Confidence Of Healthcare Professionals Research Articles

Concordance between General Practitioners and Radiation Oncologists for Cancer Follow-Up Care.

(1) Background: Patients treated with radiotherapy require follow-up care to detect and treat acute and late side effects, and to monitor for recurrence. The increasing demand for follow-up care poses a challenge for specialists and general practitioners. There is a perception that general practitioners do not have the specialised knowledge of treatment side effects and how to manage these. Knowing the concordance between general practitioner and oncologist clinical assessments can improve confidence in healthcare professionals. This study aimed to measure the level of agreement between general practitioners and radiation oncologists using a standardised clinical assessment; (2) Methods: a cross-sectional clinical practice study; sample aim of 20 breast, prostate or colorectal patients, three years post-radiotherapy treatment; their general practitioner and radiation oncologist; (3) Results: There was acceptable percent agreement (>75%) and a moderate to almost perfect agreement (Fleiss kappa) for all variables between the 15 general practitioner-radiation oncologist dyads; (4) Conclusions: The general practitioner and radiation oncologist concordance of a clinical follow-up assessment for radiation oncology patients is an important finding. These results can reassure both general practitioners and oncologists that general practitioners can provide cancer follow-up care. However, further studies are warranted to confirm the findings and improve reassurance for health professionals.

Use of preventive measures, beliefs and information received about COVID-19 and their effects on mental health, in two stages of the pandemic in Colombia

Background Several studies have highlighted the effects of the COVID-19 pandemic on both physical and mental health. The aim of this study is to analyse the effects on mental health in two phases of the COVID-19 pandemic (April 2020 and February 2021) in the population of Colombia. Methods Observational, prospective, cross-sectional study along two periods, April 2020 and February 2021. The sample (N = 1309) was extracted from the Colombian population, only including individuals over the age of 18 and residing in Colombia during the pandemic. The IMPACTCOVID-19 questionnaire was used, previously validated in Spain and cross-culturally adapted to the Colombian population, which included sociodemographic data, use of preventive measures, information received and the Goldberg General Health Questionnaire (GHQ-12) for psychological distress (PD). Participants had to sign an informed consent before taking part in the investigation. Results A higher level of PD was observed among women (M = 3.99, SD = 3.39) (p < .001), in those who lived without a partner (M = 3.83, SD = 3.47) (p = .036), and in those with a worse perception of health (M = 6.27, SD = 3.51) (p < .001). PD decreased in the second period from M = 3.99 (SD = 3.36) to M = 2.98 (SD = 3.30) (p < .001), coinciding with a higher use of preventive measures, less distress caused by COVID-19 and greater confidence in healthcare professionals and clinical structures. In the second period, the time spent in getting informed decreased, but the sources of information were the same, principally social media and official sources. Conclusions Better information on the effects and preventive measures to prevent the pandemic improves confidence in the health system and its professionals, reducing the level of PD. There is a need for quality information on social networks and an adaptation of telemedicine to address the pandemic effects on mental health. Key messages Psychological distress (PD) decreased in February 2021, as compared to April 2020, due to a greater use of preventive measures against COVID-19, and the confidence on the recommendations made by health officials and professionals. Higher PD has been found in women and people who lived without a partner, in line with studies performed in other countries. The accessibility to quality information on the pandemic should be promoted by the Official Health Authorities, thus counteracting data that could be classified as “fake news”.

The angels and heroes of health care: Justified and appropriate, or harmful and destructive?

The angels and heroes of health care: Justified and appropriate, or harmful and destructive?

Barriers to help-seeking from healthcare professionals amongst women who experience domestic violence\xa0-\xa0a qualitative study in Sri Lanka

