Patient-centered Care Research Articles

"It is not the fault of the health care team - it is the way the system works": a mixed-methods quality improvement study of patients with advanced cancer and family members reveals challenges navigating a fragmented healthcare system and the administrative and financial burdens of care.

Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study's goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients' mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient's death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, "It is not the fault of the health care team - it is the way the system works." Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, "It seems like everything is like an isolated incident… there's no overall, big picture viewpoint." (2) Administrative burdens, "In the end I gave up [scheduling care] because I was tired of calling." (3) Financial burdens, "This oncologist wanted to put him on a drug…but it was $4000 a month." Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

QOL-11. GBM PATIENTS CONTINUE TO FACE BARRIERS TO PERSONALIZED AND COMPREHENSIVE CARE THAT MAY IMPACT LONGEVITY AND QUALITY-OF-LIFE

Abstract We assessed the quality and accessibility of healthcare services provided to Glioblastoma (GBM) patients across the United States through an online survey distributed among the OurBrainBank community and partners and promoted on social media. A total of 297 patients or caregivers completed the survey (85% caregivers; 15% GBM patients). Median age at diagnosis was 57, lower than the national average of 64. 78% of our respondents described having some college education, and 69% had commercial insurance. Preliminary results revealed that 69% were informed about tumor testing. Among those informed, 64% did not have any molecular testing beyond initial diagnostic tests. For all respondents, 65% were not informed about storing tissue for future testing, and 79% reported not having their tissue stored for possible treatments or clinical trial qualification. Additionally, 52% reported no discussion of seeking a second opinion, and 64% reported not being offered enrollment in any clinical trial. Overall, people living with GBM face significant barriers to achieving comprehensive and personalized care. Lack of tumor testing and storage present missed opportunities for future access to emerging therapies that could improve individual outcomes. Over half of patients had no discussion about seeking a second opinion and were not offered enrollment in clinical trials, highlighting significant barriers to accessing life-extending or quality-of-life (QOL) improving treatments. Compared to the general population affected by GBM, survey respondents represented a disproportionately young and urban population, suggesting potential bias in who is able to respond to the survey. This may underestimate the challenges faced by patients with additional barriers. We are implementing strategies to reach a more geographically diverse participant group, particularly in rural areas. Ongoing targeted recruitment will further elucidate barriers to patient-centered care in GBM, with the potential for significant improvements in survival and QOL.

DISP-08. GBM PATIENTS FACE TTF ACCESS AND INFORMATION INEQUITY THAT MAY IMPACT PATIENT OUTCOMES AND QUALITY-OF-LIFE

Abstract We evaluated the quality and accessibility of healthcare for Glioblastoma (GBM) patients across the United States through an online survey distributed to the OurBrainBank community and partners and promoted on social media. A total of 297 patients or caregivers completed the survey (85% caregivers; 15% GBM patients). Median age at diagnosis was 57, lower than the national average. 78% described having some college education, and 69% reported commercial insurance coverage. Our preliminary findings highlight that 82% of respondents reported that their treating doctor recommended the standard-of-care for GBM consisting of tumor resection, 3-6 weeks of chemo/radiation, and 6 months of chemotherapy and sometimes Tumor-Treating-Fields (TTF), per the Comprehensive- Cancer-Network (2021) guidelines. 40% reported no discussion of TTF as an option. Of those offered TTF, nearly half (46%) received it as part of their initial treatment combined with standard chemotherapy and 36% received it as a subsequent option. For those attempting to access TTF, 29% encountered difficulties, often due to financial constraints linked to insurance denials. These findings illuminate significant concerns regarding dissemination of information on treatment options, as well as access to treatments. Access to these treatments can have a significant influence on survival and quality of life of GBM patients. The substantial number of patients not offered TTF, combined with challenges to accessing treatments due to insurance issues, highlight critical obstacles to engaging in informed and shared decision-making. Compared to the general GBM-affected population, our survey respondents tend to be younger and from urban areas, indicating a possible selection bias in survey participation. This skew could lead to an underrepresentation of the challenges encountered by patients facing additional barriers. We are adopting measures to engage a more diverse participant group, especially from rural communities Ongoing targeted recruitment will further elucidate barriers to patient-centered care in GBM, with the potential for significant improvements in survival and QOL.

