Future Medical Care Research Articles

Factors Associated with Completion of Advance Directives among Advanced Care Planning Outpatients at a Regional Hospital in Southern Taiwan

<p>目的：在台灣，民眾可以透過「預立醫療照護諮商」門診簽署「預立醫療決定」，然而諮商門診目前仍未被廣泛使用。本研究目的是希望了解影響民眾來本院參與預立醫療照護諮商門診和簽署完成預立醫療決定的相關因素。</p> <p>方法：我們使用回朔性病歷研究，研究對象為針對2019年1月1日到2020年2月28日來本院諮商門診的參與者。校正相關共變項後，使用羅吉斯回歸評估完成預立醫療決定的相關影響因素。</p> <p>結果：總共144位參加者被納入研究，預立醫療決定完成率為90.2%。較多的參加者為年齡較大、女性、較為健康、費用較低和之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書。校正相關共變項後，之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書的參加者有較高的機會完成預立醫療決定(aOR 14.56, 95% CI 1.62-131.23)；參加者與有社工參與的諮商團隊進行諮商有較高的機會完成預立醫療決定(aOR 5.59, 95% CI 1.05-28.87)。</p> <p>結論：諮商門診的參加者其預立醫療決定完成率高，之前已簽過預立安寧緩和醫療暨維生醫療抉擇意願書的參加者有較高機會完成預立醫療決定。諮商時，針對參加者個別情況進行討論和使用輔助資料理解諮商內容，協助完成預立醫療決定。未來能針對社區民眾衛教宣導預立醫療照護諮商門診的諮詢服務，針對從未簽過預立安寧緩和醫療暨維生醫療抉擇意願書的民眾更需進一步的推廣。</p> <p> </p><p>Purpose: Advance care planning (ACP) is the process of communicating a person’s preferences regarding future medical care. In Taiwan, people can visit an ACP outpatient clinic and complete advance directives (AD). ACP is an emerging medical service, and information about completing AD is lacking. The aim of this study was to investigate the factors affecting AD completion among ACP clinic outpatients at a regional hospital in southern Taiwan.</p> <p>Methods: This retrospective study used chart reviews to evaluate participants who attended an ACP outpatient clinic from 1 January 2019 to 28 February 2020. AD completion was analyzed using logistic regression after adjusting for covariates including previously signing do-not-resuscitate (DNR) forms.</p> <p>Results: A total of 144 participants were included, and the AD completion rate was 90.2%. Participants attending ACP sessions were more likely to be older, female, having a high school education and below, better health status, paying less for ACP sessions, and previously signing DNR forms. After adjusting for the covariates, participants who had previously signed DNR forms were more likely to complete AD (aOR 14.03, 95% CI 1.56-126.06). In addition, the presence of a social worker in the ACP team was significantly associated with higher AD completion (aOR 5.74, 95% CI 1.05-31.32).</p> <p>Conclusions: Participants previously signing DNR forms were more likely to completion AD. In addition to tailoring ACP discussions about the benefits of AD and providing supplement materials to improve AD completion, further strategies are needed to encourage the public in southern Taiwan to visit ACP outpatient clinics, especially for those who were unfamiliar with concepts such as DNR or life-sustaining treatment at the end of life.</p> <p> </p>

Japan's healthcare delivery system: From its historical evolution to the challenges of a super-aged society.

Although Japan's healthcare delivery system is highly regarded internationally, the COVID-19 pandemic has exposed its structural problems. Behind these issues lies a history of medical care provisions supported mainly by an unrestricted, "free labeling" system, and independently financed private hospitals. In addition, patients have a high degree of freedom of choice under the Japanese medical insurance system, making it difficult to provide comprehensive and continuous health management from initial diagnosis and treatment (primary care), specialized treatment, to supporting a return to home, providing nursing care and lifestyle support. As Japan becomes a "super-aged" society with individuals over 65 making up over 30% of the population, the nature of medical care will have to undergo major changes. Medical care's basic function must still be the treatment and cure of patients, but the system will also have to provide support. That means conceiving of care in a way that treats a person's life with dignity and does not sacrifice life for treatment. The implementation of a family doctor function and the clarification of the functions and roles of small and medium-sized community-based hospitals that support this function, as well as the establishment of a community comprehensive care network with multidisciplinary cooperation that goes beyond medical care, should also be set forth in future regional medical care plans.