BackgroundDomestic violence (DV) is a major global public health problem which is associated with significant adverse consequences. Although Sri Lankan women who experience DV receive treatment from healthcare professionals (HCPs) for DV related physical and psychological problems, disclosure of DV within health services is quite low. This study explored barriers to disclosure of DV to HCPs among Sri Lankan women who experience DV.MethodThis qualitative study took place in the Central Province of Sri Lanka. Twenty women who had experienced DV were recruited from Gender Based Violence Centers (Mithuru Piyasa Centers) and a toxicology unit of the two selected hospitals. Participants were purposefully selected using maximum variation sampling technique. In-depth interviews were conducted until data saturation was reached. Interviews were recorded, and analyzed using thematic analysis.ResultsSurvivor related barriers to help seeking included women’s lack of knowledge and perceptions about the role of HCPs, lack of confidence in HCPs, fear of repercussions, personal attitudes towards DV, and their love and loyalty towards the perpetrator. Women preferred it if HCPs initiated discussions about DV, and they valued it when HCPs could be confidential and protect their privacy, and give enough time for DV related issues during consultations. A perpetrator related barrier was the controlling behavior of the perpetrator. Social stigma and social and cultural norms about the role of women emerged as the socio-cultural constraints to disclosure.ConclusionsBarriers to help seeking for DV from HCPs exist at individual, healthcare level, and societal level. Community programs are needed to increase women’s access to healthcare services and interventions should be implemented to develop effective, preventive, and supportive strategies at the healthcare system level.

Rehabilitation healthcare professionals\u2019 competence and confidence in differentially diagnosing deafblindness from autism spectrum disorders: a cross-sectional survey in South Africa

BackgroundEarly diagnosis and management of children who are deafblind is important to alleviate the effects of deafblindness on the development of the child who is deafblind and their families. However, children who are deafblind are often misdiagnosed or diagnosed late. The misdiagnosis or late diagnosis has been attributed to many factors, one of which is the competence and confidence of healthcare professionals in differentially diagnosing deafblindness from other conditions, in most cases, autism spectrum disorder (ASD). The study therefore aimed to establish the competence and confidence of rehabilitation healthcare professionals in differentially diagnosing deafblindness from ASD in the South African context.Methods A cross-sectional survey design was employed for the study. An online questionnaire was distributed to rehabilitation healthcare professionals (N = 78) via Survey Monkey. Data were analyzed using descriptive and inferential statistics. Ethical clearance and permission were obtained from relevant stakeholders prior to the commencement of the study.Results Regarding the rehabilitation healthcare professionals in this study, 54% were competent in diagnosing ASD, while only 35% could correctly diagnose deafblindness. In some instances, symptoms were classified as associated with both ASD and deafblindness, when they were just those of deafblindness. Of all the rehabilitation healthcare professionals in this study, speech language therapists displayed the most knowledge of deafblindness. Furthermore, healthcare professionals who had between one and nine years of working experience had more knowledge of deafblindness than other professionals with more or less experience.ConclusionDeafblindness is often underdiagnosed or misdiagnosed as ASD. This is due to the lack of competence and confidence of rehabilitation healthcare professionals in diagnosing it. The findings therefore highlight the need for training of rehabilitation healthcare professionals. Training on deafblindness could be included as part of the curriculum in the various undergraduate programs. Deafblindness could also form part of the Continuous Professional Development (CPD) training programs at various healthcare facilities. A team approach to the training would be ideal as it would facilitate peer learning and support. More research is required as it would inform evidence-based assessment, and management and support strategies for children who are deafblind and their families.

Exploring Uniformity of Clinical Judgment: A Vignette Approach to Understanding Healthcare Professionals' Suicide Risk Assessment Practices.

Suicide risk assessment often requires health professionals to consider a complex interplay of multiple factors, with a significant reliance on judgment, which can be influenced by factors such as education and experience. Our study aimed at assessing the uniformity of decision making around suicide risk within healthcare professionals. We used a factorial survey approach to gather information on healthcare professionals' demographics, clinical experience, and their decision on 3 vignettes of patients with suicidal ideation. We used Kruskal-Wallis tests for determining if there were significant differences between groups for continuous variables and Spearman rank correlation for measuring the association between continuous variables. Content analysis was used for analyzing free-text comments. Responses were gathered from 79 healthcare professionals (nurses, nurse practitioners, physicians) who worked in primary care, mental health, or emergency department settings. Median suicide risk rates across all respondents were 90%, 50%, and 53% for vignettes 1, 2, and 3, respectively. Confidence in healthcare professionals' decisions was significantly associated with the clinical designation and personal risk profile of the healthcare professional in certain vignettes, with nurses and those willing to take more risks having a higher confidence in their decisions for vignettes 1 and 3, respectively. Treatment decision was significantly associated with mental health experience (i.e., those with lengthier mental health experiences were less likely to choose "admit to psychiatry ward" for vignette 2), clinical designation (i.e., nurses were more likely to "admit to psychiatry ward" for vignette 1), and practice setting. It should be noted that these associations were not consistent across all 3 vignettes, and results for each association were only specific to 1 of the 3 vignettes. Findings compare decision-making practices for suicide risk assessment across several types of healthcare professions over a range of practice settings, with the high-risk vignette showing the least variability. Insights from this study are relevant when building clinical decision support systems for suicide risk assessment. Designers should think about incorporating tailored messaging and alerts to health professionals' mental health experience and/or designation. Within our Canadian sample, there was considerable variability among healthcare professionals assessing the risk of suicide, with important implications for tailoring education and decision support.

