Effective Health Care Delivery Research Articles

AI-driven optimisation of EHR systems implementation in Tanzania’s primary health care

Purpose This study aims to explore how artificial intelligence (AI) can be used to overcome the challenges associated with implementing electronic health record (EHR) systems in primary health-care facilities in Tanzania. It aims to assess the technological, organisational and environmental barriers to EHR system implementation and investigate the role of AI in optimising these systems for more effective health-care delivery. Design/methodology/approach The study adopts a qualitative approach, using case studies from five regions in Tanzania: Dar es Salaam, Mwanza, Morogoro, Singida and Pwani. Data were collected through 26 semi-structured interviews with health-care providers, including medical doctors, nurses, pharmacists and IT personnel. The study applied the diffusion of innovation (DOI) theory and the technology-organisation-environment framework to assess the factors affecting EHR implementation and the potential integration of AI to enhance these systems. Findings Key challenges include unreliable network connectivity, frequent power outages, insufficient training and complex system usability issues. Despite these challenges, EHR systems have improved patient data accessibility and workflow efficiency. AI presents opportunities to address these challenges, mainly through predictive analytics, AI-driven encryption for data security and personalised training modules. AI integration can enhance system reliability, usability and security, ultimately improving health-care outcomes. Originality/value This study provides valuable insights into integrating AI to optimise EHR systems in resource-constrained environments like Tanzania. It addresses a gap in the literature by focusing on how AI can be adapted to low-resource settings and provides a framework for future EHR system implementations in similar contexts. The findings contribute to the global discourse on health-care informatics and the role of AI in improving health-care systems in developing countries.

Exploring telemedicine and organizational challenges in the healthcare system: a qualitative analysis using Grounded Theory.

Telemedicine is a context-specific intervention that implies significant procedural changes in a health organization. The objective of the study is to explore healthcare professionals' usage of and perceptions towards telemedicine technology and identify the perceived factors and related process change, influencing the effective adoption of telemedicine from an organizational perspective. The study includes multi-disciplinary commentaries of a purposive sample of 31 healthcare professionals, conducted through semi-structured qualitative interviews and employs Grounded Theory and Thematic Analysis techniques to analyze the data. Telemedicine is perceived as a highly beneficial digital intervention in healthcare, focusing on the delivery of effective healthcare, and promoting healthcare equity. Healthcare professionals showed their willingness to assimilate technology into clinical decision-making, resulting in better treatment outcomes, and recommended its' adoption into mainstream healthcare as a viable approach to providing remote healthcare. The key organizational issues with telemedicine adoption were system requirements, network connectivity, non-standardized medical records, and legal bottlenecks, that can be addressed by improving infrastructural convenience, optimizing service processes, imparting training, and adopting better technical measures. The focus is on exploring factors significant for the adoption of telemedicine technology from the perspective of multi-specialties in a health organization, rather than a specific specialty, as studied in previous scholarly work. This study contributes to the theory by proposing a conceptual framework on critical factors for telemedicine adoption, integrating the theory of planned behavior (TPB) and diffusion of innovation (DOI).

Evaluating the usability of Iran’s national comprehensive health information system: a think-aloud study to uncover usability problems in the recording of childcare data

IntroductionHealth information systems play a crucial role in the delivery of efficient and effective healthcare. Poor usability is one of the reasons for their lack of acceptance and low usage by users. The aim of this study was to identify the usability problems of a national comprehensive health information system using the concurrent think-aloud method in the recording of childcare data.MethodsA descriptive cross-sectional study was conducted in the health centers of Kashan University of Medical Sciences, Iran, in 2020. Ten healthcare providers as system's users were purposively selected to evaluate the system. To identify problems, a concurrent think-aloud evaluation was conducted. Two administrators of the system designed scenarios for ten childcare data recording tasks. By analysing the recorded files, usability problems were identified. The severity of the problems was then determined with the help of the users and problems were assigned to usability attributes based on their impact on the user.ResultsA total of 68 unique problems were identified in the system, of which 47.1% were rated as catastrophic problems. The participants assigned 47 problems (69%) to the user satisfaction attribute and 45 problems (66%) to the efficiency attribute; they also did not assign any problems to the effectiveness attribute.ConclusionThe problems identified in the national comprehensive health information system using the think-aloud method were rated as major and catastrophic, which indicates poor usability of this system. Therefore, resolving the system problems will help increase user satisfaction and system efficiency, allowing more time to be spent on patient care and parent's education as well as improving overall quality of care.

