Participation Of Healthcare Professionals Research Articles

Healthcare professionals and students’ knowledge on termination of pregnancy: A systematic review

Abstract Background Providing safe termination of pregnancy (TOP) according to each country’s legalisation is an important public health matter internationally. Healthcare professionals (HCPs) and healthcare students have key roles and need to be aware of legislation and clinical practice guidelines on TOP in their country to facilitate safe and effective care. The main aim of this systematic review was to investigate the level of knowledge on TOP legislation among HCPs and healthcare students. The second objective was to assess the knowledge of TOP methods, procedures and/or potential associated complications. Methods This is a systematic review of qualitative and quantitative peer-reviewed studies published in English or Portuguese until July 2020. Databases included in the search were EBSCO, PubMed, Embase and Scopus. The quality appraisal was done using the CASP Critical Appraisal tools. Results A total of 31 studies were included, published between 2002 and 2020 and from several regions around the globe. No studies were carried out in Europe or the United Kingdom. A total of 22 studies included healthcare professionals and nine studies included students. Overall, all the studies showed poor knowledge of TOP legislation and TOP methods, procedures and complications. Knowledge of special circumstances established in the law where TOP might be legal was also very limited. In studies focussing on medical (MA) and surgical (SA) TOP, knowledge of MA was lower than of SA. Studies reported that practitioners and students have limited training in TOP. Overall, education/training and experience with TOP seem to be the main factors associated with increased levels of knowledge. Similar results were found for student’s knowledge. Conclusions This study highlighted the importance of involving and promoting the participation of HCPs and students in the provision of TOP services. A clear need and desire for staff education and training on TOP was shown. Key messages • TOP training is limited and broadly excluded from medical and healthcare education globally. Students and staff have recognised this issue and the critical impact it has on TOP care provided. • Adequate knowledge and training in TOP ensures service sustainability and preparation of current and future healthcare practitioners to provide high-quality, respectful and compassionate care.

Perioperative medication therapy for Muslim patients in Germany undergoing oncological surgery: a retrospective study

PurposeEngagement of healthcare professionals with patients from diverse cultural and religious backgrounds is crucial in our multicultural society, where miscommunication and errors in medical history taking can lead to incorrect treatment. In particular, Muslim patients may present unique considerations due to their specific cultural and religious beliefs, which can significantly impact treatment outcomes. This study focuses on perioperative medication therapy for patients undergoing upper and lower gastrointestinal tract and pancreatic tumor surgery, specifically examining whether Islamic beliefs were duly considered in medication selection compared to a matching patient cohort.Materials and methodsData from January 2004 to July 2023 were analyzed. Muslim patients were identified using the onomastic method and matched with non-Muslim patients at a 1:3 ratio based on age, gender, and procedure. Analysis included examination of subcutaneous, oral, and intravenous medications, with attention to ingredients and compatibility with Islamic principles.ResultsAmong 5272 patients, only 5 met the study’s inclusion criteria as Muslim patients, undergoing procedures such as anterior rectum resection, gastrectomy, and pancreatic head resection. Their religious affiliations were not documented in the admission records. According to the matched-pair analysis, consistent treatment was performed regardless of religious beliefs. All patients received subcutaneous medication, primarily enoxaparin, instead of fondaparinux, an Islam-compliant alternative. Intravenous heparin was used once for short period. Contrary to Islamic dietary restrictions and the availability of alternatives, capsules containing animal-derived gelatin and other non-compliant medications were administered orally.ConclusionThis study underscores the importance of acknowledging Muslim patients’ cultural and religious backgrounds in the perioperative setting, as failure to do so may lead healthcare professionals to overlook their potential alternative medication needs, which are essential for providing tailored medical care in modern societies. Integration of diversity-related topics into medical curricula is essential for better preparing physicians for clinical practice and ensuring patient-centered care.

