Individual Semi-structured Telephone Interviews Research Articles

Caring burden and coping with haemodialysis: a qualitative study with family caregivers in Sri Lanka

ObjectiveThe number of patients with end-stage kidney disease (ESKD) requiring renal replacement therapy in Sri Lanka is significantly rising. Most of these patients depend on haemodialysis, carrying a significant burden...

Patients’ experiences with participating in a team-based person-centred intervention for patients at risk of or diagnosed with COPD in general practice

BackgroundSymptoms and complications of chronic obstructive pulmonary disease (COPD) can affect daily activities and quality of life, and patients with COPD require long-term follow-up by their general practitioner. Providing patients with or at risk of COPD practical skills and motivation to improve their self-management is important. On this background, an interdisciplinary follow-up program was designed based on the Guided Self-Determination counselling method to facilitate problem-solving and mutual decision-making between healthcare professionals and patients. The aim of the study was to explore patients and healthcare professionals` experiences with the Guided Self-Determination-program to investigate feasibility issues.MethodsA qualitative design was used to get insights in the experiences of receiving the Guided Self-Determination counselling program. In total, 13 patients with COPD (mean age 71.7 ± 7.7 years) 4 were current smokers, and 7 at risk of COPD (mean age 54.1 ± 9.9 years) all current smokers, received the Guided Self-Determination program. The researchers performed individual semi-structured telephone interviews after the 12 months Guided Self-Determination program with two patients at risk of COPD, four patients with COPD, three nurses, and five general practitioners. The intervention consisted of structured consultations with the nurse and patient in collaboration with the general practitioner at baseline and after 3, 6, and 12 months. The Guided Self-Determination method comprised facilitation of a mutual reflection process between the patient and the nurse to enhance self-management skills. Each consultation lasted for 60 min. The interviews were analysed using thematic analyses.ResultsTwo themes were identified: (1) A structured follow-up is challenging but motivating. (2) A counselling method that opens for conversation, but it requires resources.ConclusionsThe findings indicated that patients with or at risk of COPD experienced enhanced self-management skills after participating in a structured and systematic team-based follow-up in general practice with use of the Guided Self-Determination method. The regularity of the follow-up seemed to be important to succeed to help the patients making lifestyle changes to increase health benefits. However, the Guided Self-Determination method was experienced as time consuming among the general practitioners and nurses, and there are currently no available financial rates for this type of treatment in Norway which may be a barrier to further implementation.Trial registrationThe trial is registered in ClinicalTrials.gov (ID: NCT04076384).

Family caregivers’ experiences of discussing their needs with a nurse during specialised home care utilizing the carer support needs assessment tool intervention - A qualitative study

PurposeThe Carer Support Needs Assessment Tool Intervention (CSNAT-I) was designed to help family caregivers identify, reflect upon, and express their support needs in a conversation with a health care professional and gain tailored support. The CSNAT-I has shown positive effects for both nurses and family caregivers but for more comprehensive understanding this study aims to examine family caregivers' experiences of discussing their needs with a nurse during specialised home care, utilizing the CSNAT-I. MethodsThe study used an inductive qualitative descriptive design based on framework analysis. Data was collected using individual semi-structured telephone interviews with 10 family caregivers, with a median age of 66, from four specialised home care services. ResultsFamily caregivers appreciated having scheduled meetings with nurses utilizing the CSNAT-I which gave them an opportunity to focus on what was important to them. Family caregivers experienced that the conversations were co-created with a flexible dialogue. The conversations provided new perspectives and insights which helped in finding possible solutions. Family caregivers felt empowered by the co-created conversation and took on a more active role in involving the rest of their family to find support to themselves and the patients. ConclusionThe CSNAT-I can facilitate communication between family caregivers and nurses leading to adequate supportive inputs. The intervention gives family caregivers an increased opportunity to be involved in their own support, which may enhance their sense of security. According to family caregivers’ experiences, CSNAT-I may be an adequate way to support family caregivers to reflect and discuss their needs.