Considering patient-centred care and patient empowerment as essential to quality health care delivery in Ghana

Background: Rising cases of non-communicable diseases (NCDs), poor health choices, mistrust of the health system, self-medication, resistance of diseases to medication and dissatisfaction with the service experience serve as red flags on the path to Universal Health Coverage (UHC).Aim: This study explored the importance of patient-centred care (PCC) and patient empowerment (PE) within the context of healthcare service delivery in Ghana.Setting: The study considered PCC and PE from the perspective of three public healthcare facilities within the Greater Accra region.Methods: The researcher adopted a qualitative exploratory research approach. The study employed purposive sampling for the selection of healthcare facilities and healthcare providers. Convenience sampling was applied to select patient participants. A total of 33 in-depth interviews and 4 focus group discussions (FGDs) were conducted across the three sampled facilities as part of the data collection process.Results: Healthcare providers and patients unanimously view quality as essential for effective healthcare delivery. The application of the capacitating role of PE and PCC is inexact and largely left to subjective interpretation.Conclusion: The Ministry of Health (MOH) has recognised that patient experiences, a key indicator of care quality, have often been suboptimal and is actively working to address these weaknesses.Contribution: This study supports the call for health systems to remain committed to efforts to achieve UHC, with a focus on PCC and PE.

Exploring patient loyalty in telemedicine through bibliometric analysis and future horizons

Purpose In an era of rapid telemedicine expansion, patient loyalty is paramount for effective health-care delivery. This study aims to understand loyalty behaviours in telemedicine to refine services. The primary objectives are to elucidate the current state of scholarly inquiry concerning loyalty within the telemedicine sphere and to address existing research deficiencies within this domain. This exploration seeks to provide valuable insights and contribute to the advancement of knowledge in this critical area of inquiry. Design/methodology/approach This study uses a bibliometric analysis to investigate patient loyalty in telemedicine. By reviewing existing literature and analysing bibliometric data, the research identifies key deficiencies and addresses pertinent research questions within the telemedicine loyalty domain. This methodological approach aims to offer a comprehensive understanding of the current state of research and highlight areas requiring further investigation. Findings This study reveals significant gaps in existing research on telemedicine loyalty, identifying a need for more focused studies on patient loyalty behaviours. Through a bibliometric analysis, the findings highlight critical areas for improvement and potential strategies for enhancing patient loyalty in telemedicine. These insights are crucial for refining telemedicine services and ensuring effective health-care delivery. Research limitations/implications The findings may not capture all dimensions of patient loyalty in telemedicine, requiring further empirical studies. Future research should expand on these limitations by incorporating diverse methodologies and broader data sets to validate and extend the study’s insights. Practical implications The insights from this study can help health-care providers refine their telemedicine services to enhance patient loyalty. By understanding loyalty behaviours, providers can develop targeted strategies to improve patient satisfaction and retention. These practical implications are essential for the continuous improvement of telemedicine services, ensuring they meet patient needs and expectations effectively. Social implications Enhancing patient loyalty in telemedicine leads to significant societal benefits, particularly by improving health-care access for underserved populations in rural or economically disadvantaged areas. Continuous and trusted care helps reduce health-care disparities and fosters health equity, positively impacting quality of life through timely medical consultations. In the context of medical tourism, telemedicine facilitates reliable remote consultations, boosting confidence in health-care systems abroad and benefiting local economies. In addition, tourists can access health-care services while travelling, enhancing their sense of safety and well-being. Overall, these advancements highlight telemedicine’s potential to create a more equitable and accessible health-care landscape. Originality/value This study fills a critical gap in telemedicine research by focusing on patient loyalty, an area often overlooked in existing literature. The bibliometric analysis offers a novel approach to understanding and addressing loyalty behaviours. The findings contribute valuable knowledge, advancing the discourse on telemedicine loyalty and providing a foundation for future research and service improvements.