Implementing a Digital Platform for Recurrent Urinary Tract Infections.

A patient-centered care model is needed for recurrent urinary tract infection (UTI) management. The aim of this study was to develop a conceptual model for a digital platform to implement evidence-based guidelines for recurrent UTI management. This was a qualitative, 3-stage mixed methods study that included (1) developing an evidence-based prototype texting platform; (2) qualitative feedback from recurrent UTI patients using the platform; and (3) quantitative data on acceptability (proportion of patients engaging with the platform), accuracy (proportion of patient messages interpreted accurately by the platform), and usability (score 0-100). Thirty-one women with recurrent UTI (median age, 71 years; range, 60-74 years) participated in testing over 4 months. The prototype platform was modified through iterative rounds of qualitative and quantitative analysis until engagement ≥85%, accuracy ≥90%, and usability score of ≥80 were achieved in 10 patients. Qualitative feedback indicated that patients valued rapid access to treatment through fewest possible health encounters during an acute episode, evidence-based education about prevention, and ability to participate in self-management with support from health care providers. Based on this feedback, a conceptual model consisting of 3 main components was developed: (1) an algorithm to triage acute symptoms, (2) educational videos emphasizing prevention strategies, and (3) supportive messages. Patient feedback identified 4 key implementation outcomes-usability, acceptability (engagement), fidelity (accuracy), and cost-and 3 clinical outcomes-self-efficacy, health care utilization, and rate of unnecessary antibiotics for testing the model. The proposed model can be used to implement and test a patient-centered evidence-based digital platform for the management of recurrent UTI.

Impact of Collaborative Nursing Care on Health Outcomes of Mental Health Day Hospital Users: A Mixed Methods Study.

Given that recovery-oriented care focuses on empowering individuals with mental health challenges, collaborative care can be an effective tool for nurses in mental health day hospitals. To deepen knowledge about the impact of collaborative nursing care for improving health outcomes of mental health day hospital users. A sequential and transformative mixed methods study was designed. In the first phase of this mixed methods study, quantitative data were collected from 144 users of mental health day hospitals. In phase two, a group of users underwent an intervention based on collaborative nursing care, through participatory action research, and qualitative data were collected. Finally, quantitative data were again collected from all users. The users who participated in the intervention group improved quantitatively in terms of the quality of the therapeutic relationship. They also improved at different stages of the recovery process, thus the qualitative results confirmed that collaborative nursing care was an essential component in their recovery process. The findings highlight the critical role of collaborative nursing care in health outcomes. The therapeutic relationship was identified as a key factor in facilitating patient empowerment. The study supports implementing collaborative nursing care models in mental health settings to enhance patient outcomes. ClinicalTrials.gov identifier: NCT04814576.

“Do You Yourself Have Any Idea What is Going On?”: Invitations for Lay Diagnosis in Dutch Primary Care Physiotherapy

ABSTRACT Lay perspectives are important in the recovery of patients with nonspecific pain as they influence levels of pain and patients’ pain experiences. Although previous interactional research has focused on patients’ unsolicited attempts to share their perspectives, health professions also employ specific techniques to solicit them. Physiotherapists are recommended to assess lay perspectives and include them in treatment. One way to do so is through invitations for lay diagnosis (this paper). However, little is known about how lay perspectives are constructed through these invitations and how physiotherapists follow up on them. In this study, physiotherapy intakes were analyzed using conversation analysis. We found that invitations for lay diagnosis are frequently embedded in previous health care visits or patients’ knowledge gathering activities. Patients often express low epistemic status when they construct their lay perspectives and engage in lay diagnostic activity in response to these invitations. Additionally, physiotherapists’ responses in the third position, such as follow-up questions, may influence the further development of patients’ lay perspectives. These invitations provide patients an opportunity to share their views on their health issues, but also create an interactional challenge due to the reversal of usual epistemic dynamics. The study highlights the complexity of doing lay diagnosis, which can include diagnoses or explanations of varying specificity. The specificity and elaboration of these perspectives are influenced by the physiotherapists’ subsequent responses. We provide recommendations for healthcare professionals to facilitate lay diagnosis, and our findings contribute to the discussion around patient empowerment, shared decision making, and patient centered care.

