Future Preferences Research Articles

Utilization patterns and preferences of telemedicine services in the post-Covid-19 era in Israel

Abstract Background While telemedicine can streamline healthcare delivery, suboptimal use may compromise care quality and access. Given the increased adoption of these services during and after the Covid-19 pandemic, understanding best practices through examination of utilization patterns and patient preferences is crucial. This study estimated utilization rates, patient preferences and perceptions of response received for different physician-encounter channels for common clinical and administrative scenarios. Methods Cross-sectional telephone survey in Hebrew or Arabic of 519 Israelis who contacted a doctor in the past year for clinical or administrative needs. Data collected during April-June 2023, focused on chosen contact channel, reasons for choice, perceived response adequacy, and hypothetical future preferences. Findings 78% of encounters with family physician for clinical need were in-person, with lower rates for phone (16%) or messaging (6%); in-person dominated with encounters with specialists (94%). Conversely, for administrative needs, more used phone (15%) or messaging (48%), though 37% still preferred in-person encounter. Video usage was negligible (<1%). Main reasons for in-person choice were perceived need for physical exam, habit, or negative perception of remote service quality. Convenience/exam-free needs drove phone/messaging use. While most patients were satisfied with their chosen channels, phone consultations had lower future preference rates. Conclusions Matching channel to need is crucial. Physical exams require in-person visits, though they are not always required and many stick with in-person out of habit; remote options like messaging can streamline administrative tasks. Patient education could address habits and help familiarize patients with new options. Optimizing phone visits and promoting video options could enhance adoption due to their benefits. Key messages • In-person visits are preferred for clinical needs, while messaging/phone are underutilized for administrative tasks, highlighting missed opportunities for convenient telemedicine options. • Addressing patient habits and perceptions around remote healthcare channels is crucial for optimizing telemedicine adoption and streamlining care delivery.

Attitudes towards being offered a choice of self-sampling or clinician sampling for cervical screening: A cross-sectional survey of women taking part in a clinical validation of HPV self-collection devices.

Primary human papillomavirus (HPV) testing in cervical screening offers the opportunity for women to be given a choice between HPV self-sampling and traditional clinician screening. This study assessed attitudes towards a choice and anticipated future preference among women who had collected a vaginal self-sample alongside their usual cervical screen. Thirty-eight general practices across five areas in England. Overall, 2323 women (24-65 years; response rate: 48%) completed a survey after collecting a self-sample and having a clinician screen at their GP practice. We asked which test they preferred and assessed attitudes to being offered a choice. We explored age, education, ethnicity and screening experience as predictors of attitudes towards a choice and anticipated future choice. Most participants felt they would like a choice between self-sampling and clinician screening (85%) and thought this would improve screening for them (72%). However, 23% felt it would be difficult to choose, 15% would worry about making a choice, and nearly half would prefer a recommendation (48%). Compared with women with degree-level education, those with fewer qualifications were more likely to say they would worry about having a choice or would not want a choice (p < 0.001). The majority said they would choose to self-sample at home if offered a choice in the future (69%; n = 1602/2320). Self-sampling is likely to be popular, but offering a choice could cause worry for some people and many would prefer a recommendation. Supporting people to make a choice will be important, particularly for those with lower levels of education.

Medical student attitudes toward mental illness: a cross-sectional study from the Gaza Strip, Palestine

BackgroundMental illness is highly stigmatized compared to physical illness, often due to false beliefs and a lack of knowledge. Negative attitudes harbored by healthcare providers reflect on the care they provide and impact their patients’ outcomes and may tailor their future preferences away from the psychiatric practice. This cross-sectional study used a stratified, randomized sampling method to survey the beliefs and attitudes of students at a Palestinian medical school toward mental illness using the Beliefs Toward Mental Illness (BMI) scale.ResultsOverall, 79.1% of 282 participants demonstrated positive attitudes toward mentally ill patients (BMI score < 43). The highest mean score (more negative attitude) was received by the ‘dangerousness’ domain (2.75 ± 0.75), while the ‘poor social and interpersonal skills’ domain received the lowest mean score (2.47 ± 0.82). Male sex (p = 0.031) and having a friend (p = 0.035) or a family member (p = 0.035 and p = 0.033, respectively) suffering from a mental illness predicted a more positive attitude toward mental illness. At the same time, age, study level, and having undergone the clinical psychiatry rotation did not impact attitude significantly.ConclusionsThe study shows that medical students in the Gaza Strip are not absolved from the negative stereotypes of their community toward mentally ill patients, which should be addressed systematically by health educators and medical schools in the country.