Informal caregivers’ experiences of supporting patients with pancreatic cancer: A qualitative study in Greece

PurposeThe purpose of the present study was to explore informal caregivers’ experiences of supporting family members with pancreatic cancer. MethodsA qualitative descriptive study was conducted with individual semi-structured telephone interviews and inductive thematic analysis. Data were collected from 10 informal caregivers in the only cancer hospital in Northern Greece. ResultsThe findings of the thematic analysis highlighted three themes, “supportive needs of patients with pancreatic cancer”, “supportive needs of informal caregivers” and “evaluation of provided care”. In the first theme, four individual subcategories of themes emerged: “psychological support”, “managing symptoms and side effects”, “daily activities” and “participation in decision-making”. The theme “supportive needs of informal caregivers” consists of five sub-themes, “psychological support”, “support in care activities”, “financial support”, “communication with the patient” and “information”. Finally, the theme “evaluation of provided care” three sub-categories of topics were reported, “staff evaluation”, “process evaluation” and “palliative care”. ConclusionPancreatic cancer patients and their informal caregivers experience multiple unmet needs. The health system, lacking an efficient treatment for this type of cancer, should provide a basis for improving the quality of life of these families with targeted support interventions.

Perceptions and experiences of exercise among pregnant women

IntroductionThough exercise during pregnancy can yield important maternal benefits, most pregnant women in China do less aerobic exercise than is currently recommended. This qualitative study aimed to explore the perceptions and experiences of physical exercise among pregnant women and to identify perceived barriers to and facilitators of exercise participation. MethodsPurposive sampling was used to recruit 40 pregnant women attending prenatal visits at an obstetrics outpatient department of a tertiary general hospital in Southern China. Individual semi-structured telephone interviews were conducted with the verbatim transcripts analyzed through content analysis. ResultsThree main themes emerged from the data: perceptions and patterns of exercise; concerns and hesitations about participating in exercise; and determinants of adoption and maintenance of exercise participation. Though pregnant women recognised their need for physical exercise instruction, their demands remained unmet due to a combination of factors such as lack of knowledge, confidence, and support, and concerns about safety. DiscussionThe findings of this study suggest that the provision of tailored exercise programs for pregnant women, which include education, reassurance, motivational strategies, and lay and professional support, may help improve knowledge, allay concerns, boost confidence, and bolster support when doing physical exercise.

Perceptions of physical activity levels after a diagnosis of acute coronary syndrome and in the context of cardiac rehabilitation

Abstract Funding Acknowledgements Type of funding sources: None. Background Physical activity [PA] is a core component of cardiac rehabilitation [CR] but those who consider themselves active are less likely to participate. It is unclear how CR services can better engage with this group and what support they should offer to encourage a return to PA at appropriate levels. Purpose We aimed to identify individuals from four UK CR services who considered themselves active prior to acute coronary syndrome [ACS] diagnosis and understand their PA support requirements. Methods A sequential mixed methods study, with data collected between October 2019 and April 2020. A quantitative survey examined self-reported PA levels, illness perceptions, and physical self-concept of ACS patients using validated questionniaires after their event but before the start of CR. Data were analysed via descriptive, correlational, and multiple regression analysis. Qualitative individual semi-structured telephone interviews were conducted with participants who self-reported to be at least moderately active. Data were thematically analysed. Data were integrated during study design and discussion stage. Results Sixty-seven participants (male n=53, 79.1%) with a median age of 63 (IQR = 56-71) completed the survey. Of these, 50 (74.6%) self-reported being at least moderately active before starting CR. During regression analysis, only physical self-concept for being physically active (F (9,56)=3.59, p<.005, adjusted R2 0.26) was significantly associated with PA level. Twenty-six participants completed qualitative interviews. Participants who perceived that they were active prior to their event based this on recollections of past PA, and step count monitoring. They made decisions about whether to engage with CR based on pre-CR information and comparison with peers. Despite considering themselves to be active, this group still required support to return to PA at appropriate intensity levels to gain secondary prevention benefits. This included information about how to self-monitor intensity effectively. Conclusions CR services should recognise that ACS survivors who consider themselves to be active prior to their event require support to return to PA at appropriate levels. Support should include exploring what patients mean when they say they are active so that CR professionals are better informed to provide indivualised advice.