Effects of COVID-19 pandemic on psychiatric and psychological consultation-liaison contacts in a general hospital in North-East of Italy: a retrospective study.

The COVID-19 pandemic has prompted significant changes in healthcare, particularly affecting psychiatric and psychological Consultation-Liaison (CL) services in general hospital settings. To assess the effects of COVID-19-related restrictions on utilization of psychiatric and psychological CL services in Northeast Italy during 2020, and to compare it to the use of services in the previous year (2019). The study collected data on psychiatric and psychological consultations in 2019 and 2020 from a hospital database. It categorizes consultations by type of patient (inpatient or outpatient) and referral source (hospital wards, general practitioners, other specialists). Pandemic-related restrictions were classified as "lockdown," "intermediate restrictions," and "no or reduced restrictions" based on the Covid Stringency Index (CSI). Poisson regression models were employed to analyze the data. The findings reveal a significant 28% increase in the number of psychiatric and psychological consultations in 2020. Consultations for outpatients increased by 51%, while those for inpatients decreased by 11%. However, the lockdown and intermediate restriction phases were deemed responsible of a decrease of 42.9% and 19.5% in consultations respectively. This study highlights the persistent psychological burden during the COVID-19 pandemic, alongside reduced CL services due to lockdown measures. Integrating telemedicine into these types of services becomes imperative for meeting patient needs during restrictions. These findings can inform policies and practices to improve effective mental health care delivery during and beyond pandemics. Future research should explore the impact of pandemic-related restrictions on mental healthcare across settings and clinical factors affecting service accessibility.

Review of Manpower Management in Healthcare System: Strategies, Challenges, and Innovations.

Hospital manpower management (HRM) is vital for effective healthcare delivery. Unique challenges, such as managing diverse staff, ensuring clear communication, and optimizing resources, complicate HRM. Rising operational costs, workforce shortages, and employee burnout necessitate strategic approaches to manpower management. This review aims to provide a comprehensive understanding of manpower management in hospitals, focusing on identifying core components and discussing innovative strategies to address current challenges, particularly those related to workforce shortages. A literature review was conducted using databases such as PubMed, Scopus, and Google Scholar. Key terms included "hospital manpower management", "HRM challenges in healthcare", and "workforce shortages", selected for their relevance to the core focus of this review. Relevant articles published from 2019 to 2023 were selected for analysis. The review identified core components of manpower management: recruitment and staffing, workforce planning, training and development, performance management, and compensation and benefits. Strategies to address workforce shortages included strategic hiring and enhancing employee engagement. The integration of technology and ongoing training emerged as critical for maintaining high-quality patient care. Effective manpower management is essential for the sustainability of healthcare systems. This review highlighted the importance of innovative HRM strategies to tackle workforce shortages and improve employee satisfaction. By focusing on comprehensive HRM practices, healthcare organizations could enhance workforce efficiency and provide better patient care. Future research should explore the long-term impacts of these strategies on healthcare.

Managing an adolescent with Type 1 Diabetes and socioeconomic deprivation in a remote primary care setting — Ethical challenges

This case study discusses the ethical challenges encountered by a primary care team in managing a 17-year-old girl with Type 1 diabetes in a socio-economically deprived tribal area. The case highlights critical issues such as justice in access to essential medicines, ethical dilemmas arising from complex family dynamics, and systemic failures within the public health system. By examining these challenges, this case study underscores the importance of addressing broader social determinants of health to ensure just and effective healthcare delivery in rural and tribal settings.