Engaging Healthcare Professionals in CKD Awareness: Insights from Hidoc Dr.'s Video Marketing Initiative

This case study details the execution and outcomes of a comprehensive video marketing campaign conducted by Hidoc Dr. aimed at raising awareness and educating healthcare professionals (HCPs) about Chronic Kidney Disease (CKD). Over the course of one year, 200 educational videos were produced and marketed, reaching an average of 500 unique HCPs per video. The campaign achieved notable engagement metrics, including a 16% engagement rate and a 6% click-through rate (CTR). The strategic approach and diligent execution resulted in significant visibility and interaction within the healthcare community. Keywords: Chronic Kidney Disease (CKD), healthcare professionals, video marketing, engagement, click-through rate, Hidoc Dr.

Involving patients and families in prioritising research in cardiomyopathies

Abstract Background/Introduction Cardiomyopathy affects 1 in 300 of the population and can have profound physical and psychological impacts on patients and families. There remains uncertainty around many aspects of disease management and patient needs. Research can address these uncertainties by identifying definitive treatments, optimal management strategies, and holistic support requirements. To ensure that cardiomyopathy research reflects the shared interests of patients, carers and clinicians, a leading cardiomyopathy patient charity sponsored a Research Priority Setting Partnership (PSP). Methods The Cardiomyopathy PSP was run according to the James Lind Alliance (JLA) method(1, Figure 1). Results A steering group (SG) comprised eight people with lived experience of cardiomyopathies and nine healthcare professionals (HCPs), representing the multidisciplinary team, decided on the scope and breadth of the PSP to cover cardiomyopathies and for a United Kingdom-wide survey. The initial survey was open to the cardiomyopathy community from June-August 2023 (six weeks). They were invited to submit questions that they would like answered by research. The survey was online and hard copies were also sent to peer support groups where group leaders encouraged members to complete the form during their in-person meeting. There were 1020 respondents generating just over 2000 questions. The majority of respondents (78%) were people with lived experience. The SG and an information specialist grouped submitted questions into topic headings, consolidated similar questions, removed those that were out of scope and agreed on the final list of 60 questions for the shortlisting survey. This second survey consisted of 2 steps: 1. Respondents selected from the full list of questions identified by the first survey and 2.They were then asked to choose 10 questions from their selection which were most important to them. A total of 660 responses were collected and selected questions were organised into 2 groups according to the type of respondent (those with lived experience or HCPs). Questions were weighted according to the number of times they were selected within each group and then merged into a single shortlist of 26. The final workshop was conducted on February 2, 2024 where the Top 10 Research Questions from the shortlist were agreed by a mixed group of lived experience and HCP participants (Figure 2). Conclusion A Research PSP using the JLA method facilitates the generation and prioritisation of research questions/uncertainties that address the mismatch between what researchers want to research and the practical solutions/information needed day-to-day by HCPs to give holistic care that is relevant to patients, families and carers.Fig 1James Lind Alliance MethodFig 2Top Ten Research Questions

Patient safety culture and medication safety in European intensive care units: a focus group study

BackgroundPatients in intensive care units (ICUs) are susceptible to medication errors (MEs) for many reasons, including the complexity and intensity of care. Little is known about patient safety culture, its...

User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study.

People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.

Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis.

Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.

Knowledge about Breast Cancer and Barriers to Screening among Saudi Women in Al-Baha Region.

The aim of this study was to measure the knowledge about breast cancer and to identify the barriers in screening among Saudi women in the Al-Baha region. To achieve this, a cross-sectional study was conducted, involving 468 women, to assess their understanding of breast cancer and to explore the obstacles they face in accessing breast cancer screening services. The cross-sectional study included 468 women from Al Baha, Saudi Arabia, starting from May 17, 2022, to May 17, 2023. Participants were interviewed by well-trained team members of the research, and their responses were subsequently entered into a Google Form. This process aimed to evaluate their awareness, knowledge, and barriers to breast cancer screening. The majority of participants (48.9%) were in the 18-28 age group. The findings reveal a high level of awareness (96.4%) among participants regarding the significance of early breast cancer detection. For the effectiveness of breast cancer treatment, 59% believed there is an effective treatment, while 32.9% were uncertain or did not know. Knowledge about various risk factors for breast cancer varied. Smoking (73.5%), genetic factors (65.6%), and a family history of breast cancer (70.7%) were well-recognized as risk factors. Education and occupation significantly influenced knowledge about breast cancer (p-value of 0.000, and 0.035 respectively). this research highlights strong awareness of breast cancer's importance but gaps in knowledge regarding lesser-known factors. Education is crucial, requiring tailored campaigns and healthcare professional engagement.

Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark.

To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs. This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions. Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care. Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.

Maximizing Professional-Led Sexual Well-being Support in Cancer Care: Findings From a Qualitative Process Evaluation Following Healthcare Professionals' Engagement With an eLearning Resource.

Provision of healthcare professional (HP)-led sexual support in cancer care is lacking, perpetuated by barriers including a lack of HP awareness of sexual concerns and strategies to help patients and partners cope. In response, the Maximizing Sexual Wellbeing|Cancer Care eLearning resource (MSW|CC) was developed and demonstrated efficacy in reducing HPs' attitudinal barriers to the provision of sexual support. However, the mechanisms for such change are not yet known. A qualitative process evaluation was used to explore mechanisms that influence HP engagement with MSW|CC and its adoption into practice. Semistructured interviews were conducted with HPs providing cancer care in Northern Ireland upon MSW|CC completion. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed. Seventeen participants were interviewed, and 4 key themes were identified: (1) MSW|CC raises HPs' awareness of the need for holistic sexual support as part of routine clinical care; (2) MSW|CC prepares and equips HPs to provide sexual support in cancer care; (3) MSW|CC is coherent, engaging, and acceptable; and (4) MSW|CC: moving forward. Participants derived benefits from MSW|CC, deeming it an acceptable resource. Insights into MSW|CC mechanisms of success were identified, including language to address sexual concerns, alongside patient referral resources. Perceived MSW|CC shortcomings from an earlier study were confirmed as a software issue.Implications for Practice:Healthcare professionals require training and resources to enhance sexual support provision in cancer care. Proactive implementation strategies used to maximize HP engagement with MSW|CC could equip HPs with tools to improve patient sexual outcomes after cancer.

A 50-Year Review of Congressional Membership by Health Care Professionals: Is Surgical Representation Adequate?

Although 100% of congressional legislators vote on health care policy, only a minority have a background in health care. A review of the participation of health care professionals (HCPs) in Congress, highlighting participation by surgeons, is critical to the future policy-making endeavors in health care. This article seeks to better understand the characteristics of HCPs who engage in advocacy and describe the trends in their representation in Congress, with commentary on participation by surgeons and its impact on current health advocacy efforts.A search of Congress.gov and the Biographical Directory of the United States Congress was performed to identify professional health care history for each congressperson, followed by review of official campaign websites for health advocacy work. Statistical analysis was performed using IBM SPSS Statistics Software for changes in representation of HCPs, physicians, and surgeons in Congress over time. Although there has been increasing representation of HCPs in Congress in the past 25 years, surgeons have the lowest increase in congressional membership. For health care reform to optimally address high costs, variable insurance coverage and reimbursement rates, and equal access to care, more physicians must make health care advocacy efforts an integral part of their careers. Incorporation of education in areas of health care advocacy and/or reform into undergraduate and graduate medical education curricula may help address deficiencies in knowledge of current health care-related events to further encourage involvement in health care legislation.

Factors related to advance directives completion among cancer patients: a systematic review