Patient experiences of remote hypertension management during covid-19: a qualitative study

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): British Heart Foundation. Background Telemonitoring of blood pressure [BP] managed within primary care is effective in reducing the risk of cardiovascular disease in patients with hypertension. However, COVID-19 disrupted service delivery and affected the support of people living with hypertension. It is unknown how patients who did or did not utilise telemonitoring self-managed their BP during the pandemic. Purpose To understand patients’ experience of hypertension service delivery in Scotland during the COVID-19 pandemic, with a focus on the use of remote BP telemonitoring technology. Methods Qualitative individual semi-structured telephone interviews were conducted between April and November 2022. Interview transcripts were analysed using the framework approach to code and categorise the data into key concepts and overarching themes. Results We interviewed 43 participants (23 males and 20 females) from 6 primary care practices. From the views of 25 patients utilising telemonitoring technology and 18 who did not, we identified five overarching themes that represented participants' experiences of hypertension services delivery during the COVID-19 pandemic. 1) Adapting NHS services. Covid-19 disrupted routine services and resulted in infrequent in-person health checks for BP, asthma, and diabetes for both groups and a lack of primary care feedback for non-telemonitored patients’ home-monitored BP. 2) Navigating access to services. Gaining timely and/or in-person access to services was challenging. Also there was fear and delay in access because it was viewed as a source of covid infection. 3) Telemonitoring. Remote telemonitoring permitted telemonitoring participants to continue receiving hypertension management during the pandemic. 4) Self-management of BP. Some non-telemonitoring participants were motivated to self-measure BP readings using home monitoring equipment to increase self-care for hypertension and lifestyle. Also, some telemonitoring participants were empowered to self-manage medication changes. 5) Experiences of covid. Upon contracting the covid-19 virus, some participants experienced an immediate increase in their BP, and post-virus, longer-term increased BP readings and/or feelings of chest discomfort and breathlessness. Conclusions The covid-19 pandemic disrupted care for patients with hypertension and although it was clear that service delivery had been adapted, patients were unwilling to access the NHS due to covid-19 risk and found access to effective primary care support difficult. When compared to non-telemonitoring, telemonitoring provided a more direct link to the primary care team who were able to manage hypertension remotely. The service disruption may have longer-term implications for patient health outcomes; however, this study suggests there is greater scope for self-management of hypertension than currently recommended.

Psychosocial and supportive care needs of individuals with advanced myeloma.

The purpose of this qualitative study is to understand, from the patient's perspective, their experience of living with advanced multiple myeloma, the psychosocial impact, and needs for support in managing and adapting to this illness. An interpretive descriptive approach was used. Individual semi-structured telephone interviews were conducted with each participant, which focused on eliciting their descriptions of psychosocial issues and concerns, as well as the supports they use for coping with cancer. Transcripts were analyzed using interpretive description, resulting in the generation of common themes that represented the data. The sample comprised twelve adults with a diagnosis of advanced multiple myeloma who had undergone at least three lines of treatment or were transfusion dependent. All participants were receiving ambulatory care for their myeloma in Toronto, Ontario, Canada. Four themes were generated: (1) confusion about the diagnosis and treatment options; (2) challenges in finding relevant information; (3) dealing with the chronicity of treatment side effects; (4) social support as critical for coping with the life-threat of multiple myeloma. Findings suggest that the psychosocial impact of living with advanced multiple myeloma is greatly impacted by one's ability to understand the complexities of the diagnosis and access supports to cope with its physical and emotional consequences. Clinical interventions specifically tailored to meeting the information and support needs of this population are needed.

Australian graduate radiographers' perspectives and experiences of work readiness.

Graduate radiographers entering their qualified positions need to orientate and familiarise themselves with a rapidly changing work environment to deliver a high standard of diagnostic imaging services. During this transitional phase, these newcomers also strive to meet self-expectations and workplace expectations. This study was performed to understand the work readiness perspectives and initial experiences of graduate radiographers on beginning their newly qualified roles. The study used a qualitative phenomenological approach to collect data through individual semi-structured in-depth telephone interviews with 14 purposively sampled undergraduate and postgraduate radiographers. The rich data were transcribed verbatim and then thematically analysed. Four major themes emerged: (1) preparing to be 'work-ready', (2) initial encounters as qualified radiographers, (3) personal and professional challenges and(4) support strategies and advice for new graduates. New graduate radiographers face many personal and professional challenges but agree that they thrive in supportive collegial environments. Most participants had a high perspective of their work readiness strongly related to their clinical placements as students, workplace familiarity, support networks and coping strategies. Further review into individual workplace orientations by organisation leaders may benefit the immersion and enhancement of graduate radiographers' initial experiences in their new role.

