Team Meetings Research Articles

IRAMP: Investigation of Risk Assessment and Management Processes Using Datix Report Analysis and Observation of Clinical Team Meetings

IRAMP: Investigation of Risk Assessment and Management Processes Using Datix Report Analysis and Observation of Clinical Team Meetings

Nursing Experience of A Young Girl with IgA Nephropathy who Received Initial Hemodialysis

<p>本文為一位青少女因IgA腎病初次接受血液透析治療，疾病進展快速，使個案及案父母產生焦慮及照護認知不足之護理經驗。護理期間自2020年06月15日至07月10日，運用Gordon十一項健康功能型態評估，以直接照護、會談、身體評估及跨科部會議等方式收集資料，確立個案健康問題有:營養不均衡、焦慮、照顧者角色緊張。照護過程中，透過陪伴、傾聽與案家建立信任之護病關係，藉由飲食日誌設計個別性菜單、透過跨科部會議調整飲食攝取模式，以改善營養不均衡；利用漫畫繪本、健康管理工具，提升自我照護技能，減輕其焦慮；同理父母心理壓力，討論照護工作之分配、喘息減壓方式，降低照顧負荷，使個案學會自主健康管理，進而達到親子共責之健康管理模式。因應蔬食飲食人口的增加，建議偕同營養師設計「透析素食菜單」，讓病人保有自己喜好的飲食模式，以增加疾病的適應性，藉此護理經驗作為日後照護此類病人之參考。</p> <p> </p><p>We reported a young girl who began to receive hemodialysis due to IgA nephropathy. Our nursing experience focus on her and her parents’ anxiety and lack of caring cognition due to rapidly progressive disease. During our nursing period from June 15th to July 10th, 2020, we used the “Gordon 11 Function Health Patterns” to collect data by direct care, interviews, physical examination and multi-disciplinary discussion. We found that our case had health problems including nutritional imbalance, anxiety and caregiver role strain. Furthermore, we established a trusting relationship by accompany, listening and building trust with her family. We used diet diaries to create individualized menu, used interdisciplinary team meetings to improve nutritional imbalances, and used comic books and health management tools to improve self-care skills and reduce anxiety. We empathized with parents’ psychological pressure, discussed the distribution of care work, provided respite care, reduced care load, taught her self-health management and then achieved the health management model of parent-child shared responsibility. In response to the increase in the population of vegetarian, we designed a "vegetarian menu for dialysis" with our dietitian. Therefore, the patients could maintain their own dietary preference to increase the adaptability to diseases. We took this nursing experience as a reference for the care of such patients in the future.</p> <p> </p>

Improving Quality of Multidisciplinary Team Meetings in Our Community Mental Health Team in NHS Greater Glasgow and Clyde, Scotland

Improving Quality of Multidisciplinary Team Meetings in Our Community Mental Health Team in NHS Greater Glasgow and Clyde, Scotland

Developing a manual clinical trials screening process in a diverse southern gynecologic oncology practice in the Deep South.

e23209 Background: At this time, there is no standard clinical trial screening process or definition that has been adopted within Gynecologic Oncology. In our low resource, highly diverse Gynecologic Oncology patient population, we sought to create an equitable, adaptable, manual screening process that better reflected our patient population. Our objective is to describe our clinical trial screening process and our success in improving trial enrollment and a matched trial portfolio. Methods: An IRB-approved, QI project was implemented in July 2022 to evaluate trial access for Gyn Onc patients. First, screenable events were defined as: the start of one’s first scheduled visit, bi-monthly tumor boards, weekly pre-op meetings, and by keeping track of on a shared Epic list. Potential patients were those with a screenable event: new patients or diagnoses, regimen changes, progressions, and recurrences. Events were categorized into screen positive or screened no trial available. Screen positives were further categorized as screen fail, screen positive, enrollment failure, or enrolled. Data about patients was collected via weekly research team meetings. Monthly meetings occurred to review progress. This data was compared to trials available, number of patients with trail available, and those that enrolled. Reasons for enrollment fails were tracked to improve access and anticipate barriers. Results: Overall demographic data of patients was collected. The average age of participants was 60.67 years (SD = 13.45), and the average distance to a treatment center was 59.27 miles (SD = 137.43). Other demographics are presented in Table 1. For each month, the percentages of “screen no trial available (SNTA)” events and patients who screened positive and did enroll on trial were recorded. Over time, SNTA rates stayed stable, but enrollment increased. Patient preference accounted for 32.8% of enrollment fails (n = 42), pre-existing symptoms/conditions accounted for 23.4% (n = 30), and distance/location accounted for 21.1% (n = 27). During a time of high employee turnover in the summer months of 2023, there was a rise in enrollment fails due to staffing (n = 6, 4.7%). Conclusions: Through a collaborative quality initiative, we describe an effective process of clearly defining and tracking our patient population and ‘screenable events’ for which all patients are screened and offered trial participation if eligible. We show that we improved understanding of the patient population, built a clinical trial portfolio better matched to population served, exceeded national averages for enrolling patients on trials, and are moving toward improved number eligible over time. [Table: see text]

On the Page and Off the Page: Adolescents’ Collaborative Writing in an After-School Spoken-Word Poetry Team

Using case study methodology, this article analyzes the collaborative writing of three adolescent girls, one Latina and two Black, composing a group poem in an after-school spoken word poetry team. Drawing from literature on distributed cognition and embodiment, we found that participants utilized a system of writing techniques “on the page,” as well as a variety of embodied and social practices “off the page” in their team meetings to collaboratively compose this poem. We argue that focusing on the intersection of distributed cognition and embodiment in collaborative writing allows writing researchers to more fully attend to the collaborative sociality of all writing and allows teachers to support youth writers in recognizing and gaining collaborative writing skills for professional and creative writing contexts.