Why is corneal donation so rare in children's hospices? A survey of multidisciplinary team members attitudes, knowledge, practice, and experience.

Corneal donation is a rare event among pediatric patients dying in children's hospices in Italy. Previous research suggests that lack of knowledge and negative attitude of Health Care Professionals (HCPs) are the most relevant factors for low donation rates in hospice, rather than patient ineligibility or public refusal. We conducted a national survey to explore children's hospice staff's knowledge and attitude toward corneal donation, to survey HCPs confidence in discussing the subject with patients and families, to investigate whether staff members receive specific training about corneal donation and its potential impact on the willingness to raise the topic with patients and families. An anonymous web-based survey with multiple-choice responses was delivered to the team members of seven Italian children's hospices to test their knowledge and attitude about corneal donation. Of the seven children's hospices approached, four agreed to participate with a response rate of 48.5%. Among respondents, 70% declared that they had not received specific training about corneal donation. Results of statistical analysis showed that there were no significant differences in responses between trained and non-trained staff and among the different professionals (nurses, doctors, psychologists, AND social workers) regarding confidence in discussing the subject with patients and families. In our sample of HCPs working in Italian children's hospices, there was no difference in self-reported trust between professionals who reported receiving specific cornea donation training and those who did not. It is remarkable that training on corneal donation was endorsed by a minority of the sample.

A 10-hours workshop improves physical activity prescription for mental illness knowledge and confidence in health care professionals: a nation-wide multicentre study from Uganda

Purpose Lack of knowledge about and confidence in physical activity (PA) prescription for people with mental illness are important barriers for clinical practice in low-income countries. The aim of this study was to evaluate whether a 10-hour workshop improved the knowledge and confidence in PA prescription among health care professionals in 13 regional referral hospitals across Uganda. Material and methods 260 health care professionals (age = 40.4 ± 10.8 years; 48% women; 63.8% nurses, 10% social workers, 8.1% psychologists, 7.3% medical doctors, 5.8% psychiatrists, 5% physical or occupational therapists) completed the Exercise in Mental Illness Questionnaire – Health Professionals Version (EMIQ-HP) pre- and post-workshop. Results The EMIQ-HP PA knowledge score (3.1 ± 0.7 versus 1.3 ± 1.3, p < 0.001, Cohen’s d = 1.28, 95% confidence interval, CI = 1.04–1.52, i.e., large effect) and EMIQ-HP confidence in PA prescription score (3.0 ± 0.8 versus 1.2 ± 1.2, p < 0.001, Cohen’s d = 1.14, 95% CI = 0.91–1.36, i.e., large effect) improved significantly following training. Significantly more benefits and fewer barriers to prescribing PA in busy low-resourced settings were reported. Conclusions Training in PA counselling improved the knowledge and confidence in PA prescription in Ugandan health care professionals. Future research should investigate whether PA uptake in people with mental illness can be improved via additional training of health care professionals. IMPLICATIONS FOR REHABILITATION The majority of mental health professionals never recommend physical activity to their patients in low-resourced settings and increased awareness is needed to improve rehabilitation programs. Training in prescribing physical activity using the 5A framework improves knowledge about physical activity prescription in mental health professionals at all levels of care. Training in prescribing physical activity using motivational interviewing improves confidence in physical activity prescription in rehabilitation programs. Training in prescribing physical activity reduces perceived barriers for prescribing in rehabilitation programs in low-resourced settings.