An Insight Into the Experiences of Malaysian Patients With Advanced Cancer and Their Preferences in End-of-Life Care: A Qualitative Study.

Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care. To explore the experiences and preferences of Malaysian patients with advanced cancer. Qualitative study of semi-structured interviews with thematic analysis. Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia. Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning. This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts.

Biomedical knowledge of dementia is not enough to counteract its stigma – quantitative research among future medical and social care staff in Poland

Objectives The aim is to assess the level of stigmatization and knowledge of dementia among university students of medical, rehabilitation and social faculties in Poland. Possible correlates of these concepts and group differences are also investigated. Methods We applied quantitative methods using an online questionnaire comprising sociodemographics, the Alzheimer’s Disease Knowledge Scale, a vignette of a person with dementia and the modified Family Stigma in Alzheimer’s Disease Scale. Results Students had low levels of dementia knowledge and moderate levels of stigma. Medical science students had significantly better knowledge than the other groups but did not differ in their level of stigma. Relationships between the main variables were complex. Emotional and cognitive stigmatizing attributions were negatively correlated with knowledge about communication and behaviors of people with dementia. Better knowledge on causes and characteristics, as well as on risks and health promotion of the disease also triggered fewer negative attributions toward people with dementia. Conclusions If health-related programs are to be effective, they should provide opportunities for the acquisition of relevant knowledge and skills that also address the stigmatization of people living with dementia. Well-established biomedical knowledge on dementia must be supplemented with a person-centered approach and proper communication skills.

The trajectory of prognostic cognition in patients with advanced cancer: is the traditional advance care planning approach desirable for patients?

Most patients with advanced cancer initially express a desire to be informed of their prognosis, and prognostic discussions between patients and their oncologists can trigger the subsequent trajectory of prognostic cognitions. On the continuum of prognostic cognition, including inaccurate/accurate prognostic awareness (awareness of incurability of cancer, terminal nature of illness or life expectancy) and prognostic acceptance (accepting one's prognosis), patients' perceptions of being informed of their prognosis by oncologists and patients' coping strategy for serious medical conditions regulate prognostic cognitions. However, nearly half of the patients with advanced cancer have poor prognostic awareness, and few patients achieve prognostic acceptance. These phenomena partly act as barriers to participation in advance care planning. When oncologists engage in advance care planning conversations, they must assess the patient's prognostic cognition and readiness for advance care planning. Considering the inaccurate prognostic awareness in a non-negligible proportion of patients and that astatic patients' preferences for future treatment and care are influenced by prognostic cognition, more research on decision-making support processes for high-quality and goal-concordant end-of-life care is needed along with research of advance care planning. In addition to making decisions regarding future medical treatment and care, oncologists must engage in continuous and dynamic goal-of-care conversations with empathic communication skills and compassion from diagnosis to end-of-life care.

Potential merits and flaws of large language models in epilepsy care: A critical review.

The current pace of development and applications of large language models (LLMs) is unprecedented and will impact future medical care significantly. In this critical review, we provide the background to better understand these novel artificial intelligence (AI) models and how LLMs can be of future use in the daily care of people with epilepsy. Considering the importance of clinical history taking in diagnosing and monitoring epilepsy-combined with the established use of electronic health records-a great potential exists to integrate LLMs in epilepsy care. We present the current available LLM studies in epilepsy. Furthermore, we highlight and compare the most commonly used LLMs and elaborate on how these models can be applied in epilepsy. We further discuss important drawbacks and risks of LLMs, and we provide recommendations for overcoming these limitations.

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.