DEVELOPING MENU PLANNING SOFTWARE USING OPTIMIZATION AND ARTIFICIAL INTELLIGENCE ALGORITHM

In today's world, awareness of health and nutrition is growing, emphasizing the need for personalized nutrition recommendations and reducing food waste. This study collected demographic data and food preferences from users and analyzed them using artificial intelligence models. A model developed with the Random Forest algorithm was trained to predict users' future preferences and guide menu planning. Tests showed that combining AI with optimization techniques successfully creates user-focused menus, enhancing satisfaction and reducing food waste. The study also highlighted challenges related to the dataset's size, pointing to a need for more qualitative data. The developed model provides innovative solutions for catering companies and institutions offering mass dining, improving employee satisfaction while minimizing waste. Future research aims to refine the model for broader applications.

Congregation members’ response to worship and fellowship in the digital space during the COVID-19 pandemic

This article investigates the congregation members to the transition from face-to-face worship and fellowship to digital spaces amid the coronavirus disease 2019 (COVID-19) pandemic, with a sample of the Huria Kristen Batak Protestan (HKBP – Batak Protestant Christian Church), specifically in District Daerah Khusus Ibukota (DKI) Jakarta province, Indonesia. This study uses an empirical questionnaire method to assess the level of satisfaction, engagement and future preferences of the congregation regarding digital versus face-to-face worship practices. The questionnaire was built on current theories of encounter and fellowship and what the congregation members need in digital worship services. Data from 421 congregations with a 95% confidence level and 5% margin of error showed a dominant 62.7% preference for returning to face-to-face worship services and a participation decline during the pandemic. Respondents also felt a 60%–90% difference in digital services from church services, especially related to the need for communal fellowship. Participation in digital services correlates with higher education levels, while older congregations preferred face-to-face worship.Contribution: This study highlights the importance of incorporating Batak cultural values into digital ministry strategies to increase community connectivity and engagement. This article suggests further research on integrating cultural elements into digital religious practices, aiming to provide insights for churches navigating the digital transformation of religious services.

An Online Visual Elicitation Tool to Facilitate Conversations About Supportive Care in the Context of Cognitive Impairment.

Older adults with dementia are often left out of decision-making about their care. We developed and evaluated the use of an online visualization tool to foster discussions about future care preferences. The study provides valuable insights on methods for facilitating conversations about complex topics in the context of cognitive decline.

Nurse-Led Advance Care Planning in Adults in the U.S.- A Scoping Review.

Advance care planning involves discussing individuals' future medical treatment and care preferences. Nurses, due to their close relationships with patients and families, may be well-positioned to lead these discussions. Exploring the components and characteristics of nurse-led ACP interventions is essential for enhancing their implementation, effectiveness, and sustainability. This scoping review aimed to explore the characteristics of nurse-led ACP interventions in adult patients, identify the populations and settings where these interventions have been utilized, and the outcomes of these interventions in the U.S. A scoping review was conducted following Arksey and O'Malley's five-stage framework. Using keywords related to nurse-led ACP interventions, a comprehensive search was performed across PubMed, Web of Science, CINAHL, EMBASE, and PsycINFO databases. Twelve studies met the inclusion criteria. These studies were conducted in varied settings. Registered nurses, oncology nurse navigators, and other specialized nurses primarily delivered nurse-led ACP interventions. The interventions ranged from one to two sessions and utilized various models and resources such as the Five Wishes and Respecting Choices. Nurse-led ACP interventions have shown significant positive outcomes, including increased engagement in ACP, improved attitudes towards ADs, higher completion rates of ADs, and enhanced patient-surrogate congruence. These interventions are well-received by patients and can be implemented in diverse settings. However, a general guideline regarding nurse-led ACP interventions is needed to address the specific duration, sessions, and mode of delivery required for their optimal effectiveness.