Barriers to Evidence-Based Treatment Decision-Making in Acute Myeloid Leukemia: A Quality Improvement Initiative Across Community Oncology Practices

BackgroundAvailability of molecularly targeted therapies has rapidly changed the treatment landscape for acute myeloid leukemia (AML). With these newer treatment choices, healthcare professionals (HCPs) must consider appropriate uses of molecular testing, treatment selection based on testing results, new sets of adverse events (AEs), and an increased need for patient education and shared decision-making (SDM). In this quality improvement (QI) initiative, we assessed barriers to evidence-based treatment planning for patients with AML in 4 community oncology systems and conducted team-based audit-feedback (AF) sessions within each system to facilitate HCP goal setting to mitigate identified barriers.MethodsThe QI initiative was conducted between Dec. 7, 2020 and Feb. 10, 2021. Initially, 14 hematology/oncology HCPs completed baseline team-based surveys to assess barriers in 4 community oncology systems (Table 1). To address identified gaps, 43 HCPs in the 4 systems participated in AF sessions. Action plans were developed by the clinical teams based on survey results (Table 1). Additional pre- and post-surveys completed before and after the AF sessions measured changes in participants' confidence and competence.ResultsOn the pre-activity surveys, the most common challenges in AML management were: 1) identifying which treatment options are most appropriate (30%), 2) coordinating with other members of the care team (24%), 3) gaining/maintaining access to new therapies (15%), and 4) integrating molecular testing information into treatment decisions (15%) (Figure 1). After the 4 AF sessions, HCPs prioritized addressing these 4 challenges. In the baseline surveys, HCPs identified additional staff/resources (64%) and additional staff training/education as top resources needed to overcome these challenges.HCPs identified additional challenges in the areas of AE management and patient centered care in the baseline surveys. Identified barriers in patient centered care, specifically, shared decision making (SDM), included not enough time to engage in SDM (57%) and patients' low health literacy (57%). After the 4 AF sessions, HCPs prioritized addressing tailoring treatment decisions to achieve patient goals (42%), coordinating follow-up visits with other care team members (32%), and engaging patients in shared decision-making (21%) as goals for improving patient-centered care.Molecular testing emerged as a key challenge in AML treatment planning over the course of the QI initiative. Pre-activity, only 36% of HCPs expressed high confidence (4/5 Likert scale) in identifying which molecular tests should be ordered to guide treatment planning, and similarly only 36% were highly confident in selecting targeted therapies based on actionable mutations. HCPs also expressed dissatisfaction with ordering and timely receipt of molecular testing results in their systems. In post-activity surveys, over twice as many HCPs selected molecular testing as a challenge they were planning to address within their team (37% compared with 15% pre-activity), suggesting increased awareness of this barrier (Figure 1). Pre- to post-activity, HCPs who self-reported use of targetable mutations as an important factor in planning treatment for patients who are not candidates for induction therapy increased from 27% to 63%.Participation in the QI initiative led to improvements in clinician confidence and competence in molecular testing, treatment selection based on molecular results, AE management, and use of SDM (Figure 2).ConclusionsHCPs participating in this QI initiative identified barriers and potential areas for improvement in AML treatment planning, including barriers related to molecular testing, treatment selection and access, AE management, and patient-centered care. Participation in the AF sessions led to measurable improvements in HCP confidence and competence in key areas of AML management which may ultimately improve the quality of AML care in the community.Study Sponsor StatementThe study reported in this abstract was funded by an independent educational grant from Genentech. The grantor had no role in the study design, execution, analysis, or reporting. [Display omitted] DisclosuresBlum: Abbvie: Honoraria; AmerisourceBergen: Honoraria; Forma Therapeutics: Research Funding; Leukemia and Lymphoma Society: Research Funding; Celyad Oncology: Research Funding; Nkarta: Research Funding; Xencor: Research Funding; Syndax: Honoraria. Fathi: Seattle Genetics: Consultancy, Honoraria; Astellas: Consultancy, Honoraria; Daiichi Sankyo: Consultancy, Honoraria; Blueprint: Consultancy, Honoraria; Pfizer: Consultancy, Honoraria; Celgene/BMS: Consultancy, Honoraria, Research Funding; Takeda: Consultancy, Honoraria; Agios: Consultancy, Honoraria, Research Funding; Servier: Research Funding; AbbVie: Consultancy, Honoraria, Research Funding; Genentech: Consultancy, Honoraria; Trillium: Consultancy, Honoraria; Kura: Consultancy, Honoraria; Foghorn: Consultancy, Honoraria; Kite: Consultancy, Honoraria; Morphosys: Consultancy, Honoraria; Ipsen: Consultancy, Honoraria. Pollyea: Takeda: Honoraria; Syros: Consultancy, Honoraria; Syndax: Honoraria; Novartis: Consultancy, Honoraria; Kiadis: Honoraria; Aprea: Honoraria; Astellas: Honoraria; Bristol Myers Squibb: Honoraria; Celgene: Honoraria; Foghorn: Honoraria; Genentech: Consultancy, Honoraria; Gilead: Consultancy, Honoraria; Jazz: Honoraria; Karyopharm: Consultancy, Honoraria; Amgen: Honoraria; AbbVie: Consultancy, Honoraria, Research Funding; Teva: Research Funding.