Development of a framework of interpersonal communication skills for MPharm students: a UK eDelphi study

Abstract Introduction The importance of communication skills for pharmacists in their daily activities, particularly in patient-centred care, is paramount. Effective healthcare, including complex tasks such as health promotion and medication reviews, heavily relies on quality communication. The GPhC emphasises the importance of graduates being able to employ communication skills in various settings1 although consensus on essential communication competencies in student pharmacist education is lacking. Aim To achieve consensus on a framework of interpersonal communication competencies for MPharm students. Method With approval from Keele University’s Research Ethics Committee, a draft interpersonal communication competency framework was developed after thorough literature review. Panellists with an interest in pharmacy education (including graduates, pharmacists and non-pharmacists) were invited to participate in an online three-round modified eDelphi study. Round 1 involved participants reviewing the draft framework, providing feedback on competency relevance/ wording and identifying missing competencies. Round 2 evaluated an updated framework for competency importance, with competencies needing 80% agreement to achieve consensus. Competencies without consensus underwent Round 3 review. Feedback was provided after each round. Results Panellists from across UK came from diverse pharmacy sectors like community, hospital, primary care, academia, industry, regulatory and education. In addition, there was as considerable participant experience, knowledge and expertise, which contributed distinct insights and viewpoints. The draft framework comprised 123 competencies across four Domains: Generic Communication (sub-divided into: organisation of an encounter, initiating and closing discussions, verbal and non-verbal communication, encouragement of person involvement, and adjusting communication based on contextual or cultural factors); Patient-Specific Communication (sub-divided into: gathering patient information and shared decision making); Peer Communication, and Other Communication (e.g., written). In total, 56, 49, and 47 participants completed each of the three consecutive rounds. In Round 1, over 500 comments prompted considerable amendments, including competency additions, removals, and mergers. This led to 126 competencies being rated for importance in Round 2 and 120 competencies (95%) were deemed important by at least 80% of eDelphi participants. Alongside competency ratings, an additional 130 comments were received, offering constructive insights. Six competencies that failed to achieve consensus in Round 2 underwent review again in Round 3. Subsequently, three more competencies failed to achieve consensus, resulting in a final agreed-upon framework of 123 competencies. Discussion This is the first competency framework developed for pharmacy student education. This study underscores the importance of interpersonal communication skills in pharmacy education and the experience of participants enriched the study, providing diverse and essential perspectives that were crucial in defining these competencies. The robustness of the iterative eDelphi process was instrumental in refining these competencies through multiple rounds. Although most competencies achieved consensus, a few contentious competencies underscored the challenges of aligning participant perspectives. The finalised framework, grounded in evidence-based development and stakeholder involvement, potentially serves as a flexible foundation for structuring pharmacy education curricula, but the scope of the study may face limitations, with the range of competencies either being too broad or too narrow, which could make implementation a challenge. Future research could focus on assessing these competencies across diverse healthcare settings. Reference 1. General Pharmaceutical Council, (2017). Standards for pharmacy professionals. Retrieved from https://www.pharmacyregulation.org/sites/default/files/standards_for_pharmacy_professionals_may_2017_0.pdf.

Teaching innovation: enhancing undergraduate student pharmacist consultation skills by introducing ‘Fishbowl’ prescribing workshops