Experiences of and treatment preferences for insomnia in autistic adults: An Interpretative Phenomenological Analysis

Insomnia and insomnia symptoms are frequent experiences of autistic people resulting in pronounced daytime effects and poor quality of life. This study employed an Interpretive Phenomenological Analysis approach to explore lived experiences of autistic adults with insomnia, perspectives on current available interventions and future treatment preferences. Twelve participants (aged 21–48 years old) were interviewed following screening for insomnia, using the Sleep Condition Indicator (scores ranged from 1 to 12; cut off >16). Each interview was analysed individually developing Personal Experiential Themes for each case, which were then mapped across cases based on identified patterns and connections. Results yielded rich personal accounts and identified two Group Experiential Themes: “The Night is Friendlier” and “It Doesn't Really Work for Me”. Participants described experiences with sleeplessness throughout their adult lives and often since childhood. They discussed how the night time offers them a more relaxed and safe space to freely behave as they wish. Advice and interventions were viewed by participants via the prism of underlying social issues, such as autism acceptance and trust, and how these structures can affect participants' experiences with insomnia, help seeking and effectiveness of current interventions. Our results highlight the need for inclusion of autistic people in insomnia research through co-production and co-creation as well as clinical practice and delivery. This is the first study to integrate perspectives and experiences of autistic people towards insomnia and sleep-related advice by health care professionals. Findings are discussed in relation to theoretical and practical implications, as well as directions for future research.

Survey on the Future Preference Values of Koreans in Advanced Science and Technology Culture

Survey on the Future Preference Values of Koreans in Advanced Science and Technology Culture

Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment.

serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI. Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina. Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available). SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR. Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes. Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits. These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.

Multi-Hop Multi-View Memory Transformer for Session-Based Recommendation

A Session-Based Recommendation (SBR) seeks to predict users’ future item preferences by analyzing their interactions with previously clicked items. In recent approaches, Graph Neural Networks (GNNs) have been commonly applied to capture item relations within a session to infer user intentions. However, these GNN-based methods typically struggle with feature ambiguity between the sequential session information and the item conversion within an item graph, which may impede the model’s ability to accurately infer user intentions. In this article, we propose a novel Multi-hop Multi-view Memory Transformer (M 3 T) to effectively integrate the sequence-view information and relation conversion (graph-view information) of items in a session. First, we propose a Multi-view Memory Transformer (M 2 T) module to concurrently obtain multi-view information of items. Then, a set of trainable memory matrices are employed to store sharable item features, which mitigates cross-view item feature ambiguity. To comprehensively capture latent user intentions, an M 3 T framework is designed to integrate user intentions across different hops of an item graph. Specifically, a k-order power method is proposed to manage the item graph to alleviate the over-smoothing problem when obtaining high-order relations of items. Extensive experiments conducted on three real-world datasets demonstrate the superiority of our method.

People with type 2 diabetes experiences of using WhatsApp-based diabetes self-management education and support: The process evaluation.

Online Diabetes Self-Management Education and Support (DSMES) offers people with type 2 diabetes mellitus (T2DM) accessible and tailored education, utilising innovative and interactive tools such as social media to enhance engagement and outcomes. Despite the demonstrated effectiveness of social media-based DSMES in improving health outcomes, there remains a significant gap in qualitative insights regarding participants' experiences. This study aims to explore the experiences of people with T2DM who are using a newly developed WhatsApp-based DSMES. A qualitative descriptive approach was adopted. Data consisted of 23 semi-structured phone interviews with people with T2DM who had received the WhatsApp-based DSMES. Interviews were analysed using qualitative content analysis. The present study adheres to the COREQ guidelines. Four themes emerged from the data: (1) acceptability of the programme, (2) flexible accessibility of the programme, (3) promoting healthy lifestyle and (4) future preferences for the programme use. This study explored the experiences of people with T2DM participating in a 6-week WhatsApp-based DSMES. The findings indicated that the programme was acceptable, accessible, effectively revealing necessary self-management knowledge and skills, and provided essential support from professional and peer. The study also indicated that WhatsApp-based programmes could be feasibly implemented in various populations, healthcare settings and communities to support people with T2DM globally.

Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire.

We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.

