement, 92.8 % had bilateral involvement, and 92.8 % showed peripheral involvement. The severity scores based on CT scans were significantly higher in patients requiring intensive care, with scores above 14 being more common in this group. ConclusionDistinct CT findings during the AI-assisted diagnosis and treatment of bone cancer provided prompt and sensitive examination capabilities. Notably, two CT phenotypes emerged, associated with large consolidation patterns and high severity scores, offering crucial insights into disease severity and aiding in clinical decision-making for intensive care requirements. The study underscores the importance of CT in the effective monitoring and management of bone cancer pre- and post-treatment.

Building an Ethical and Trustworthy Biomedical AI Ecosystem for the Translational and Clinical Integration of Foundation Models.

Foundation Models (FMs) are gaining increasing attention in the biomedical artificial intelligence (AI) ecosystem due to their ability to represent and contextualize multimodal biomedical data. These capabilities make FMs a valuable tool for a variety of tasks, including biomedical reasoning, hypothesis generation, and interpreting complex imaging data. In this review paper, we address the unique challenges associated with establishing an ethical and trustworthy biomedical AI ecosystem, with a particular focus on the development of FMs and their downstream applications. We explore strategies that can be implemented throughout the biomedical AI pipeline to effectively tackle these challenges, ensuring that these FMs are translated responsibly into clinical and translational settings. Additionally, we emphasize the importance of key stewardship and co-design principles that not only ensure robust regulation but also guarantee that the interests of all stakeholders-especially those involved in or affected by these clinical and translational applications-are adequately represented. We aim to empower the biomedical AI community to harness these models responsibly and effectively. As we navigate this exciting frontier, our collective commitment to ethical stewardship, co-design, and responsible translation will be instrumental in ensuring that the evolution of FMs truly enhances patient care and medical decision-making, ultimately leading to a more equitable and trustworthy biomedical AI ecosystem.

Effectiveness of electrocardiogram interpretation education program using mixed learning methods and webpage

AimThis study was conducted to develop an electrocardiogram education program that incorporates an HTML webpage and blended learning methods to enhance electrocardiogram interpretation skills. Through continual and efficient education, the program aims to assist nurses in providing appropriate care and treatment to patients.DesignPre-post design study.MethodsWe developed an electrocardiogram interpretation HTML webpage based on an electrocardiogram interpretation algorithm and implemented an 18-week (2023.5.15 ~ 2023.9.22) electrocardiogram education program, which included daily 5-minute training sessions. Twenty-seven ward nurses were provided with the URL (https://ecgweb.github.io/ECGwebEN) to the electrocardiogram interpretation HTML webpage and shared one electrocardiogram case daily for self-interpretation. Electrocardiogram interpretation performance and confidence were evaluated through questionnaires at three phases: before the program, after 6 weeks of basic electrocardiogram and arrhythmia education, and after 12 weeks of application of the electrocardiogram interpretation HTML webpage and case-based lecture education. The statistical tests used were repeated-measures ANOVA or the Wilcoxon signed-rank test.ResultsThe average score for electrocardiogram interpretation performance before the electrocardiogram education program was 11.89(SD = 3.50), after 6 weeks of basic electrocardiogram and arrhythmia education it was 14.15(SD = 3.68), and after 12 weeks of application of the electrocardiogram interpretation HTML webpage and case-based lecture education, it was 15.56(SD = 3.04). This shows that electrocardiogram interpretation performance significantly improved over time (p < .001). Additionally, post-hoc analysis revealed significant differences in electrocardiogram interpretation performance at each stage, i.e., before, during, and after the application of an electrocardiogram education program. Furthermore, the electrocardiogram interpretation confidence questionnaire score (pre-Median 18, IQR = 5; post-Median 23, IQR = 3) was improved significantly after the completion of the 18-week education program (p < .001).ConclusionsBased on the results of this study, we believe that an electrocardiogram education program using HTML webpage, and a blended teaching method would be very beneficial for maintaining and improving electrocardiogram interpretation skills of clinical nurses. Such a program can help nurses interpret electrocardiograms more effectively and assist them in making important decisions in patient care.