Abstract Introduction The new ‘Standards for the initial education and training of pharmacists’1 outline the skills, knowledge, and attributes required to enable pharmacists to independently prescribe at the point of registration. Third-year MPharm students at the University of Nottingham have previously practised consultation skills in professional practice workshops, conducting shorter form, over the counter-type consultations. These lacked the depth required for pharmacy students to develop skills they will now need. Therefore, we identified a requirement for advanced consultation practice, including prescribing, alongside clinical history taking, to better prepare students to be prescribers. Creation of a new module occurred, ‘Pharmaceutical Care and Prescribing’, including ‘Fishbowl’ workshops. ‘Fishbowl’ is a small group teaching method where an individual student engages in a discussion, while observers form a circle around them2. Students were able to ‘tap out’ of consultations at any point, to discuss consultation direction with their peers. Five case studies were written to incorporate a variety of clinical conditions, patient demographics and clinical settings, with a key emphasis of holistic, patient-centred care. All third-year students were timetabled for five workshops, in groups of around 25. Facilitators regularly discussed consultation progress, outstanding care issues and gave feedback on areas done well or needing improvement. Aim Do students perceive ‘Fishbowl’ workshops to enhance their clinical history taking skills and prescribing knowledge? Methods Following the five workshops, all third-year students (n=256) were invited via email to complete a Microsoft Forms questionnaire, to evaluate the workshop aims . The questionnaire included ten 5-point Likert-scale questions and free-text answers. Primarily quantitative methods were used with free-text responses used to contextualise results. This study obtained ethical approval from the University of Nottingham, School of Pharmacy Postgraduate Research Projects Ethical Approval group. Results 82 students (32%) completed the questionnaire. 91% of students felt they helped practice taking a clinical history. 80% of students felt they better understood how to include share care decision making into their consultations. One student commented, they were ‘very thought-provoking sessions and easy to interact and learn from each other’. 67% said the sessions helped them to better understand the pharmacist’s role in prescribing. With regards to prescribing awareness, a student commented ‘It would have been nice to have scenarios where we prescribed a POM in the end for more of the sessions to help us get used to thinking like prescribers.’ 85% of students would recommend the teaching technique to other MPharm students, 76% felt these sessions should be introduced in earlier years of the MPharm course. A few students commented that the facilitation style varied considerably depending on academics involved. Discussion/Conclusion ‘Fishbowl’ method of teaching provides a suitable environment for practising clinical history taking and prescribing and were generally well received by students. Further work is needed to integrate this teaching technique earlier in the MPharm programme. Facilitator skills play a significant part in student engagement, we need to ensure there is appropriate staff training to run this session type. Limitations of the study include lack of comparison against other student teaching tools.

Understanding the Process of Acceptance Within the Nurse–Patient Therapeutic Relationship in Mental Health Care: A Grounded Theory

Background/Objective: Deepening knowledge about the meaning of acceptance in the context of the nurse–patient relationship will help us to understand the importance and value that people with mental health challenges attach to this attribute in the process of the therapeutic relationship. The objective of this study was to understand the process of acceptance as part of the therapeutic relationship between nurses and patients in the field of mental health. Methods: This study employed a qualitative research design using Strauss and Corbin’s grounded theory approach. Using theoretical sampling, data were collected through unstructured interviews with mental health nurses and with people with mental health challenges. Results: Acceptance is a complex and dynamic process that takes place when both patients and nurses feel and make the other feel like an individual human being. Acceptance is not an automatic process; rather, it requires awareness on behalf of both parties involved in the therapeutic relationship. The creation of a non-hierarchical caring environment is fundamental for fostering mutual acceptance and engagement in the therapeutic process. Conclusions: Nurses must develop self-awareness and reflect on their attitudes and biases to provide person-centered care. Nurse training and personal development are essential requirements for achieving an effective therapeutic relationship and empowering patients in their recovery process.

Lessons learned from the experiences of patients with long-term conditions: recommendations for enhancing the undergraduate medical curriculum

ABSTRACT The importance of involving patients in medical education is widely accepted, but their contribution to medical curriculum design is not well documented. Patients have the potential to bring a unique perspective and more refined experience to curriculum development. This applies particularly to those with long-term conditions (LTCs) who have multiple exposures to doctors throughout their healthcare journey. The aim of this study is to explore what views patients with LTCs have on the attributes medical students require to have, in order to provide them with high-quality care. Ten patients with LTCs, encompassing both primary and secondary care over a broad set of demographics, were interviewed by telephone using a semi-structured questionnaire. The interviews were recorded using a digital voice recorder and manually transcribed verbatim onto a Microsoft Word document for thematic analysis using NVIVO software and following Braun and Clarke’s six-phase framework. Five themes have emerged highlighting where the care of LTC patients could be improved: ‘advocacy’; ‘compassion’; ‘the desire to be acknowledged as an individual’”; acknowledgement of their expertise”; and ‘benefits of continuity of care’. The findings make a major contribution to undergraduate and postgraduate clinical training development. They reinforce themes in healthcare which need more emphasis in the medical curriculum, whilst simultaneously highlighting that even well-recognised concepts such as patient-centred holistic care, are not well implemented in the context of actual practice.

Nurses' Advocacy in Intensive Care: What Insights Can Nurses' Experiences During the Pandemic Reveal?