Physicians’ understandings and experience of advance care planning in Norwegian nursing homes: a qualitative study

BackgroundAdvance care planning is a way of facilitating conversations with patients about future health care, values, and preferences at end of life. Nursing home physicians have the medical responsibility and the main obligation to facilitate planned meetings with patients. Although there has been a great deal of focus on establishing advance care planning in Norwegian nursing homes, it has yet to be widely implemented. Stated reasons are that the work routines in a nursing home do not include such meetings or that implementation seems complex due to frail patients. The aim of this study is thus to explore how physicians understand and experience advance care planning and follow-up of care plans in Norwegian nursing homes.MethodsThe study has a qualitative research design with a phenomenological-hermeneutic approach based on interviews of twelve nursing home physicians working in community care. Interviews were conducted in February 2023 to May 2023, using a semi-structured interview guide. All interviews were recorded on audio files, transcribed, and analyzed using structural text analysis.ResultsThe findings are presented based on the following themes: (1) advance care planning is a dialog and a process, (2) advance care planning implies clarifying mutual expectations, and (3) advance care planning that brings relief and hope to patients is a medical art.ConclusionsAdvance care planning is a complex and dynamic process that implies medical treatment, decisions on treatment level, pain relief, and formulation of care plans where the patient’s self-determination and personal values are respected. It implies an ongoing dialogue between physicians, patients, and their relatives about values such as dignity, self-understanding, social relations, and existential questions at end of life. Advance care planning requires a holistic approach that meets patients’ psychological and existential needs such as comfort, trust, hope, and respect as well as their preferences and concerns.

Desired dementia care towards end of life: Development and experiences of implementing a new approach to improve person‐centred dementia care

AbstractAimsTo describe the co‐creation of the ‘Desired Dementia Care Towards End of Life’ (DEDICATED) approach to improve person‐centred palliative care for individuals with dementia and to describe the experiences of healthcare professionals during the approach's implementation.MethodsA needs assessment, comprising both qualitative and quantitative studies, informed palliative care needs of healthcare professionals, family caregivers and individuals with dementia. The approach was co‐created with healthcare and education professionals, guided by the findings. Then, healthcare professionals were trained to implement the approach in their organizations. From April to June 2022, semi‐structured interviews with actively engaged professionals were analysed using Conventional Content Analysis.ResultsThe needs assessment yielded six key themes: (1) raising palliative care awareness, (2) familiarization with a person with dementia, (3) communication about future care preferences, (4) managing pain and responsive behaviour, (5) enhancing interprofessional collaboration in advance care planning and (6) improving interprofessional collaboration during transitions to nursing homes. Interviews with 17 healthcare professionals revealed that active involvement in co‐creating or providing feedback facilitated implementation. Overall, the DEDICATED approach was perceived as a valuable toolkit for optimizing palliative care for people with dementia and their loved ones.ConclusionCo‐creating the DEDICATED approach with healthcare professionals facilitated implementation in daily practice. The approach was considered helpful in enhancing person‐centred palliative dementia care.Impact StatementThis study underscores the importance of active involvement of healthcare professionals in the research and development of new interventions or tools for palliative care, which can influence the successful implementation, dissemination and sustained usage of the developed tools.Implications for the Profession and Patient CareThe developed approach can improve person‐centred palliative care for individuals with dementia, ultimately improving their quality of life and that of their loved ones.Reporting MethodThis study used the Consolidated Criteria for Reporting Qualitative Research.Patient of Public ContributionNo patient or public contribution.

Oxytocin receptor function regulates neural signatures of pair bonding and fidelity in the nucleus accumbens.

The formation of enduring relationships dramatically influences future behavior, promoting affiliation between familiar individuals. How such attachments are encoded to elicit and reinforce specific social behaviors in distinct ethological contexts remains unknown. Signaling via the oxytocin receptor (Oxtr) in the nucleus accumbens (NAc) facilitates social reward as well as pair bond formation between mates in socially monogamous prairie voles 1-9 . How Oxtr function influences activity in the NAc during pair bonding to promote affiliative behavior with partners and rejection of other potential mates has not been determined. Using longitudinal in vivo fiber photometry in wild-type prairie voles and those lacking Oxtr, we demonstrate that Oxtr function sex-specifically regulates pair bonding behaviors and associated activity in the NAc. Oxtr function influences prosocial behavior in females in a state-dependent manner. Females lacking Oxtr demonstrate reduced prosocial behaviors and lower activity in the NAc during initial chemosensory investigation of novel males. Upon pair bonding, affiliative behavior with partners and neural activity in the NAc during these interactions increase, but these changes do not require Oxtr function. Conversely, males lacking Oxtr display increased prosocial investigation of novel females. Using the altered patterns of behavior and activity in the NAc of males lacking Oxtr during their first interactions with a female, we can predict their future preference for a partner or stranger days later. These results demonstrate that Oxtr function sex-specifically influences the early development of pair bonds by modulating prosociality and the neural processing of sensory cues and social interactions with novel individuals, unmasking underlying sex differences in the neural pathways regulating the formation of long-term relationships.