Cancer specialist nurses' experiences of supporting family members of persons diagnosed with colorectal cancer: A qualitative study.

The purpose of the present study was to explore cancer specialist nurses' experiences of supporting family members of persons diagnosed with colorectal cancer. The study was designed as a qualitative study. Data was collected using individual semi-structured telephone interviews with 21 cancer specialist nurses. The interviews were transcribed and analysed with reflexive thematic analysis. The analysis generated one overarching theme, In the shadow of the person diagnosed with colorectal cancer, and four themes: striving for confidence, searching for ways to support, seeking individualization, and balancing between needs. Swedish colorectal cancer care is organized with the persons diagnosed with colorectal cancer as the centre of care and lacks both structure and allocated resources for supportive care for family members. Thus, support for family members has to be provided within the existing colorectal cancer care. The support provided focuses mainly on strengthening the family members' ability in the caregiving role and is offered primarily at the time of diagnosis. There is an apparent need for developing supportive care plans for family members, involving repeated assessments of multidimensional needs, a tailored support, and follow-ups. Accordingly, a re-evaluation of the cancer specialist nurse's role is needed so that key nursing responsibilities are not ranked second to administrative tasks.

Patient Choice After Referral to Physical Therapy for Lower Back Pain and Knee Osteoarthritis

ObjectiveTo assess factors influencing Veterans' decisions to initiate physical therapy (PT) after referral for low back pain (LBP) or knee osteoarthritis (OA). DesignQualitative study using individual semistructured telephone interviews. SettingDurham Veterans Health Administration Health Care System. ParticipantsA total of 44 Veteran patients (N=44) aged 26-85 were referred for LBP or knee OA between January and August 2021. ResultsPatient-level factors influencing PT initiation included confusion with navigating the health system, efficacy beliefs about PT, and thoughts about physical therapists' ability to diagnose their pain. At the provider level, discussion about PT care appeared to increase initiation of PT. At the system level, influences included wait times, availability of appointments outside business hours, and easy-to-access locations. Motivational themes included respondents' symptoms and functional limitations that drove them to initiate care. Respondents suggested that changes to wait times through same-day or rapid appointments, assistance and increased ease of the scheduling process, transportation support, convenient care locations, and information about PT, including its benefits, could improve PT care access. ConclusionsThis study of patient perceptions of initiating PT care after referral identified tangible barriers to care at patient, provider, and system levels for respondents with LBP or knee OA. Patient knowledge and system-level barriers, including how challenging the system is to navigate, are major factors that reduce patients' use of PT after referral. Health systems and physical therapists should address barriers to care through patient education, scheduling assistance, and changes to the health care system, including options for same-day appointments.

Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study

BackgroundFamily member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PurposeTo explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. MethodQualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FindingsWe interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme ‘Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a ‘distance’ due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient’s wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. ConclusionVisiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members’ perceptions of distance and exclusion from the intensive care unit.

Male Farmers' Perspectives on Psychological Wellbeing Self-Management Strategies That Work for Them and How Barriers to Seeking Professional Mental Health Assistance Could Be Overcome.