Patient advocacy must be understood as an ethical component of nursing practice that involves respecting and defending patients' rights and autonomy. During the COVID-19 pandemic, the vulnerability of patients in intensive care units (ICUs) increased requiring that nurses advocate for those patients more than ever in a context in which changes in daily nursing practices of care imposed by the pandemic deeply impacted nurses' advocacy. In this study, we examined ICU nurses' patient advocacy during the pandemic, using feminist ethics as a theoretical lens. Twenty-five ICU nurses from Brazil participated in individual interviews. Our findings reflect that advocacy is a moral component of nursing identity. This moral identity represents the identity of nurses as a profession as it represents their values and responsibilities which are social in nature. Although the pandemic challenged nurses' advocacy practices these professionals had an important role to give voice to patients and to preserve their autonomy and dignity, strengthening patient-centered care.

Evaluation of a trauma-informed care (TIC) training program across community health centers in Texas: a qualitative study

BackgroundIn April 2019, Texas Association of Community Health Centers launched the Trauma-Informed Care (TIC) program in community health centers across Texas. This initiative aimed to transform organizational culture for consistent delivery of TIC by providing training and coaching opportunities for Trainers and Champions in each health center. This study is an interim qualitative evaluation to gain participants’ insights into their experiences of and perceptions about TIC training as part of the TIC initiative.MethodsWe conducted semi-structured key informant interviews via Zoom with Trainers across four cohorts of participating health centers between February 2020 and April 2023. We used rapid assessment procedures to conduct analysis in tandem with data collection given the ongoing TIC training. We present salient quotes to illustrate the emergent themes.ResultsWe interviewed a total of 36 Trainers and identified the following emergent themes from the interviews: (1) Perceived need for the TIC training, (2) Perspective shift in patient care, (3) Increased support for staff wellness, (4) Importance of equal involvement of staff at all levels, (5) Need for leadership buy-in, and (6) Lack of self-efficacy and empowerment to train others.ConclusionsA trauma-informed environment in a healthcare setting can bolster patient-centered care as well as a culture of staff wellness. This qualitative evaluation revealed that after TIC training, Trainers had improved attitudes and behaviors to commit to organizational TIC transformation to prevent unintended consequences of trauma for both patients and staff. Trainers’ experiences with and suggestions for enhancing the TIC training should be considered for training future cohorts as they continue to strive for TIC transformation in their health centers.

Exploring Spiritual Care Competency in Palliative Medicine: A Narrative Inquiry of Physician Care Notes on Spiritual Distress.

Background: Spiritual care is a critical component of hospice and palliative medicine; however, physicians frequently lack the necessary competencies to adequately address patients' spiritual needs. This study aims to examine the spiritual care competencies of physicians as reflected in their care notes, thereby providing insights into their approaches for managing spiritual distress. Methods: A narrative inquiry approach was employed to qualitatively analyze interaction notes from 30 palliative care patients experiencing spiritual distress. Data were collected from a medical university professor's care notes between April 2019 and February 2024. Results: The most common form of spiritual distress observed was reluctance to leave life, followed by loss of dignity. Physicians demonstrated expertise in holistic care, addressing physical, psychological, and spiritual needs with a comprehensive approach. Their demeanor reflects acceptance of mortality and acknowledgment of the limitations of medical care, helping foster gratitude and contentment in patients. Effective communication was pivotal, involving the conveyance of information, empathetic engagement, and active listening. Compassionate interactions emphasized the importance of spiritual care in patient-centered care delivery. Conclusions: Spiritual care competencies are essential for improving patient outcomes and advancing comprehensive palliative care. Future efforts should integrate these competencies into communication training within medical education to more effectively enhance health care providers' competencies.