A Peer and Volunteer Program for Patients and Their Families in the Pediatric Intensive Care Unit: A Pilot Program Evaluation.

Introduction: Patients in the pediatric intensive care unit (PICU) are at risk of developing long-term morbidities following recovery from their critical illness. One such health outcome is called post-intensive care syndrome (PICS). PICS in pediatrics may be mitigated by interventions that facilitate adjustment to the PICU setting.Methods: The PICU implemented a two-pronged Peer and Volunteer (P/V) Program to help: (a) families adjust to the PICU experience with the support of a peer mentor (PM); and (b) patients receive non-medical interaction from trained volunteers (V). We designed a mixed-methods program evaluation targeting perspectives and feedback from PICU families and healthcare professionals (HCPs).Results: All stakeholder groups agreed that the PICU P/V Program was a valuable resource for PICU patients and their families. HCPs reported that they lack both time and training to provide regular developmental care to patients. However, the P/V Program may influence both families' and HCP's confidence in their ability to offer non-medical interaction to children in the PICU.Discussion: Important initial and on-going strengths and barriers to successful implementation were identified, including the need to clarify roles and intervention scope. The program evaluation served as a change management strategy and also helped to identify both areas for improvement and strategies for on-going sustainability. HCP's exposure to the program and modeling by PMs may have helped HCPs to feel that it is within their job description and capacity to provide emotional support and guidance to families.

Pain Management and Opioid Therapy: Persistent Knowledge Gaps Among Primary Care Providers.

IntroductionGiven the opioid epidemic in the US, it is vital that clinicians who prescribe opioids for pain management to do so in an evidence-based manner, eg considering all pharmacologic and non-pharmacologic options, assessing risk of opioid use disorder prior to initiating opioids. Continuing education regarding the evidence-based prescribing of opioids is now required for US healthcare providers who prescribe opioids. A “blueprint” of the content to be included in continuing education programs was developed by the US Food and Drug Administration and updated in 2018.MethodsTo understand the baseline knowledge and confidence of healthcare professionals in prescribing opioids for pain management, we posed 27 unique knowledge-based questions and 1 confidence question to clinician participants before or during 2 continuing educational programs that were based respectively on the 2016 and 2018 FDA Risk Evaluation and Mitigation Strategy (REMS) educational blueprints for pain management.ResultsOverall, 5571 clinicians completed these programs, including 1925 physicians (1516 [79%] identifying as primary care), 1181 physician assistants, 737 advanced practice nurses, 719 nurses, and 479 pharmacists. Responses to pretest questions in both programs indicated profound and persistent gaps in knowledge, particularly in definitions and mechanisms of pain, general principles of pharmacologic analgesic therapy, and specific aspects of opioid analgesic therapy and addiction. Participants in both programs also expressed limited confidence in their abilities to incorporate patient engagement techniques into pain management or develop a treatment plan for a patient with chronic pain.DiscussionThese data support an ongoing need for comprehensive clinician-based education as outlined in the FDA REMS educational blueprint, especially given recent data of escalating overdose deaths during the COVID-19 pandemic.