This research aimed to explore the self-management strategies that Australian male farmers use to improve or maintain their psychological wellbeing and their views on what would assist them to overcome barriers to seeking professional mental health assistance. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed inductively using thematic analysis. Fifteen male farmers participated, who were an average of thirty-nine years of age (23–74 years) with twenty years of farming experience (5–57 years). Seven themes relating to self-management strategies were identified: (1) interacting with a supportive network; (2) involvement in groups and teams; (3) physical activity; (4) proactively educating themselves; (5) self-prioritising and deliberately maintaining work–life balance; (6) being grateful; and (7) focusing on the controllable aspects of farming. Five themes were identified that related to mitigating barriers to seeking mental health assistance: (1) actively welcoming mental health professionals into the community; (2) normalising help-seeking; (3) making seeking mental health assistance a priority; (4) offering services that are culturally appropriate and accessible for male farmers; and (5) tailoring mental health information delivery to farming populations. Australian male farmers already use strategies to maintain and improve their mental health that are culturally and contextually appropriate. These proactive strategies could form the basis of interventions aiming to further promote male farmers’ wellbeing. Barriers to seeking professional mental health assistance may be overcome by implementing solutions directly suggested by male farmers. Given the elevated risk of suicide in this group, investment in trialing promotion of these strategies is warranted.

Acceptability of multimodal pelvic floor physical therapy to treat dyspareunia after gynecological malignancies: a qualitative study of women’s views and experiences

Introduction and hypothesisMultimodal pelvic floor physical therapy (PFPT) is recommended after gynecological malignancies to treat dyspareunia. However, data to strongly support its implementation in the cancer care continuum are lacking. The aim of this study was to explore the views and experiences of gynecological cancer survivors with dyspareunia regarding the acceptability of multimodal PFPT.MethodsThis qualitative study was conducted with the participants (n = 28) of a study investigating a 12-week multimodal PFPT treatment. Individual semi-structured telephone interviews served to collect qualitative data pertaining to women’s views and experiences of the treatment they received. Interviews were recorded and transcribed for analysis using the interpretative description framework.ResultsOur cohort described the appropriateness of the treatment in terms of modalities, physical therapist, care delivery, and intensity (Theme 1). While the intensity was reported as demanding by a few, all participants stressed that it was relevant to see significant improvements (Theme 2). In addition to the treatment characteristics and women’s beliefs and attitudes, noticing the treatment effects motivated their participation (Theme 2). Women expressed being highly satisfied with the treatment based on their positive experiences and the balance between their efforts and the results they obtained (Theme 3). As a result, they all recommended this treatment (Theme 3).ConclusionsThis is the first study to examine the acceptability of multimodal PFPT in the context of gynecological malignancies. This treatment was found acceptable and can be offered to gynecological cancer survivors.

Women's Experiences of Dyspareunia after Gynecological Cancer Treatment and Care-seeking Behavior: An Insight from a Qualitative Study

ABSTRACT Introduction Dyspareunia frequently affects women after gynecological cancer treatment. The focus of previous studies has been on the biomedical factors contributing to dyspareunia in this population. To our knowledge, no study has yet examined the biopsychosocial factors associated with women's experiences of dyspareunia after gynecological cancer treatment. Moreover, cancer survivors appear to refrain from seeking care despite the consequences of dyspareunia. Objective The aim of this study is to examine gynecological cancer survivors’ experiences of dyspareunia and factors influencing their care-seeking behavior. Methods A nested qualitative study was performed with the participants of a clinical trial investigating a multimodal pelvic floor physical therapy intervention. This enabled a comprehensive understanding of women's experiences and care-seeking behavior, including factors that could influence whether they seek care as well as their decision to undertake treatment. Women were included in the trial if they had completed endometrial or cervical cancer treatment and if they had experienced a minimum vulvovaginal pain intensity of 5 out of 10 during most intercourse attempts for at least 3 months. Individual semi-structured telephone interviews were conducted. The questions pertaining to women's experiences and factors influencing their care-seeking behavior were constructed based on the Common-Sense Model of Self-Regulation (i.e., identity, timeline, causes, consequences, and control attributes). The interviewer adopted a biopsychosocial perspective of health to approach these topics during the interviews. Interviews were recorded and transcribed for analysis using the interpretative description framework. Results Of the 31 women included in the trial, 28 (90%) participated in the qualitative study. The participants had been diagnosed with different cancer stages and had received various treatments. For all participants, dyspareunia occurred after cancer treatment and persisted for a median time of 3 years (ranging from 3 months to 11 years). Loss of libido, lower vaginal lubrication, and reduced vaginal cavity were reported by women as contributing factors to dyspareunia. Participants explained how dyspareunia and these changes led them to engage in less, and even to interrupt, sexual activity. They also expressed that they were distressed, felt like less of a woman, and experienced low control and/or self-efficacy. Several women described that their condition had an impact on their relationship with their partner. Regarding factors influencing women's care-seeking behavior, participants emphasized that they were provided with insufficient information and support. Other barriers included balancing priorities, denial or reluctance, misbeliefs, resignation and acceptance, and negative emotions. Facilitators reported by women included acknowledgement of sexual dysfunction, desire for improvement, awareness of treatment possibilities, willingness to undertake treatment, and treatment acceptability. Conclusions Women's experiences of dyspareunia after gynecological cancer treatment highlight the complexity of this condition, which involves biopsychosocial factors. The related consequences described by women also stress the importance of appropriate management. As the current study provides insight to guide the provision of services, efforts should focus on promoting the facilitators and overcoming the barriers to seeking care for sexual dysfunction after gynecological cancer treatment. Disclosure No