Potential Role of Soundscape and Music Interventions in post-Intensive Care Rehabilitation

Background Post Intensive Care Unit (ICU) survivors face physical, psychological, and cognitive impairments during their recovery phase, adversely affecting their quality of life. Given the scarcity and barriers to access to post-ICU care worldwide, patient-centered adjuncts are worth exploring. Although music interventions have gained recognition as non-pharmacological approaches in the acute phase of critical illness; exploration of their potential benefits in the post-ICU is scarce. Objective This paper examines the potential of sound and music interventions as an adjunct therapeutic modality to improve the well-being of adults post-ICU patients, through a narrative overview of published research evidence regarding post-ICU recovery and other relevant post-acute conditions, such as post-traumatic disorder and anxiety. Results The effectiveness of sound/ music interventions on several key outcomes including reduced anxiety, stress, pain, and PTSD, improved sleep, and enhanced mood and emotional well-being have been studied. Research indicates that music-based approaches to physical and psychological well-being reduce emotional distress, foster connectedness, and improve overall well-being. The importance of tailoring sound and music interventions to the individual needs and preferences of post-ICU patients is emphasized. Conclusion The potential benefits of sound and music interventions, both in terms of physiological and psychological well-being, encourage further investigation into their potential application and implementation into post-ICU care and rehabilitation. Ultimately, this therapeutic approach could contribute to enhancing the overall quality of life and empowerment of post-ICU patients on their path to recovery.

Listening "At the Bedside": Podcasts as an Emerging Tool for Medical Ethics Education.

Medical ethics education is crucial for medical students and trainees, helping to shape attitudes, beliefs, values, and professional identities. Exploration of ethical dilemmas and approaches to resolving them provides a broader understanding of the social and cultural contexts in which medicine is practiced, as well as the ethical implications of medical decisions, fostering critical thinking and self-reflection skills imperative to providing patient-centered care. However, exposure to medical ethics topics and their clinical applications can be limited by curricular constraints and the availability of institutional resources and expertise. Podcasts, among other Free Open Access Medical Education (FOAMed) resources, are a novel educational tool that offers particular advantages for self-directed learning, a process by which learners engage in asynchronous educational opportunities outside of traditional academic or clinical settings. Podcasts can be readily distributed to wide audiences and played at any time, reducing barriers to access and offering a level of flexibility that is not possible with traditional forms of education and is well-suited to busy schedules. Podcasts can also use real voices and storytelling to make the content memorable and eminently human. This paper describes the development, production process, and impact of Core IM's "At the Bedside," a podcast focusing on issues in medical ethics and the medical humanities, intending to supplement standard bioethics curricula in an accessible, relevant, and engaging way. The authors advocate for broad incorporation of podcasts into medical ethics education.

Study protocol for a multicenter randomized controlled trial on simulation-based communication training for pediatric cardiology trainees (SIMUL-CHD)

BackgroundEffective physician-patient communication is crucial to compassionate healthcare, particularly when conveying life-altering diagnoses such as those associated with congenital heart diseases. Despite its importance, medical practitioners often face challenges in communicating effectively. Because of these gaps, we aim to introduce a simulation-based training protocol to improve pediatric cardiology trainee’s communication skills. This study will be conducted in collaboration with associations supporting caregivers of children with congenital heart disease. It strives to demonstrate how specific training programs can efficiently foster humanistic, patient-centered care in standard medical practice.MethodsThis multicenter, open-label randomized controlled trial will be conducted in pediatric cardiac units and simulation centers of across 10 universities in France. The study population comprises pediatric cardiologists in training (including pediatric cardiac fellows or specialist assistants). The SIMUL-CHD intervention will consist of simulation-based training with standardized patients, focusing on improving communication skills for pediatric cardiology trainees during diagnostic counselling. Patients and caregivers have been recruited from a National Patient Association named “Petit Cœur de Beurre”. The primary outcome is the quality of physicians’ communication skills. The evaluation committee, which will review video recordings of the sessions, will be blinded to which participants received simulation-based training (group of interest) and which received theory-based training (control group). Secondary outcomes are the effect of SIMUL-CHD on empathy and anxiety levels in young pediatric cardiologists. Baseline scores pre and post-intervention will be compared, and skill improvement resulting from the intervention measured.DiscussionSimulation-based training has proven efficacy in teaching technical skills in various scenarios however its application to communication skills in pediatric cardiology remains unexplored. The involvement of experienced parents provides a unique perspective, incorporating their profound understanding of the emotional challenges and specific hurdles faced by families dealing with congenital heart disease.Trial registrationThis trial is registered with the OSF registry (registered https://osf.io/ed78q).