Ocimum Basilicum (basil/tulsi): a herbal sustainable treasure and its therapeutic potency

Basil is a good source of free radical scavenging compounds that have their traditional medicinal applications that may be successful for future modern medical applications and personal care as well. Ocimum basilicum (Basil) has long been revered for its culinary allure, but its medicinal benefits are equally remarkable. Ocimum basilicum is known for its bioactive therapeutic metabolites. Basil is used in Ayurveda and in traditional medicine to treat digestive system disorders like stomach ache, fever and diarrhoea, kidney infections. Various vegetative parts of Ocimum species were explore by researchers to test their anti-inflammatory and antinociceptive potential. Holy basil is also found to contain eugenol oil that may helpful to treat hypertension. Basil essential oils and its phytochemical compounds were found to exhibit excellent antimicrobial activity against a wide range of Gram-negative and Gram-positive bacteria, yeast, and mold. The analysis of antimicrobial properties was also confirmed that Ocimum basilicum essential oils have excellent inhibiting activity by showing growth inhibition zones ranged from 9.67 to 15.33 mm in Gram-positive microbes and Gram-negative microbes including inhibition zone ranging from 5.33 to 7.33 mm in yeast. Observed lowest minimal inhibition concentration (MIC) of Ocimum basilicum essential oils was 3.21 µL/mL against Gram -negative Azotobacter chrococcum and Gram -positive Micrococcus luteus. Notable highest insecticidal activity was also found against Pyrrhocoris apterus that caused the death of 80% of individuals globally. As a result, Ocimum basilicum essential oils have potent broad spectrum of activity, so that its various extracts can become safe and sustainable herbal choice to preserve fruit and vegetables against plant pathogenic infections.. Hence, this discrete review is strived to explore basil's safe and sustainable therapeutic approaches in combating microbial and viral infections, oxidative stress including improving metabolic disorders, cognitive improvement, strengthening the immune system, oral health and skin wellness.

ADVANCE CARE PLANNING IN PRIMARY CARE: ENGAGING ACCOMPANIED OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Abstract Alzheimer’s Disease and Related Dementias (ADRD) are among the most profoundly disabling and costly of all health conditions, and persons living with dementia are at heightened risk for high utilization of burdensome and costly end-of-life care. Family caregivers are at the forefront of managing ADRD, however, they are not routinely engaged in primary care discussions about prognosis and the healthcare preferences of the people for whom they care. Advance care planning (ACP) is a longitudinal communication process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. Early initiation of ACP, communication with the primary care team, and the inclusion of associated caregivers is imperative in ADRD care due to progressive and devastating effects on decision-making capacity connected with the disease. SHARE, a multicomponent communication intervention, engaged 273 patient-family caregiver dyads in a randomized-controlled trial collecting baseline and six-month survey data related to experiences in the primary care setting. 145 patient-caregiver dyads assigned to the intervention received an offer for a facilitated advance care planning conversation. This symposium will highlight 6-month outcomes from caregiver-reported surveys. Attendees will gain a perspective on ACP considerations in a cognitively impaired population including ethical considerations and the factors influencing preparedness for medical decision making for involved family caregivers. Additional attention concerning the quality and content of ACP conversations with patient-caregiver dyads and the development of a fidelity tool for usage with audio-recorded ACP conversations will be presented.

SOCIODEMOGRAPHIC DIFFERENCES IN ADVANCE CARE PLANNING AMONG OLDER LESBIAN AND GAY ADULTS

Abstract Advance care planning (ACP) is a process that supports adults at any stage of health in ensuring that their values, goals, and wishes are met regarding future medical care. Factors associated with completing ACP include older age, being White, higher education, and higher socioeconomic status. However, scant research has investigated if these same characteristics are associated with ACP among lesbian and gay adults. Using data from an online survey (N=139), bivariate analyses were conducted to investigate predictors of ACP outcome measures. Being White (p<.01), older (p<.01), and employed (p<.05) were associated with having a higher level of comfort with medical decision making. Having a higher income (p<.01), being employed (p<.01), and having a health condition (p<.05) were associated with having completed a living will. Having a higher income (p<.01) and being employed (p<.05) were associated with having a durable power of attorney for healthcare. These outcomes demonstrate that while some variables were similar to previous findings, additional sociodemographic characteristics were found to have an influence on ACP among older lesbian and gay adults. Given that completing ACP has shown to improve quality of care at end of life, it is imperative to understand what factors influence ACP for older lesbian and gay adults. Understanding these within group differences will lead to future research and outreach efforts developed to inform and equip healthcare workers and community organizations with the means to better serve older gay and lesbian adults, a group that has been historically discriminated against by the healthcare system.