Patient-Family Experience at the Onset of COVID-19: Interviews with Ten Palliative Chaplains.

Background: As thousands of patients, often with complex care needs, were hospitalized due to the coronavirus disease 2019 (COVID-19) pandemic, demand for palliative care was magnified. Part of hospitals' palliative care teams, palliative chaplains delivered emotional support while specializing in the religious, spiritual, and the existential aspects of care. With COVID-19 containment measures increasing isolation and disrupting supportive family connections, the emotional and spiritual well-being of the patients and families were unclear. Objectives: Through the unique perspectives and insights of inpatient palliative care chaplains, we sought to qualitatively capture their perceptions and the patient-family experience as the pandemic emerged. Setting/Subjects: This investigation was based in the United States. Design: Individual semistructured telephone interviews (n = 10) were conducted between April 22 and May 6, 2020. Through thematic analysis, analyses progressed through initial coding sessions, refining a codebook, identifying representative quotes, and recognizing themes. Results: Five themes were identified and described through the coding process and recognizing representative quotes: (1) visitor restrictions-patients, (2) visitor restrictions-families, (3) religious struggle, (4) spiritual distress, and (5) decision making. Conclusions: Inpatient palliative care chaplains were active interprofessional partners caring for patients and families as the uncertainty of the pandemic unfolded. The crises of this pandemic magnified chaplain specialization as they attended to emotional, spiritual, and religious suffering and as well as complex decision making with patients and their family members.

“I never went to see that doctor again”: A qualitative study examining Australian women's experiences requesting removal of LARC within 12 months of insertion

ObjectivesRemoval or discontinuation of long-acting reversible contraception (LARC) requires cooperation of healthcare providers. The objective of this study was to explore young women's experiences when they request removal of LARC within 12 months of insertion. Study designWe conducted a qualitative study using individual semi-structured telephone interviews with women living in Victoria, Australia. We recruited participants using physical and online advertising flyers. We audio-recorded and transcribed interviews and thematically analyzed the data. ResultsFifteen women participated in an interview. The experience of unacceptable side effects prompted “early” LARC removal in all cases. The non-autonomous nature of LARC removal was not considered by women pre-insertion and participants reported confidence in their ability to access LARC removal when requested. Although satisfaction was reported when LARC was removed on request, participants reported negative feelings towards their healthcare provider when there was perceived pressure to continue with LARC for longer than desired. This had implications for the patient-clinician relationship. Women experienced resistance to removal as a challenge to their bodily autonomy and this resulted in a loss of trust in health services. ConclusionResistance to removal of LARC can damage the patient-clinician relationship and be experienced as a challenge to women's autonomy and reproductive rights. ImplicationsPatients have confidence in their ability to get their LARC removed on request and autonomy is not largely considered prior to LARC initiation. Supportive removal services should be emphasized for women who request removal of LARC at any point after insertion in order to maintain trust in healthcare providers and health services.

Men's experiences of sex and intimacy after prostate cancer treatment in China: a qualitative study.