Previous Mode of Education and Future Learning Style Preferences among Medical students: A Cross-Sectional Study

Previous Mode of Education and Future Learning Style Preferences among Medical students: A Cross-Sectional Study

Testing a theory of strategic multi-product choice

This paper tests a theory of strategic multi-product choice (SMPC) using empirical evidence from a large-scale choice experiment, two smaller longitudinal choice experiments, and multi-market panel data. Multi-product choice involves two stages. In the first stage, the consumer chooses a set of substitutable products, where “set” refers to both the variety of alternatives and the quantities of each. In the second stage, the set is consumed. Assuming consumers are strategic, their consumption decisions will consider both the utility of whichever product is selected for consumption and the expected utility (i.e., value) of the set that remains. SMPC therefore requires a dynamic model. We test two such dynamic models in this paper. These models are derived from a basic random utility framework with a stochastic error term for the utility of each product alternative at the moment of consumption. Despite maintaining state variables for the quantity of every alternative, these SMPC dynamic models offer both a value function and optimal consumption policy in closed form. These structures allow us to test for strategic consumption in the second stage and for optimality of the choice sets selected in the first stage. Data from the large-scale choice experiment and the smaller longitudinal choice experiments support strategic consumer decision-making, consistent with SMPC theory. SMPC theory further predicts that the amount of variety consumers select will be higher for lower consumption rates and lower for higher consumption rates. Evidence from panel data of yogurt purchases supports this prediction. While we find that consumption choices are consistent with SMPC theory, they are not consistent with alternative explanations such as variety seeking or diversification bias. Viewed in its entirety, the empirical evidence presented in this paper confirms that both the choice set selected and the way it is consumed are consistent with dynamic models of future preference uncertainty.

Residents’ future residential preference and its affecting factors in the rapid urbanization zone of rural China from a family life cycle perspective

Understanding farmers’ future residential preferences and the factors affecting these choices is crucial for tackling the issues related to hollow village management and rural planning. Despite limited research on the role of the family life cycle, this study explores how the family life cycle, characteristics of the household head, livelihood strategies, and resource availability shape farmers’ future residential preferences. Data were collected from 777 households in China’s main grain-producing area. The findings reveal that 52.90% of households prefer to stay in their current rural residences. Other favored options are elderly care facilities (13.90%), living with children in the village (12.36%), and ancestral homes (11.68%). The family life cycle significantly affects these preferences (p < 0.01), with changes in family structure and age leading to different living choices. Specifically, households in the initial (71.29%), burden (70.32%), and stable stages (40.14%) prefer their current rural residences, while those in the maintenance and empty-nest stages opt for living with their children’s residences (22.22% and 16.96%, respectively) or in elderly care facilities (30.00% and 33.93%). Meanwhile, age, health, income, livelihood strategies, and land ownership also markedly influence the choice of residence. Recommendations include educational programs for elderly rural residents, improving older individuals’ adaptability to rural changes, creating more rural employment opportunities, and enhancing medical and infrastructural services for the sustainable rural development.

Ethical Challenges for Plastic Surgery in Treating Internationally Adopted Children With Cleft Lip and Palate.

A large number of children with cleft lip and palate (CLP) were adopted to Sweden in the last decade, mainly from China. Most of the children arrived with unoperated palates and at later ages than earlier years. This article aims to present an overview of ethical challenges within the practice of international adoption of children with CLP from the perspective of plastic surgery in a welfare health care system. An overview of CLP treatment is presented, followed by a normative discussion and ethical analysis using the 4 principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. The following themes and subthemes were analyzed: the search for normality and the potential challenge of being adopted and having CLP-treatment autonomy of the child and future preferences, adoptive parents' expectations of plastic surgery, the journey of the adoptee and the adoptive parents; and general issues-reconstructive possibilities and consequences of CLP in the country of origin, information to the adoptive parents, health care needs, and reconstructive possibilities for children with CLP in the receiving country. Clinical implications are discussed, and suggestions for future research are provided.