CURRENT AND FUTURE SERVICE USE, SATISFACTION, AND NEED FOR SERVICES AS DEFINED BY RURAL AND FRONTIER OLDER ADULTS

Abstract This study focused on differences for current service utilization and satisfaction, along with perceived future service use and need for rural versus frontier residing older adults. A sample of older adults (age 65+), stratified using United States government and State of Wyoming definitions for rural (n=70) and frontier (n=72) counties, were interviewed. Frontier respondents reported less education F (1, 141) = 10.19, p = .002, η2 = .068, monthly income F (1, 141) = 17.03, p = .001, η2 = .108 with fewer financial resources F (1, 141) = 10.32, p = .002, η2 = .069, experience with technology F (1, 140) = 4.53, p = .035, η2 = .032, and potential for telehealth F (1, 140) = 19.27, p < .001, η2 = .112, along with fewer computers F (1, 141) = 11.08, p < .001, η2 = .084, and less access to the internet F (1, 141) = 10.19, p = .001, η2 = .073. Differences were evident for recent use of senior nutrition programs and meal sites, dental care, and senior centers along with future use of senior nutrition programs and meal site location, food related services, hearing and vision clinics, and housing needs. Policy concerns have been identified for the funding of future senior housing, medical care, transportation, and food support in frontier and rural areas.

PRAGMATIC IMPLEMENTATION OF AN ADVANCE CARE PLANNING INTERVENTION: FINDINGS FROM SHARING CHOICES

Abstract Advance care planning (ACP) is defined as a key task in ambulatory care for patients to share values, goals, and preferences for future medical care. Ideally ACP is revisited throughout the course of serious illness and engages family in discussions with clinicians. Most interventions, however, have not targeted primary care as a setting for ACP but have instead targeted a specific illness, conversation or setting such as the inpatient hospital or nursing home. Additionally, family is often not included in ACP discussions. This symposium will discuss critical components of the SHARING Choices cluster-randomized pragmatic trial, including the setup, monitoring, and analysis of this intervention within two primary care health systems located in the Baltimore-Washington DC metropolitan corridor. Each presenter will discuss key efforts conducted during the trial that highlight challenges, lessons learned, and novel approaches of embedding an evidence-based intervention within usual care settings targeting older adults 65 years of age and older. Preliminary analyses indicate that the ACP intervention was highly effective for increasing the likelihood of having advance directives in the patients’ electronic health records within 1-year of intervention initiation (odds ratio = 2.88, p < 0.001). Attendees of this symposium will take away relevant insights for implementing effective ACP and communication interventions within primary care settings as well as supporting outcome data. Our discussant will provide thoughts on the implications of these results for current primary care organizations and in the field of ACP and communication for older adults including those with dementia.

Health literacy, worry about unmet needs for medical care, and psychological well-being among older Chinese adults.

This study aims to examine the relationship between older adults' health literacy and their psychological well-being and the role of worry about future unmet needs for medical care in mediating this relationship. We adopted a sample of 965 older Chinese people aged 60+ (49.74% female) from the 2021 Chinese General Social Survey. A series of structural equation models (SEMs) were performed. Health literacy was measured by three items regarding older people's ability to understand medical professionals, ask them questions, and read medical instructions. A single-item question was adopted to measure participants' worry about unmet needs for future medical care. Psychological well-being was measured by three items regarding emotional problems and depressed or anxious mood in the past 4 weeks. Worry about future unmet needs for medical care mediates the relationship between lack of health literacy and Chinese older people's psychological well-being. The indirect effect accounts for 22.3% of the total effect. The SEM model has a satisfactory model fit (goodness of fit index = 1.000, comparative fit index = 0.999, Tucker-Lewis index = 0.997, root mean square error of approximation = 0.009, standardized root mean square residual = 0.023, chi-square test = 50.96, P = 0.321). The findings of this study underscore the importance of improving communication quality between healthcare providers and older adults. Clinical interventions that promote health literacy and address worries about unmet needs for medical services may benefit older adults. Geriatr Gerontol Int 2024; 24: 202-207.