Evaluation of a Neonatal Resuscitation Training Programme for Healthcare Professionals in Zanzibar, Tanzania: A Pre-post Intervention Study.

Background: Neonatal mortality rates remain high in Sub-Saharan African countries. Improving the newborn resuscitation skills of healthcare professionals is important in addressing this challenge. The aim of this study was to evaluate a neonatal resuscitation training programme delivered over a two-year period for healthcare professionals in Zanzibar, Tanzania.Methods: A pre- and post-intervention study was designed. We delivered neonatal resuscitation training over a 2-day period in 2017 and 2 days of refresher training in 2018. Knowledge was evaluated by a self-designed survey (11 items with a total score of 22) before and after the two training periods, and skills were evaluated by a skills checklist (six domains with 25 items with a total score of 50) completed by the trainers based on their observations. Statistical analysis included differences in the knowledge and skills scores before and after the training sessions and between the two periods.Results: A total of 23 healthcare professionals participated and completed both neonatal resuscitation training sessions. The knowledge mean scores before and after the training in 2017 increased from 9.60 to 13.60 (95% CI: −5.900; −2.099, p < 0.001), and in 2018, the scores increased from 10.80 to 15.44 (95% CI: −6.062; −3.217, p < 0.001). The mean knowledge scores post-training over time were 13.60 in 2017 and 15.44 in 2018 (95% CI: −3.489; 0.190, p = 0.030). The resuscitation skills performance between the two time periods increased from a mean of 32.26 (SD = 2.35) to a mean of 42.43 (SD = 1.73) (95% CI: −11.402; −8.945, p < 0.001).Conclusion: The neonatal resuscitation training programme increased the theoretical knowledge and resuscitation skills before and after the two training sessions and over time after a 9-month period. Continuous neonatal resuscitation training based on the local needs in resource-limited countries is essential to provide confidence in healthcare professionals to initiate resuscitation and to improve newborn outcomes.

143-LB: Changes in Perceptions and Confidence of Health Care Professionals across Medical Specialties Regarding Use of SGLT2 and GLP-1 for Cardiorenal Benefit in Type 2 Diabetes

Sodium-glucose cotransporter (SGLT2) inhibitors and glucagon like peptide 1 (GLP-1) receptor agonists have been demonstrated to provide cardio-renal benefits in patients with type 2 diabetes (T2D). Little is known about confidence and perceptions of healthcare professionals (HCPs) across medical specialties to utilize these agents in clinical practice. An online survey was conducted among a national sample of 1,006 physicians, nurse practitioners, and physician assistants in cardiology, endocrinology, nephrology, and primary care. They were asked about current and past perceptions and confidence in prescribing SGLT2s and GLP-1s for cardio-renal benefit. Survey results were analyzed using weighting for gender, region, and practice type. Participants were 56% male, 53% had &amp;gt;10 years of experience, and 32% saw &amp;gt;100 patients/month with T2D. Two-thirds of HCPs reported greater confidence now in prescribing SGLT2s compared to one year ago, with highest proportions among cardiologists (77%) and nephrologists (76%). Over half of HCPs (55%) were more confident now compared to one year ago with prescribing GLP-1s. A greater proportion of participants felt HCPs across all specialties are more responsible now for prescribing SGLT2s and GLP-1s compared to one year ago. Specifically, cardiologists (84%) and nephrologists (76%) felt their own specialties are now responsible for prescribing these agents for cardio-renal protection. These results suggest confidence to prescribe SGLT2s and GLP-1s for cardio-renal benefit has recently increased among medical specialties involved in T2D care. Lower HCP confidence to prescribe GLP-1s compared to SGLT2s may be due to the injectable mode of administration for GLP1s. These results also indicate a growing perception that prescribing these agents is not just the responsibility of a single specialty but is a shared responsibility across the T2D care team. Disclosure D. Zytnick: None. R. Woolley: None. M. Bruns: None. C. M. Shay: None.

Global approaches to cardiogenetic evaluation after sudden cardiac death in the young: A survey among health care professionals.