IntroductionAdvance directives (ADs) has recently been considered as an important component of palliative care for patients with advanced cancer and is a legally binding directive regarding a person’s future medical care. It is used when a person is unable to participate in the decision-making process about their own care. Therefore, the present systematic review investigated the factors related to ADs from the perspective of cancer patients.MethodsA systematic review study was searched in four scientific databases: PubMed, Medline, Scopus, Web of Science, and ProQuest using with related keywords and without date restrictions. The quality of the studies was assessed using the Hawker criterion. The research papers were analyzed as directed content analysis based on the theory of planned behavior.ResultsOut of 5900 research papers found, 22 were included in the study. The perspectives of 9061 cancer patients were investigated, of whom 4347 were men and 4714 were women. The mean ± SD of the patients’ age was 62.04 ± 6.44. According to TPB, factors affecting ADs were categorized into four categories, including attitude, subjective norm, perceived behavioral control, and external factors affecting the model. The attitude category includes two subcategories: “Lack of knowledge of the ADs concept” and “Previous experience of the disease”, the subjective norm category includes three subcategories: “Social support and interaction with family”, “Respecting the patient’s wishes” and “EOL care choices”. Also, the category of perceived control behavior was categorized into two sub-categories: “Decision-making” and “Access to the healthcare system”, as well as external factors affecting the model, including “socio-demographic characteristics”.ConclusionThe studies indicate that attention to EOL care and the wishes of patients regarding receiving medical care and preservation of human dignity, the importance of facilitating open communication between patients and their families, and different perspectives on providing information, communicating bad news and making decisions require culturally sensitive approaches. Finally, the training of cancer care professionals in the palliative care practice, promoting the participation of health care professionals in ADs activities and creating an AD-positive attitude should be strongly encouraged.

Challenges and strategies for conducting research in primary health care practice: an integrative review

BackgroundProviding accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.ObjectiveTo identify challenges and strategies for conducting practice-based research in primary health care services.MethodAn integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.ResultsOut of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.ConclusionThe challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

The Development of a Communication Tool to Aid Parent-Centered Communication between Parents and Healthcare Professionals: A Quality Improvement Project.

Good communication is central to good healthcare. As a result of poor communication between parents and healthcare professionals (HCPs) in clinical settings, this study aimed to address this problem by developing a communication tool to empower parents and act as a prompt for HCPs to talk about the child's care and gather information at the point of admission to hospital about what is important to families, therefore supporting patient-centered communication. A design thinking process was used to develop a physical copy of Chloe's card and evaluate its use. Design thinking is a problem-solving approach, which uses an empathetic lens to integrate viewpoints of different stakeholders throughout the process of creating solutions. Design thinking involves five processes: (1) empathise-including a literature review and data synthesis, (2) define-by completing semi-structured interviews with parents about their experience of communication and HCPs perceptions of parent's experience of communication, (3) ideate-iterate the design of Chloe's card with parents and HCPs, (4) prototype-develop the design of Chloe's card, and (5) test-pilot test in clinical practice. Results from this initial study suggest that a small hand-held card, with emoticons and a place to write concerns, was acceptable to parents and feasible to use in clinical practice. Parents do not always feel heard by HCPs and a tool such as Chloe's card may help facilitate sharing of information about matters important to them and their child. However, some HCPs felt the need for a communication tool undermined their clinical skills. Feedback from HCP participants suggests that the idea of Chloe's card was acceptable and perceived as potentially being useful in clinical practice. Further work is required, as part of a larger study, to further refine this communication tool, identify those parents who would benefit most from Chloe's card, as well as to further refine the HCP process prior to implementing it into clinical settings. It was noted future iterations would benefit from a digital version linked with a child's electronic record, as well as multi-language versions and information for parents.

Weight Management for Children With Disabilities: Exploring the Perspectives of Health Care Professionals Working in Pediatric Weight Management Clinics in Canada.

Background: Children with disabilities are twice as likely to have overweight/obesity than their typically developing peers. Higher weights in these individuals may compound challenges already experienced with their disability, including mobility and activities of daily living. However, children with disabilities often find it challenging accessing weight management care. It is therefore important to understand the experiences and needs of the health care professionals (HCPs) who work in specialized pediatric weight management clinics about providing weight-related care to children with disabilities. Methods: Employing an interpretive description approach, purposeful sampling was used to recruit 17 HCP participants working in pediatric weight management settings in Canada. Qualitative semistructured interviews were conducted online or via telephone. All interview recordings were transcribed and a reflexive thematic analysis approach was used to develop themes from the data. Results: Four themes were developed: (1) infrequent referrals leads to a lack of experience with children with disabilities; (2) adapting group-based clinics can be challenging; (3) perceived lack of disability-specific knowledge causes moral distress; and (4) disability-specific training and greater interdisciplinary collaboration are desired. Conclusions: This work identifies the urgent need for more evidence-based, specialized, weight-related treatment options for children with disabilities, as well as more support for HCPs working in existing programs.