Street Medical for Future Medical Care

Street Medical for Future Medical Care

Advance Care Planning in Huntington Disease: The Elderly Care Physician's Perspective

ObjectiveHuntington disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become impaired as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). Elderly care physicians (ECPs) can play an important role in ACP in HD patients. However, little is known about their experiences in this role. The aim of this study is to gain insight into how ECPs practice ACP with HD patients. DesignA qualitative interview study. Setting and ParticipantsNine ECPs working in HD-specialized nursing homes in the Netherlands. MethodsWe conducted semistructured interviews with ECPs between June 2018 and July 2020. ResultsTwo phases could be identified in the process of ACP. In the first phase, when the feared future seems to be far away, the ECP asks about the patient's wishes for the future in an accommodating manner. In the second phase, when the feared future is closer, future medical treatment and care becomes less hypothetical. Agreement has to be reached on upcoming treatment decisions. In this phase, the ECP takes a more guiding role, and consequently encounters more difficulties, such as maintaining a positive patient/family-physician relationship while dealing with disagreements with patient or family. Most participants shared their experiences with euthanasia when asked about ACP. When making a comparison of ACP between HD patients and patients with other neurodegenerative disorders in nursing homes, the ECPs emphasized the similarities. Conclusions and ImplicationsACP in HD can be classified into 2 phases, which differ in ECPs’ approach and the complexity experienced by the ECP. Awareness of this finding may help to further develop training and education in ACP, including dealing with euthanasia, to make ECPs feel better equipped in practicing ACP in HD.

Recovery from (treatment-resistant) depression after lifestyle changes and micronutrient precision supplementation: a preliminary field study in patients

Background and purposeThe incidence of depression is increasing, despite continued advances in psychological and pharmacological interventions. New treatment approaches are urgently needed. Here we assess the effects on depression of individualized micronutrient supplementation, in concert with a standard set of lifestyle changes.MethodsWe conducted a small field-study with 17 participants in Austria. Patients with depression (n = 11) and healthy volunteers (n = 6) underwent laboratory serum analysis and filled out the DASS-21 and a questionnaire about their medical history and condition. The list of parameters to be tested in the serum analysis was derived from an expert heuristic compilation of factors known to influence depression, narrowed down to a workable list to be tested in this initial study. On the basis of the results, the participants (n = 17) received individualized recommendations for micronutrient supplementation, in collaboration with their treating physician. Participants followed the individual supplementation regime for two months, along with a standard set of lifestyle changes. After two months the laboratory serum analyses, the DASS-21, and the questionnaire were repeated.ResultsAll patients with micronutrient deficiencies were in the patient group; none of the healthy volunteers showed any micronutrient deficiencies. After two months of precision supplementation and lifestyle changes, all but one patient had recovered from their depression or had considerably improved. The one patient who didn’t recover was the only one with a known trigger of their depression (trauma). Of 11 patients with depression, the trigger was unknown for the other ten.ConclusionsThese results have promising implications for further research, treatment, drug development, and public health. We propose that systematic screening of patients with symptoms of depression be developed for future research, medical care, and practice. Psychiatry and psychotherapy may see improved results once they no longer have to push against the underlying constraints of existing micronutrient deficiencies.

Experiences of dialogue in advance care planning educational programs.

Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2years; 50 women and 16 men) participated in focus group interviews. This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Real-Time Automatic Assisted Detection of Uterine Fibroid in Ultrasound Images Using a Deep Learning Detector.