Thorough investigation of sudden cardiac death (SCD) in those aged 1-40 years commonly reveals a heritable cause, yet access to postmortem genetic testing is variable. The purpose of this study was to explore practices of postmortem genetic testing and attitudes of health care professionals worldwide. A survey was administered among health care professionals recruited through professional associations, social media, and networks of researchers. Topics included practices around postmortem genetic testing, level of confidence in health care professionals' ability, and attitudes toward postmortem genetic testing practices. There were 112 respondents, with 93% from North America, Europe, and Australia/New Zealand, and 7% from South America, Asia and Africa. Only 30% reported autopsy as mandatory, and overall practices were largely case by case and not standardized. North American respondents (87%) more often perceived practices as ineffective compared to those from Europe (58%) and Australia/New Zealand (48%; P = .002). Where a heritable cause is suspected, 69% considered postmortem genetic testing and 61% offered genetic counseling to surviving family members. Financial resources varied widely. Half of participants believed practices in their countries perpetuated health inequalities. Postmortem genetic testing is not consistently available in the investigation of young SCD despite being a recommendation in international guidelines. Access to postmortem genetic testing, which is critical in ascertaining a cause of death in many cases, must be guided by well-resourced, multidisciplinary teams.

82 Person-Centred Emergency Care Outcome Measurement For Older People Living with Frailty

IntroductionHealth outcome goals are the results individuals seek from healthcare. These may incorporate holistic themes including function, mood, and quality of life. People living with frailty have poorer outcomes from even short hospital stays. They benefit from person-centred, goal-directed care over protocol-driven pathway approaches. This could be improved by monitoring attainment of health outcome goals.MethodsA systematic review for older people’s health outcome goals in emergency care was conducted using narrative synthesis. A qualitative study based on grounded theory expanded the outcome framework to include people living with frailty. People with cognitive and communication barriers were included in semi-structured interviews. Discussions focussed on the events and outcomes sought from emergency care.ResultsOlder people’s health outcome goals for emergency care were classified as efficient and comprehensive care, sensitivity towards vulnerability, and person-centred informed care. The importance of understanding individual perceptions was explicit. Research generally recruited based on age rather than physiological and functional state, and did not assess for impact of frailty on healthcare perceptions. The interview study was paused due to the COVID-19 pandemic. Initial results showed a predominance of person-centred and holistic care themes among health outcome goals. Participants’ most common goal for emergency care was relief of symptoms: people often had pain. Participants mostly had severe frailty and wanted their mobility to be assessed, with goals of recovering their functional baseline. While participants had confidence in healthcare professionals and were generally willing to “do as we are told to feel better”, they expected to undergo at least basic tests in order to receive a working diagnosis for their problem. People wanted to understand their illness and for explanations to be communicated to their relatives. Next steps Patient-reported outcome measures (PROMs) for this range of emergency care outcomes are being identified for field-testing in acute settings.

Introducing a low-risk breast screening pathway into the NHS Breast Screening Programme: Views from healthcare professionals who are delivering risk-stratified screening.

Objectives:Proposals to stratify breast screening by breast cancer risk aim to produce a better balance of benefits to harms. Notably, risk estimation calculated from common risk factors and a polygenic risk score would enable high-risk women to benefit from more frequent screening or preventive medication. This service would also identify low-risk women who experience fewer benefits from attending, as lower grade and in situ cancers may be treated unnecessarily. It may therefore be appropriate for low-risk women to attend screening less. This study aimed to elicit views regarding implementing less frequent screening for low-risk women from healthcare professionals who implement risk-stratified screening.Methods:Healthcare professionals involved in the delivery of risk-stratified breast screening were invited to participate in a focus group within the screening setting in which they work or have a telephone interview. Primary care staff were also invited to provide their perspective. Three focus groups and two telephone interviews were conducted with 28 healthcare professionals. To identify patterns across the sample, data were analysed as a single dataset using reflexive thematic analysis.Results:Analysis yielded three themes: Reservations concerning the introduction of less frequent screening, highlighting healthcare professionals’ unease and concerns towards implementing less frequent screening; Considerations for the management of public knowledge, providing views on media impact on public opinion and the potential for a low-risk pathway to cause confusion and raise suspicion regarding implementation motives; and Deliberating service implications and reconfiguration management, where the practicalities of implementation are discussed.Conclusions:Healthcare professionals broadly supported less frequent screening but had concerns about implementation. It will be essential to address concerns regarding risk estimate accuracy, healthcare professional confidence, service infrastructure and public communication prior to introducing less frequent screening for low-risk women.