#3226 DEVELOPMENT AND USABILITY ASSESSMENT OF AN AI-ENHANCED DASHBOARD SUPPORTING AVF MANAGEMENT IN CLINICAL PRACTICE

Abstract Background and Aims Despite the rise in publications reporting Artificial Intelligence (AI) solutions in healthcare, their usage in clinical practice remains limited. Prominent barriers for their implementation in clinical practice are the lack of integration of AI-based tools in the hospital health information system and clinical workflows. We previously developed an AVF Failure risk score to assess the expected incidence of AVF failures within 3 months based on routinely collected dialysis data. The risk score showed high accuracy (AUC = 0.81) and calibration. Based on this risk score, we developed an AI-enhanced dashboard supporting the management of AVF in hemodialysis patients. The usability and usefulness of the AI-enhanced AVF management dashboard was evaluated in a pilot quality improvement program. Method A quality improvement framework was used to evaluate the usability of an AI-enhanced dashboard for AVF management (Fig. 1A). First, healthcare professionals (HCP) were involved to provide inputs for model design, endpoint definition, and potential predictors through various qualitative interview techniques such as brainstorming sessions and focus groups (Phase I). A machine learning model was then developed to assess the expected incidence of AVF failure within 3 months. The model used routinely collected clinical data to minimize additional burden on clinical workflow. (Phase II). After developing and validating the model, a model error analysis was conducted using case studies methodology to improve model performance (Phase III). Once the model reached a good accuracy, think-aloud interview was used to abstract HCP needs and to design a user interface for model output. A user-friendly dashboard was developed to display the risk of AVF failure within 3-months and patient's vascular access history (Phase IV). This solution was integrated in the health record system and updated monthly with the latest risk score and medical information. A pilot quality improvement program was conducted in 15 clinics across 4 countries (IT, CZ, SK, SG) from May to December 2022. HCP were asked to evaluate their agreement with the risk score using a 5-point Likert scale (completely disagree to agree) and assess the usefulness of the dashboard in clinical decision making. At this stage the dashboard is not used for medical decision making (Phase V). The evaluation results were compiled into a monthly report and shared with all the HCP involved in the project to promote awareness and engagement. After 3 months of usage, a round-table discussion was held with all participants to gather their feedback and discuss clinical cases (Phase VI). Results Access to the AI-enhanced dashboard increased during the evaluation period. In the first two months of the pilot quality improvement program, the AI-enhanced dashboard was evaluated for 20% patients with an AVF, a proportion that doubled by the end of the program (Fig. 1B). HCP reported 90% agreement with risk model rating (Fig. 1C), suggesting that the model capture relevant physiological status of the patient and its output is understandable by the healthcare staff. Qualitative analysis of round-table discussions showed that the dashboard is perceived as useful and clear. HCP suggested few changes in the user interface to enhance actionability and improve clinical workflow integration. Conclusion Our results support the usefulness and intelligibility of the AI-enhanced AVF management dashboard. The advance of AI-models highlighted the importance to develop new strategies for their integration and evaluation in clinical practice. The engagement of HCP in the early phases of AI-model design and development grants a continuous feedback loop bringing clinical and AI world together. A clinical perspective in dashboard design reflects the needs of healthcare professionals and enhance consideration of patient medical needs. The synergy between theoretical and clinical perspective is crucial to improve model performance, usability, and implementation in clinical practice.