Uterine smooth muscle hyperplasia causes a tumor called a uterine fibroid. With an incidence of up to 30%, it is one of the most prevalent tumors in women and has the third highest prevalence of all gynecological illnesses. Although uterine fibroids are usually not accompanied by symptoms, there are physical effects, such as impairment of the ability to conceive. To reduce morbidity, early detection and treatment are crucial. Ultrasound imaging is a common method used for pre-operative guidance and interventional therapy. Many applications of object detection are performing well with the advancement of deep learning in the field of medical image analysis. To ensure accuracy, computer-assisted detection can further solve the subjective problem generated by different doctors when they read images. Our research provides an improved YOLOv3 that combines the properties of EfficientNet and YOLOv3, which use a convolutional neural network to extract features, to detect uterine fibroid ultrasound images. Our approach attained an F1 score of 95% and an average precision of 98.38% and reached a detection speed of 0.28 s per image. We reviewed and analyzed several detection techniques and identified potential future research hotpots. This technique offers enough supplementary diagnostic tools for amateur or expert ultrasonologists and sets a solid foundation for future medical care and surgical excision.

Defining advance care planning from the perspective of people with dementia: Focus groups with the European Working Group of People with dementia

AbstractBackgroundThe European Association for Palliative Care (EAPC) defines advance care planning (ACP) as a process enabling individuals with decisional capacity to define goals and preferences for future medical treatment and care, discuss these with family and health‐care providers, and record and review them if appropriate. There are concerns that this and other definitions may not apply to ACP in the context of dementia. ACP needs for people with dementia differ from those of people with other diseases. Furthermore, current definitions are not informed by input from people with dementia, but rely on professional expert recommendations. We gathered the perspectives of the European Working Group of People with Dementia (EWGPWD) regarding the EAPC ACP definition to explore its applicability in the context of dementia.MethodsWe conducted 3 online focus groups with members of the EWGPWD (n = 12) and their supporters (n = 9). We deconstructed ACP in four topics revolving around the what, why, who, and when of ACP to guide discussions. To analyze the data, we used inductive thematic analysis.ResultsThree key issues were highlighted as important to consider in an ACP definition which would be inclusive for people with dementia. First, participants disagreed with the focus on people with decisional capacity, as they saw loss of capacity as a gradual process that depends on context and should be supported throughout the dementia trajectory. Second, although some noted that family dynamics vary, the essential role of families or trust‐based relationships was found to be under‐addressed, as families were generally considered to have personal knowledge of the person with dementia. Third, participants suggested that ACP is too centered on medical care. It should include broader conversations on what matters to people in the future, social care, and future daily life activities.ConclusionWe identified three points of contention with the EAPC ACP definition corresponding to dementia‐specific issues. The perspectives of the EWGPWD emerging from our focus groups contribute to the understanding of ACP in the context of dementia and highlight the need for a dementia‐inclusive ACP definition focusing on the issues of decisional capacity, family involvement and social aspects of care.

What do patients think about the Hungarian health care system and medical students’ learning outcomes? A cross-sectional study on the patients’ perspective in Hungary

BackgroundThe doctor-patient relationship has changed a lot in the 21st century and the varying expectations of the patients play an important role in future professional medical care. The knowledge of patients’ needs is crucial in determining the learning outcomes in medical education. The objective of this study was to examine the expectations of the patients regarding professional and soft skills (e.g. communicational skills, empathy) of doctors and to get a deeper view.MethodsFace-to face data collection through self-reported questionnaire in accredited health care institutions (GPs, hospitals, outpatient care) in Hungary was carried out in 2019. Descriptive statistics, independent sample t-tests, k-means cluster and gap matrices were performed to analyze the data.ResultsIn total 1115 patients (male-female: 50–50%, age groups: between 18 and 30: 20%, between 31 and 60: 40% above 60: 40%) participated in the survey. They rated sixteen learning outcomes along with two dimensions: importance and satisfaction. Except for one learning outcome, patients rated the outcomes more important than they were satisfied with them (negative gap). Positive gap was registered only in the case of respecting individual specialty during patient care.ConclusionsThe results suggest the importance of learning outcomes in relation to the rate of satisfaction from the patients’ perspectives. In addition, the results support that patients’ need are not met in medical care. Patients’ ratings also make an emphasis on the fact that besides professional knowledge other learning outcomes are also important in health care which should have been emphasized as a basis in medical education.