4.C. Scientific session: Navigating through complex challenges of responding to outbreaks of multidrug-resistant organisms

Abstract Antimicrobial resistance is one of the top ten global public health threats according to the WHO, contributing to millions of deaths each year. While outbreaks of multidrug-resistant organisms (MDROs) are well studied in hospital and nursing home settings, knowledge gaps exist concerning the complex challenges of outbreaks of MDROs among vulnerable patient populations, such as patients with intellectual disabilities or elderly patients living longer at home with multiple comorbidities. The coordination of such outbreaks requires a multidisciplinary approach as these patients often receive care throughout different healthcare settings, including long-term care and home-based nursing care. We delve into the complexities of coordinating an MDRO outbreak response involving healthcare professionals from various healthcare settings. The challenges inherent to the coordination of multidisciplinary involvement and the use of innovative strategies for outbreak preparedness and surveillance, will be thoroughly examined based on scientific evidence and practice based experiences. Workshop objectives • To exchange experiences on managing cross-institutional outbreaks of MDROs • To foster deeper understanding of the complexities of multidisciplinary involvement during MDRO outbreaks among vulnerable patient populations The workshop structure: - A brief introduction will be provided on the generic challenges in providing long-term care to vulnerable patient populations carrying MDROs. We will subsequently illustrate potential challenges faced during a cross-institutional MDRO outbreak among these patients through a realistic scenario (5 min): A patient with severe intellectual and physical disabilities living in both a long-term care facility as well as with family at home, unexpectedly turns out to be carrying an MDRO after recent hospital admission. As the patient receives nursing care from both from family members and nursing staff in different healthcare settings, a cross-institutional MDRO outbreak has occurred requiring a coordinated response. - Hereafter, individual presenters will address evidence- and experience-based challenges faced in MDRO outbreak responses within the specific healthcare settings covered in the previously presented scenario. We will navigate through the scenario together with the participants, discussing practical and ethical dilemmas, and explore ways for containing the MDRO outbreak while maintaining effective and compassionate healthcare delivery. In addition, we will discuss the use of public health innovations, such as social network analysis as a basis for the development of a stress test exercise to improve preparedness for MDRO outbreaks, and the role of wastewater surveillance in MDRO outbreaks. Discussions will be facilitated by (online) voting tools to invite participants to exchange experiences (40 min). We conclude with an exciting quiz to summarize the key messages of this workshop (10 min). Key messages • Healthcare setting, knowledge, proportionality and well-being of vulnerable patients populations are important to acknowledge during cross-institutional MDRO outbreaks. • Novel stress test exercise and wastewater surveillance are potential methods to improve preparedness and surveillance, respectively, during cross-institutional MDRO outbreak responses.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Virtual medical astronaut avatars for future deep space missions

This paper explores the telemedicine possibilities available to astronauts during spaceflight, focusing on the possible utilization of medical avatars for continuous health monitoring. Various types and sources of telemedicine are examined, along with their applications in deep space travel to address the challenges faced by astronauts and facilitate timely intervention in case of injuries and illnesses. The use of medical avatars presents a promising solution to mitigate risks and ensure effective healthcare delivery in the absence of immediate physical medical support. Furthermore, potential terrestrial applications of telemedicine and virtual medical avatars are discussed, highlighting the wider implications and benefits beyond space exploration. By leveraging advanced technologies and innovative approaches, telemedicine in conjunction with medical avatars offers a compelling avenue for enhancing healthcare practices both in space and on Earth.