#3956 PRIORITY OUTCOMES FOR EDUCATION AND SELF-MANAGEMENT IN NON-DIALYSIS CHRONIC KIDNEY DISEASE: A PATIENT AND PROFESSIONAL DELPHI SURVEY

Abstract Background and Aims It is important for people living with Chronic Kidney Disease (CKD) to develop the knowledge, skills, and confidence (patient activation) to effectively self-manage their health in partnership with their healthcare team. Resources intended to educate and support self-management should be subject to robust evaluation to provide the evidence base for clinical implementation. Trials in both research and clinical practice settings should include outcomes which are meaningful and valued by all users, but these are not known for CKD education and self-management interventions. We carried out a Delphi survey to identify the priorities valued by both CKD patients and healthcare professionals (HCPs) in the UK. Method Kidney patients and multidisciplinary kidney HCPs based in the UK were invited to complete two sequential rounds of an online Delphi survey. People with CKD and their significant others (SOs) were invited via social media, and HCPs via direct email. For Round One, participants were asked to identify in their own words the 3 potential benefits (outcomes) for CKD self-management that they personally considered to be most important. These free-text responses were collated and analysed inductively using conventional content analysis to identify dominant themes and constituent items. In Round Two, participants were asked to rate each of these items on a 9-point Likert scale from 1 (least important) to 9 (most important), and overall median ratings were calculated for each theme. Results 135 participants contributed to Round One: 47% (64) CKD patients/SOs; 51% (69) kidney HCPs; 2 individuals identified in both groups. 58% of HCPs who were invited by email agreed to take part. Round One analysis identified 28 outcome items which fell into 5 main themes: clinical; knowledge, skills, and confidence to manage own health; behaviour and self-care; psychological and social factors; healthcare usage. 69% (44) of invited CKD patients/SOs and 77% (53) HCPs took part in Round Two. Table 1 shows the median ratings for each theme. The highest-ranked overall and for both groups was “clinical”, while “healthcare usage” was ranked the lowest. Conclusion Our UK Delphi survey has identified a range of potential benefits for successful self-management in non-dialysis CKD, which were categorised into 5 main themes. Clinical outcomes such as improving blood pressure management or avoiding progression to end stage kidney disease were the top priority for both CKD patient/SO and HCP participants. Aspects of patient activation (knowledge, skills, and confidence to manage health) were also rated as important by both groups. This Delphi survey identified which benefits kidney patients and HCPs value most from effective CKD education and self-management. It is important that the views of intended users of new interventions are consulted throughout the development process to ensure that the product meets their needs and expectations. The information we present here is vital for the successful design, evaluation and implementation of interventions and support tools to educate people with CKD and enable them to improve self-management behaviours.

Addressing Racial Disparities in Maternal and Infant Health Outcomes Through an Anti-Racism Curriculum.

The purpose of this project was for current and future health care professionals to acknowledge and address implicit biases through education and engagement in workshops surrounding the topic of racism in medicine. Current anti-racism curricula exist in various spaces, including schools, businesses, and health care. However, these curricula often target different audiences, lack interactive components, and do not always incorporate community voices into the work. Therefore, a series of novel workshops was created for students, residents, and faculty to address biases and policies that perpetuate inequity. Over the course of the 2021-2022 academic year, 74 participants engaged in three workshops addressing racial disparities in maternal and child health. The first workshop focused on allowing participants to develop a common language about race and racism, provided background and historical context, and started to encourage awareness and acceptance of responsibility for engaging in anti-racist behavior. The second workshop incorporated voices from the community to understand how those affected by the disparity feel that it can best be addressed and to explore what effective allyship means. The third workshop explored the effect of microaggressions and allowed participants to review common problematic responses to being made aware of our own biases as well as to practice responding authentically and openly. This workshop series has been expanded into a second year, with new topics based on participant feedback. Although many participants had previously engaged in anti-racism training, there was still a lack of knowledge regarding both historical context and current factors contributing to disparities. The goal of this workshop series was to provide a forum for participants who may not otherwise have an accessible opportunity for engagement to better understand the relevance of current disparities to their practice. Through this curriculum, participants accomplished several goals, including: 1) increasing awareness about the prevalence of racial and ethnic disparities and the effect of these on health outcomes; 2) exploring implicit biases, the culture of medicine, and the difference between intention and effect; 3) understanding the role that practitioner bias plays in health outcomes; and 4) understanding culturally derived mistrust of the health care system. As health care professionals, we need to address our own implicit biases and acknowledge the collective failures as a health care system before we can build an equitable health care space. Anti-racism workshops can contribute to the elimination of systemic racism and health disparities by engaging health care professionals at various points in their personal journeys toward becoming anti-racist. This allows individuals and institutions to begin the conversations needed to address system-level policies and practices that perpetuate inequity.