Healthcare professional awareness of eating disorders in people with type 1 diabetes: a staff survey

Background: People with type 1 diabetes are at increased risk of eating disorders. ‘Diabulimia’, ‘Syndrome of Insulin Omission’ and ‘Type 1 diabetes and Disordered Eating’ (T1DE) are all terms used to describe the omission or restriction of insulin in type 1 diabetes for fear of weight gain. For consistency, Type 1 diabetes and Disordered Eating (T1DE) is used throughout this article. The condition is associated with a significant increase in morbidity and mortality but is not yet recognised as a unique entity.Aim: To determine healthcare professional awareness and knowledge of eating disorders in type 1 diabetes.Methods: A short, cross-sectional, online healthcare professional survey across primary, secondary and community settings.Results: Healthcare professional confidence is low when it comes to recognising and supporting people with T1DE, but there is an interest in learning more.Conclusion: The findings from this study support strategies to improve healthcare professional awareness of T1DE.

Are UK healthcare professionals equipped to provide information and support on Human Papillomavirus to patients diagnosed with cancer of the head and neck?

AbstractAim:Incidence rates of Human Papillomavirus (HPV) positive head and neck cancer (HNC) are increasing. The aim of this study was to explore the availability of information and the knowledge and confidence of healthcare professionals (HCPs) involved in the cancer pathway to provide information on HPV to patients.Materials and method:An online questionnaire was designed using closed and open questions to investigate the availability of patient information for patients diagnosed with HPV-associated HNC; health professional’s knowledge of the information available; and their confidence in discussing the topic. The questionnaire was advertised to health professionals through the British Association of Head and Neck Oncologists website. Twenty-five health professionals from six professions across five UK Cancer Alliances completed the questionnaire between November and December 2018.Results:Nearly half of the participants did not know whether patients were routinely provided with information on HPV following an HPV-positive (HPV+) cancer diagnosis; 52% indicated that specific information was available within their hospital trust, however, there were inconsistencies with participants’ knowledge of the content of the information leaflets currently available. On a scale of 1–100, the mean confidence in providing HPV-related information was 58.Findings:Inconsistencies appear to exist with respect to information about HPV available to patients presenting with HNC. A need has been identified for the education of health professionals involved in the patient care to support information provision.

Preoperative concerns of patients undergoing general surgery

ObjectivesThis qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period. MethodsMedline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden’s methodology. Results27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients’ trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs’ credibility and capabilities. ConclusionPatients’ preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered. Practice implicationsPreoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients’ fear and anxiety.

Information on COVID-19 and Psychological Distress in a Sample of Non-Health Workers during the Pandemic Period.

Methods by which the population should be informed when going through a pandemic such as COVID-19 have been questioned because of its influence on the adoption of preventive measures and its effects on mental health. Non-health workers are at risk of psychological distress from exposure to contaminated people or materials or by having to stay at home and adapt their activity to telework. The objective of the study is to analyze information the public receives about COVID-19 and its influence on their level of distress. For this, 1089 questionnaires from non-health workers were collected online between 26 March and 26 April 2020 in Spain, and analysed and distributed by snowball effect. 492 participants carried out essential activities away from home, and 597 did so from home. They were surveyed about information received about COVID-19 regarding its source, time, assessment, or the beliefs expressed in it. Mental health was also measured with Goldberg’s General Health Questionnaire (GHQ-12). The classification and regression tree (CART) method was used to design a binary tree with sample cases. It has been found that the time spent learning about COVID-19 and the level of knowledge about symptoms, pathways, prevention, treatment, or prognosis are associated with the level of distress, where 25% of participants were found to have spent more than 3 h daily on this activity. Social media and television are the most widely used sources, but they are considered to be of lower quality and usefulness than official sources. There is greater confidence in healthcare professionals than in the health system, and the main concern of those working away from home is spreading the virus to family members. It has been concluded that there is a need to enhance quality and truthful information on the Internet for non-health workers due to its accessibility, which should be constantly updated, a fact which international and national public bodies, research centers, and journal publishers have begun to understand during the current pandemic. Such quality information is needed to combat distress.