Urbanization factors and the vagaries of the rural health care industry in Nigeria: an analysis of the accessibility of healthcare services by older adults in the Nsukka Local Government Area

This study sought to determine the effects of urbanization on access to healthcare services by older adults in Nsukka Local Government Area. The Nigerian healthcare industry is organized under the three tiers of government: Federal, State and Local governments. As such, most of the healthcare facilities are located in urban areas while majority of older adults reside in different local governments in rural communities where there are a few of the facilities. This has led to poor utilization of medical services by older adults in rural areas. This study adopted a mixed method approach. While questionnaire was used to collect quantitative data, interviews were used to collect qualitative data for the study. Questionnaire survey was used to collect data from 1180 older adults between the ages of 60 years and above from six communities in the study area. Descriptive statistics and Chi square were used to analyze the data while frequency distribution tables and percentages were used to present the results. The research showed that there are inadequate health facilities for the older adults in rural communities in Nsukka LGA. It also found that the older adults suffered challenges arising from lack of medical doctors, nurses, equipments, and drugs for effective healthcare delivery. It is recommended that more efforts should be geared towards providing adequate health facilities and health workers by government at public hospitals in rural communities to increase accessibility and adequate utilization by the older adults.

Transition and change: opportunities and challenges of CHW programme reform for community health systems and vertical disease programmes in Liberia

BackgroundGlobally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016–2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa.MethodsWe used a qualitative case study approach conducted between March 2017 and August 2018. Our instrumental case study approach uses qualitative methods, including document review of five CHW and NTD program-related policy documents; 25 key informant interviews with facility, county, and national level decision-makers; and 42 life and job histories with CHWs in Liberia. Data were analysed using a thematic framework approach, guided by Kok et al. framework of CHW performance. Data were coded in QRS NVIVO 11 Pro.ResultsOur findings show that CHW programme reform provides opportunities and challenges for supporting enhanced CHW performance. In relation to health system hardware, we found that CHW programme reform provides better opportunities for: formal recognition of CHWs; strengthening capacity for effective healthcare delivery at the community level through improved and formalised training; a more formal supervision structure; and provision of monthly incentives of 70 US dollars. Efficiency gaps in routine intervention delivery can be mitigated through the strengthening of these hardware components. Conversely, supervision deficits in routine CHW functioning can be supported through health interventions. In relation to systems software, we emphasise the ongoing importance of community engagement in CHW selection that is responsive to gendered power hierarchies and accompanied by gendered transformative approaches to improving literacy.ConclusionsThis study shows how CHW programme reform provides opportunities and challenges for health system strengthening that can both positively and negatively impact the functioning of routine health interventions. By working together, CHW programmes and routine health interventions have the opportunity to leverage mutually beneficial support for CHWs, which can enhance overall systems functioning by enhancing CHW performance.

New horizons in systems engineering and thinking to improve health and social care for older people.

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary approach to change that is focused on people, system understanding, design and risk management. These principles are the basis of many established quality improvement (QI) tools in health and social care, but implementation has often been limited to single services or condition areas. Newer engineering techniques may help reshape more complex systems. Systems thinking is an essential component of this mindset to understand the underlying relationships and characteristics of a working system. It promotes the use of tools that map, measure and interrogate the dynamics of complex systems. In this New Horizons piece, we describe the evolution of systems approaches while noting the challenges of small-scale QI efforts that fail to address whole-system problems. The opportunities for novel soft-systems approaches are described, along with a recent update to the Systems Engineering Initiative for Patient Safety model, which includes human-centred design. Systems modelling and simulation techniques harness routine data to understand the functioning of complex health and social care systems. These tools could support better-informed system change by allowing comparison of simulated approaches before implementation, but better effectiveness evidence is required. Modern systems engineering and systems thinking techniques have potential to inform the redesign of services appropriate for the complex needs of older people.