461 Developing a Carer-Led Intervention Supporting older people and their carers with Medicines Management through pathways of care using interviews: a qualitative service evaluation

Abstract Introduction Previous studies have shown that informal carers involved in assisting with patients’ medicines have considerable knowledge about patients’ usual medication management (1). This could be helpful for healthcare professionals (HCPs) in secondary care caring for such patients and facilitate their safe discharge. However, carer involvement is often lost during patients’ hospital admissions, as carers report feeling excluded from decisions surrounding patients’ medicines management (2). Aim To assess the opinions of HCPs, patients and carers on strategies in place for HCPs to (i) identify informal carers during patients’ hospital admissions and (ii) aid communication between HCPs and carers with regards to medicines management during an inpatient stay and after discharge. Methods Semi-structured interviews were conducted with HCPs (doctors, nurses, pharmacists, occupational therapist and physiotherapist), adult patients, and their unpaid carers assisting with medication at home. Participants were recruited from three elderly care wards at one London teaching hospital. HCPs were approached directly; patients and carers were recruited with assistance from ward HCPs. Interviews explored participants’ opinions on current and potential methods for HCPs to identify informal carers, as well as how communication between HCPs and carers about medicines management could be improved. Interviews were transcribed verbatim and analysed using thematic analysis. Results Sixteen interviews were conducted. Thirteen participants provided demographic data, eight identified as female and five as male. Six identified as white British, one as Indian and one as Asian. A number of barriers to effective identification of carers were identified. Some HCP and carer participants were unaware of the carer’s identification lanyard provided by the hospital, which could help identify patients’ informal carers. Carers and HCPs suggested information about who assisted with medicines was not always passed between different HCPs, and that this should be on a central record that is assessed by all HCPs. Carers expressed the need to be kept updated on changes to medicines throughout the patient’s stay. Carers and HCPs made suggestions to improve this, including having a central point of contact to update carers during a patient’s hospital admission, having ‘five minute update’ discussions throughout admission, and involving carers in multidisciplinary interactions. Finally, carers suggested having access to written information about medication changes, especially before discharge. Carers and HCPs also identified lack of post-discharge follow up communication. Some HCPs and carers proposed community teams lead on follow-up, but HCPs highlighted the need for a clear referral process between secondary and primary care. Other carers and HCPs suggested the HCP teams looking after the patient during admission should follow-up with patient and carer shortly after discharge. Conclusion A strength of this service evaluation was identification of possible solutions to the problems identified. By asking about the personal experience of patients and carers, we identified suggestions for improvement. The main limitation is potential lack of generalisability, as interviews were only conducted at one hospital. The findings will be used to inform the development of a tool to improve communication and carer involvement in the medicines management process during an inpatient admission and after discharge.

An Asset-Based Quality Improvement Tool for Health Care Organizations: Cultivating Organizationwide Quality Improvement and Health Care Professional Engagement.

In the United States, health care organizations are often biased toward deficit-based quality and safety improvement techniques, such as incident reporting and peer review. However, deficit-based techniques may elicit negative sentiments from frontline health care professionals, causing disengagement and adverse event underreporting. To complement deficit-based quality improvement, our institution developed an organizationwide asset-based quality improvement tool. Inspired by asset-based quality improvement methodologies such as appreciative inquiry, Safety-II, and positive deviance, this tool facilitates the identification and analysis of clinical excellence. Resultant best practices and quality improvement projects are then propagated throughout our organization. Ultimately, asset-based quality improvement tools are logistically and technologically feasible for organizationwide deployment, and they potentially improve care quality and team culture. Health care organizations should consider adding these tools to their quality and safety improvement initiatives.