Higher and Middle Management Perspectives on Patient-Centered Care in an Oncology Setting: A Qualitative Study

Background: Patient center care (PCC) plays a crucial role in achieving the organizational and patient outcomes. Literature suggests that PCC enhance patient’s adherence to treatment, lower the cost of health care organization. This study aimed explore the higher and middle managers’ perceptions of patient-centered care (PCC) in an oncology setting, identify the PCC implementation challenges in the oncology setting, and understand the role of managers in facilitating PCC within the oncology context. Methods: Sampling involved the use of the purposive sampling technique on 17 middle managers and 6 upper managers who had been working in an oncology setting. The six-step thematic analysis method was used for data analysis. Results: The interviews identified six main themes and seventeen subthemes: “comprehensive care, partnership, and informed decision-making”, “infrastructure and support systems”, “leadership influence on patient-centered care”, “cultural and operational barriers”, “perceived outcomes”, and “strategies to enhance PCC in oncology”. The subthemes of comprehensive care included fostering partnerships and enabling informed decisions. The infrastructure and support systems encompassed educational empowerment and service integration. Leadership influence highlighted the role of elevating awareness, providing organizational support, and promoting comprehensive care. The cultural and operational barriers addressed the challenges faced in implementation. The perceived outcomes focused on the results of patient-centered care, while strategies to enhance PCC in oncology provided actionable insights for improvement. This provides a comprehensive understanding of the perceptions of middle and higher managers on patient-centered care (PCC) in oncology settings. It identifies key challenges in PCC implementation, highlights the critical role of managers in facilitating PCC, and offers actionable strategies for enhancing PCC.

Patient-Centered Care and Process Improvement: A Systematic Review of Impacts on Satisfaction Outcomes

Patient-centered care (PCC) has emerged as a crucial approach in enhancing healthcare delivery, focusing on the needs and preferences of patients. This systematic review explores the impact of process improvement strategies on patient satisfaction outcomes within PCC frameworks. Databases including PubMed, Scopus, and Web of Science were searched for relevant studies published between 2016 and 2024, analyzing the effectiveness of process improvement interventions such as Lean, Six Sigma, and workflow optimization in various healthcare settings. Inclusion criteria focused on studies that specifically measured patient satisfaction as an outcome. The review found that process improvement initiatives positively influence patient satisfaction by streamlining care delivery, reducing wait times, and improving communication between healthcare providers and patients. However, variations in intervention types and healthcare settings highlight the need for context-specific applications. This review underscores the importance of integrating process improvement tools into PCC practices to achieve better satisfaction outcomes and improve overall care quality. Future research should focus on long-term effects and broader applications of these interventions in diverse healthcare environments.

Harnessing Wearables and Digital Technologies to Decode the Cardiovascular Exposome.

The cardiovascular exposome encompasses the array of external and internal factors affecting cardiovascular health throughout life, inviting comprehensive monitoring and analysis to enhance prevention, diagnosis, and treatment strategies. Wearable and digital technologies have emerged as promising tools in this domain, offering longitudinal, real-time data on physiological parameters such as heart rate, heart rhythm, physical activity, and sleep patterns. This review explores the advancements in wearable sensor technology, the methodologies for data collection and analysis, and the integration of these technologies into clinical practice and research. Primary findings indicate significant improvements in device accuracy and functionality, facilitated by enhanced sensor technology, artificial intelligence, and data connectivity. These advancements enable precise monitoring, early detection of cardiovascular anomalies, and personalized healthcare interventions. Ultimately, wearables and digital health technologies have the potential to facilitate a deeper understanding of cardiovascular disease and behavior and bridge gaps in traditional healthcare models to help usher in more efficient, personalized, patient-centered care.

Spirituality in Professional Patient-Centered Care for Adults with Primary Brain Tumors: An Exploratory Scoping Review.

People with primary brain tumors face spiritual challenges due to neuro-cognitive disturbances such as aphasia and rapid neurological deterioration. This scoping review aimed to map the evidence regarding professional spiritual care in this neuro-oncological population. The literature search was conducted utilizing two databases (PubMed, CINAHL) and two peer-reviewed journals ('Spiritual Care', 'Journal of Religion and Health'). In total, 27 studies were analyzed, and five thematic categories were identified: (1) spiritual needs, (2) integrating the spiritual dimension in care, (3) spiritual care generalist interventions, (4) spiritual care specialist interventions, (5) assessments. Early integration of spiritual care and specific training are important.