Effectiveness of Community-Based Multidisciplinary Integrated Care for Older Adults with General Practitioner Involvement: A Systematic Review and Meta-Analysis

Abstract Background Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. A knowledge gap exists with regards to what elements of integrated care facilitate effective age-attuned healthcare delivery. This systematic review examines the effectiveness of community-based multidisciplinary integrated care strategies with General Practitioner (GP) participation for community-dwelling older adults and describes the level of care integration in each study. Methods PUBMED, EMBASE, CINAHL, Central Register of Controlled Trials in the Cochrane Library and MEDLINE were systematically searched in April 2023. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community-dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence and used the Rainbow Model of Integrated Care taxonomy to describe the elements of integrated care used within studies. The primary outcome was functional status. Meta-analyses were performed using Review Manager 5.4. Results Twelve trials (14 reports) recruiting 8069 participants across 8 countries were included. Community-based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD) 0.21, 95% confidence interval (CI) 0.05-0.37; low certainty evidence), hospitalisation (risk ratio (RR) 0.77, 95% CI 0.63-0.95; very low certainty evidence) and participant satisfaction with care (SMD 0.46, 95%c CI 0.15-0.76; low certainty evidence) from 12-36 months. No statistically significant effects favouring community-based MDT interventions for functional status at 6-month follow-up, Emergency Department presentation, mortality, health-related quality of life, or nursing home admission were established. Conclusion Community-based MDT integrated care with GP participation improves clinical and process outcomes for community-dwelling older adults. Future research should focus on models of integrated care that respond to the needs and preferences of older adults.

A Systematic Review of Primary Healthcare Services: Evaluating Differences and Similarities Between Developed and Developing Nations

Background: Primary healthcare (PHC) systems play a critical role in ensuring equitable and effective healthcare delivery. However, significant disparities exist in the scope and performance of PHC services between developed and developing countries. Understanding these differences is crucial for improving global health outcomes. Objective: This systematic review aims to compare the scope and effectiveness of primary healthcare services across developed and developing countries. It seeks to identify key differences in healthcare delivery, system performance, and governance structures and provide insights into enhancing PHC services. Methods: We conducted a comprehensive search of electronic databases, including PubMed, MEDLINE, and Scopus, and explored grey literature and reports from relevant organizations. Studies were selected based on their comparative data on PHC services in developed and developing countries, published in peer-reviewed journals or reputable sources. Data were extracted on study characteristics, population details, and key outcomes related to service delivery and system performance. Quality assessment was performed using appropriate tools for different study designs. Results: The review identified significant variations in PHC service scope and effectiveness between developed and developing countries. Key findings include differences in healthcare delivery models, governance structures, and system performance metrics. The review highlights both strengths and challenges in various contexts, providing a comparative overview of PHC services. Conclusions: The findings emphasize the need for context-specific strategies to improve PHC services. Recommendations include enhancing coordination and governance, addressing gaps in accountability and transparency, and focusing on scalable interventions. This review provides valuable insights for policymakers and health system planners aiming to optimize PHC services globally.

Abstract A154: Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities

Abstract Introduction: Breast cancer is the leading cause of cancer-related deaths among women, with rural communities having the highest rates of breast cancer mortality. Despite this burden, many women begin mammography later than recommended and the mammography screening rate remains low, with a previously reported declining trend, particularly among rural women compared to urban women. This study seeks to identify barriers to breast cancer screening and examine strategies to overcome these barriers in rural Missouri. Methods: In partnership with the Missouri Cancer Consortium and the Missouri Comprehensive Cancer Control Programs, we conducted key informant interviews with mammography health providers at health centers in each of ten counties with the highest breast cancer mortality and lowest screening mammography rates in Missouri. Semi-structured interviews included questions about seeking and delivering breast cancer screening as well as provider experiences with patient navigation, mobile mammography, and the CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Data were analyzed using a deductive-inductive thematic approach in NVivo 14. Results: We conducted 14 interviews with health providers across 12 health sites. The majority of these sites used patient navigation (67%), mobile mammography (80%), and the CDC NBCCEDP (67%) as strategies to improve access to breast healthcare. Health providers frequently mentioned “no-shows” as a major challenge to providing breast healthcare, along with limited transportation, cost, fear, and competing work priorities as the major barriers faced by patients in seeking breast healthcare. Patient navigation and mobile mammography were beneficial in bringing breast healthcare closer to the community, while the CDC NBCCEDP covered screening and follow-up costs. The main facilitating factors to implementing these strategies were having dedicated staff and funding for patient navigation, and existing partnerships with other health institutions for mobile mammography. However, health providers identified several implementing challenges for the strategies. This included limited staff capacity and difficulty contacting or following up patients to schedule appointments for patient navigation and mobile mammography. For the CDC NBCCEDP, the challenges included difficulty identifying eligible patients and extensive paperwork in the enrollment process. Providers recommended increasing staff capacity to support patient navigation, using digital technology in identifying and enrolling women for the CDC NBCCEDP, and integrating mobile mammography with the CDC NBCCEDP to improve implementation efficiency. Discussion: The integration of multiple component strategies within breast healthcare may address the multi-level barriers women face in accessing breast cancer screening. This study contributes to the identification of organizational supports and informs development of policies needed to enhance the adoption and implementation of strategies that support the effective delivery of breast healthcare. Citation Format: Thembekile Shato, Carmen Vardeman, Sarah J. Chavez, Ashley C. Holmes, Joann Lee, Xarria Lewis, Katie Manga, Misty Phillips, Keisha Windham, Bettina F. Drake. Mammograms Across Missouri: A Qualitative Evaluation among Healthcare Providers to Improve Breast Cancer Screening in Rural Communities [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 A154.