PurposeWhile the existing knowledge base on the impact of prostate cancer (PC) and its treatment on sexuality and intimacy has been generated from Western populations, there is a lack of such evidence in the Asian context. This study aimed to explore men’s experiences of sex and intimacy after PC treatment in China.MethodsThis study adopted an interpretive descriptive design. Using purposive sampling, 13 PC patients were selected from a urology outpatient unit of a hospital in South China and proceeded with individual semi-structured telephone interviews. Each interview was transcribed verbatim and analyzed using constant comparison analysis.ResultsFour themes emerged from the interview data, including (a) encountering altered sexuality, (b) communication and sexual adjustments, (c) maintenance of quality intimate relationship, and (d) lack of sexual health support.ConclusionsThe findings revealed that PC treatment significantly impaired patients’ sexual functions, and their sexual health needs were mainly unmet by healthcare providers. There is a great need to design culturally relevant interventions to improve sexual health among this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06720-w.

Understanding and addressing psychological distress experienced by farmers, from the perspective of rural financial counsellors.

To explore rural financial counsellors' experiences interacting with psychologically distressed farmers and identify contextually appropriate methods to maintain their own well-being and link farmers to psychological supports, within their existing roles. Rural, regional and remote Australia. Fifty rural financial counsellors participated. They worked across 6 Australian states/territories. Individual semi-structured telephone interviews were audio-recorded with consent. Qualitative data were analysed using thematic analysis. Themes were identified using an essentialist, bottom-up approach. Forty-six themes emerged relating to the 5 topics explored: (a) how to recognise distress in farmers (eg inability to focus/make decisions, deterioration in presentation/organisation, anger, blaming); (b) impact of farmers' psychological distress on the financial case management process (eg slows, disrupts or stops it, negatively impacts counsellor well-being); (c) strategies for working effectively with distressed farmers (eg flexibility, open-ended questions, listening to story, simplicity, instilling hope); (d) referral of distressed farmers to psychological support (eg willing if tried themselves/positive reports, lack of local rural face-to-face services, stigma and lack of understanding of importance challenging, a farming focus and support from family/ community assists); and (e) strategies to maintain their own well-being (eg compartmentalising, exercise, supervision). Rural financial counsellors play an important role by recognising signs of distress in farmers and referring them to appropriate psychological supports. However, this is a demanding role and ensuring counsellors have appropriate services to refer farmers to, and support with their own well-being, is imperative.

Clinicians\u2019 experiences of using and implementing a medical mobile phone app (QUiPP V2) designed to predict the risk of preterm birth and aid clinical decision making

BackgroundAs the vast majority of women who present in threatened preterm labour (TPTL) will not deliver early, clinicians need to balance the risks of over-medicalising the majority of women, against the potential risk of preterm delivery for those discharged home. The QUiPP app is a free, validated app which can support clinical decision-making as it produces individualised risks of delivery within relevant timeframes. Recent evidence has highlighted that clinicians would welcome a decision-support tool that accurately predicts preterm birth.MethodsQualitative interviews were undertaken as part of the EQUIPTT study (The Evaluation of the QUiPP app for Triage and Transfer) (REC: 17/LO/1802) which aimed to evaluate the impact of the QUiPP app on management of TPTL. Individual semi-structured telephone interviews were used to explore clinicians’ (obstetricians’ and midwives’) experiences of using the QUiPP app and how it was implemented at their hospital sites. Thematic analysis was chosen to explore the meaning of the data, through a framework approach.ResultsNineteen participants from 10 hospital sites in England took part. Data analysis revealed three overarching themes which were: ‘experience of using the app’, ‘how QUiPP risk changes practice’ and ‘successfully adopting QUiPP: context is everything’. With these final themes we appeared to have achieved our aim of exploring the clinicians’ experiences of using and implementing the QUiPP app.ConclusionThis study explored different clinician’s experiences of implementing the app. The organizational and cultural context at different sites appeared to have a large impact on how well the QUiPP app was implemented. Future work needs to be undertaken to understand how best to embed the intervention within different settings. This will inform scale up of QUiPP app use across the UK and ensure that clinicians have access to this free, easy-to-use tool which can positively aid clinical decision making when caring for women in TPTL.Clinical trial registry and registration numberISRCTN 17846337, registered 08th January 2018, https://doi.org/10.1186/ISRCTN17846337.