Abstract B029: Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment

Abstract Introduction: Medical mistrust, characterized by distrust in healthcare providers, institutions, and systems, can hinder effective Patient-Centered Communication (PCC) — a method of healthcare interaction that ensures patients (pts) voices, needs, and values guide clinical decisions and care planning. Medical mistrust can impede effective healthcare delivery, particularly to those from historically marginalized backgrounds. We aimed to explore the effect of race on the association of mistrust with PCC among older Black and White pts with cancer. Methods: Pts were aged 65+, 50% Black, receiving any cancer treatment and were recruited from July 2022 to August 2023. Pts perception of providers’ PCC was assessed using the Patient-Centered Communication in Cancer Care-36 (range: 1-5; higher score=better PCC), and medical mistrust using the Group Based Medical Mistrust Scale (range 12-60; higher score=greater mistrust) which includes subdomains of discrimination, suspicion, and low support. Multivariable linear regression models examined the association of mistrust with PCC separately among Black and White pts controlling for education, income, depression, and anxiety. The interaction of race on the association of mistrust with PCC was also explored. Beta (β) coefficients, 95% Confidence Intervals (CI), and p-values are reported. Results: Forty-three (21 Black) pts, mean age=73.6 years (range 65-86) completed the study. Sociodemographic and psychosocial characteristics was similar, except income <$50,000 was more common among Black than White pts (48% vs 27%; p=0.005) as was unmarried status (57% vs 27%; p=0.020). Between Black and White pts there were no significant differences in the median levels of mistrust (22.5 vs 20.0; p=0.34) and PCC (4.6 vs 4.5; p=0.82). Among Black pts increased overall mistrust and all mistrust subdomains were associated with decreased PCC [Overall Score: (β=-0.06; 95% CI=-0.09 to - 0.02; p=0.003), discrimination (β=-0.20; 95% CI=-0.30 to -0.11, p<0.001); suspicion (β=-0.14; 95%CI=-0.25 to -0.02; p=0.022) and low support (β=-0.15; 95% CI=-0.27 to -0.03; p=0.017)]. Among White pts, only the mistrust domain of low support was negatively associated with PCC (β=-1.21; 95%CI=-0.25 to -0.02; p=0.028). Exploration of racial differences in the association of mistrust and its subdomains and PCC revealed that the association of the discrimination subdomain and PCC varied between Black and White pts at the 9.5% significance level; p=0.095. Conclusion: Black pts with diminished trust in healthcare providers, institutions, and systems, may be less inclined to actively participate in open and collaborative communication with healthcare providers, which could adversely affect their clinical outcomes. Furthermore, considering the trending difference in mistrust domain of discrimination between Black and White pts, developing communication strategies tailored to address discrimination might be key to mitigating mistrust, cultivating strong patient-provider bonds, and advancing health equity among older Black pts with cancer. Citation Format: Nikesha Gilmore, Nikesha Jean, Nikesha Loh, Nikesha Strawderman, Rev Patrina Freeman, Elizabeth Diaz Fontanez, Marquita Thames-Lewis, Lee Kehoe, Marie Flannery, Ronald Epstein, Supriya Mohile, Charles Kamen. Communication barriers: The role of medical mistrust in patient-centered communication in cancer care among Black and White older patients with cancer receiving treatment [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 B029.

Exploring the potential of pantomime games in medical education: Non-verbal exercise

The primary educational challenge in medical education is the lack of focus on non-verbal communication skills, such as body language, facial expressions, and gestures. This gap is crucial, particularly in multicultural and multilingual contexts where non-verbal cues can bridge language barriers and enhance understanding between healthcare professionals and patients. To address this, our wave explores the potential of integrating art, specifically pantomime games, into medical education as a non-verbal exercise. Inspired by ancient drama and role-play, pantomime games offer an innovative methodology for enhancing non-verbal communication skills. These games help students develop observation, empathy, and ambiguity tolerance—skills essential for effective healthcare delivery. Incorporating art and game-based learning into medical curricula has improved visual perception, personal reflection, and student engagement. The benefits of this integration extend globally, fostering emotional intelligence, creative thinking, and cross-cultural understanding. Educational games create a safe environment for students to experiment, learn from mistakes, and gain practical experience, ultimately reducing training time and instructor load. Moreover, non-verbal communication training can enhance professor-student interactions, improving feedback quality and learning outcomes. To implement these innovations, clear guidelines and effective facilitation are crucial. Educators should provide supportive environments for experimentation and learning, using minimal materials such as open spaces and simple props. High-resource settings can leverage AI technologies for feedback and create mobile applications to modernize the approach. This wave advocates for a student-centered, multimodal communication and learning environment, highlighting the transformative potential of integrating performing arts into medical education to prepare future healthcare providers better.

Defining minimum workforce standards for intensive care physiotherapy in Australia and New Zealand: A Delphi study

BackgroundIntensive care staffing guidelines provide recommendations for the safe and effective delivery of health care while recognising professional requirements of the workforce. To guide recommendations for physiotherapy staffing guidelines, profession-specific consultation is needed. ObjectivesThe objective of this study was to develop consensus-based recommendations for minimum workforce standards for physiotherapy in intensive care. MethodsA Delphi survey process was conducted involving physiotherapists from Australia and New Zealand. ResultsThe panel consisted of 65 physiotherapists in the first round and 60 in the second round (92% retention). Respondents were from both Australia (49, 76%) and New Zealand (16, 24%) who had been physiotherapists for an average of 18.8 ± 9.0 years and were primarily senior intensive care physiotherapists (44, 68%). Respondents had experience across level 3 (50, 77%), level 2 (18, 28%), and level 1 (5, 8%) adult intensive care units (ICUs), adult high-dependency units (27, 42%), and paediatric intensive care (6, 9%). A total of 42 statements were presented, with 37 reaching consensus after two rounds. After two rounds, consensus was achieved for a minimum staffing ratio in paediatric ICUs of one physiotherapist per six (1:6) beds. For adult ICUs, use of the median value of the participant's responses was supported to establish minimum staffing ratios of 1:8, 1:7, 1:6, and 1:8 for levels 1, 2, and 3 ICUs and high-dependency units, respectively. The requirement for an additional allocation for senior physiotherapist staffing for each ICU level was also established. Statements that also gained consensus included recommendations for access to on-call and weekend services for all ICU settings and the consideration of evening shifts specifically for level 3 and paediatric ICUs. ConclusionsRecommendations for minimum staffing for physiotherapy in intensive care settings were achieved and supported requirements for clinical service delivery, supervision, and training.