Implementation of the Responsibilities of Land Deed Making Officials in Requesting Proof of BPHTB Payment and Reporting BPHTB Taxes to the Regional Revenue Agency (Central Lombok District Study)

BPHTB is part of the tax payable in every transaction to acquire land and building rights. In Law Number 1/2022 concerning Regional Taxes and Regional Levies, Regencies/Cities are given the authority to collect 11 types of Regional Taxes, including BPHTB. The conditions for collecting these 11 types of Regional Tax are unique in practice, where in collecting BPHTB tax, BAPENDA chooses to hold a team meeting to determine the value of the tax object, while PPAT feels that it is ineffective and inefficient when determining the value of BPHTB tax (Land Rights Acquisition Fee). carried out through team meetings, therefore it is necessary to review the Articles and Regulations related to regional taxes and levies, so that the BPHTB tax value is no longer carried out based on team meetings, this is one of the causal factors If PPAT does not report BPHTB to BAPENDA, if PPAT does not report every 10th of every month, it will be considered as not reporting for a year, and BAPENDA as the regional government will impose sanctions on the PPAT in the form of administrative sanctions, namely paying a fine of Rp. 10,000,000, through empirical normative research and interpretation of primary, secondary and tertiary legal materials, it can be concluded that there is a misconception between the Notary/PPAT and BAPENDA Central Lombok, where this administrative sanction has been in effect since 16 July 2023 which is contained in article 60 PP 35/2023, which requires PPAT to carry out BPHTB tax reporting.

Multidisciplinary team meeting Chairs' attitudes and perceived facilitators, barriers and ideal improvements to meeting functionality: A qualitative study.

Oncology care provision by multidisciplinary teams (MDTs) is widely acknowledged as best practice. Formal team meetings, led by chairpersons, coordinate decisions on diagnosis, staging, treatment planning, and review. This study addresses a gap in meeting Chairs' perspectives on factors affecting functionality across the meeting cycle, from pre-meeting patient list triage to post-meeting dissemination of recommendations. Semi-structured interviews were conducted in person with Chairs within two urban geographical regions in New South Wales, Australia as part of a larger project. Though the population of oncology MDT Chairs in Australia is small, the richness and depth of data from nine Chairs were considered to be valuable knowledge in support of extant literature on meeting functionality. An integrated deductive-inductive approach was applied to data analysis. Perceived facilitators, barriers, and ideals relating to pre-meeting, in-meeting, and post-meeting functionality were identified across five pre-determined analytic categories: the team; meeting infrastructure; meeting organization and logistics; patient-centered clinical decision-making, and; team governance. Key barriers included inadequate information technology, limited support staff, and lack of dedicated time for Chair duties. Corresponding facilitators included robust Information Technology infrastructure and support, provision of clinically knowledgeable MDT meeting coordinators, and formal employment recognition of Chairs' responsibilities and skill sets. Chairs across various tumor streams develop workarounds to overcome barriers and ensure quality meeting outcomes. With more robust support they could enhance value by sharing evidence, conducting audits, and engaging in research. The findings highlight the need for healthcare systems to support tumor stream clinical networks by allocating greater resources to prioritize multidisciplinary meetings and cancer care decision-making.

Expertise Development at Work: A Workplace Curriculum Perspective in the Domains of Sales Representatives and Leadership Coaches in a German Context

Context: Active engagement and participation in professional practices are an important requirement for expertise development in vocational domains. However, not much is known about how work contexts foster or hinder such expertise development. To further fill this research gap, this study investigates two vocational domains, namely sales representatives and leadership coaches, using the Workplace Curriculum Approach. This approach focuses on three aspects. First, how novices get access to certain tasks. Second, which tasks at work are especially conducive to learning, referred to as pedagogically-rich activities. Third, what knowledge is hard-to-learn through practice alone. By focusing on these three aspects, the Workplace Curriculum Approach helps to understand learning. Method: Eleven highly competent sales representatives and ten highly competent leadership coaches from German organizations participated in an interview study. A thematic qualitative text analysis was applied using deductive and inductive coding. Results: For sales representatives, task sequencing is different across organizations due to structural factors, particularly products, and infrastructure. Ideally, apprentices start by getting to know the customers by selling products on site at a counter and by getting to know the products in the warehouse. challenging interactions with customers on the phone are most conducive to learning. The scope of the product portfolio and the amount of technical knowledge are hard to learn. Leadership coaches are encouraged by peers to start at team leader and smaller team levels before moving on to more senior executives and larger team levels. Weekly team meetings offer important social learning opportunities similar to informal discussions among peers. Methodological and organizational knowledge are hard to learn. Conclusion: Regardless of differences between both domains, the Workplace Curriculum Approach proved useful for analyzing learning and expertise development in the different workplace contexts. The approach proved to be a fairly tangible and easy-to-use tool to investigate how workplaces support expertise development and how workplace learning regimes might be changed to further foster novices’ learning and development. Researchers and practitioners alike can utilize the Workplace Curriculum Approach to analyze learning in different domains in their respective organization. However, individual factors of the learners such as motivation to participate in activities in the workplace are not explicitly included in this approach to investigate professional learning and development. They should be of additional focus in any study interested in vocational expertise development.

SupporTive Care At Home Research (STAHR) for patients with advanced cancer: Protocol for a cluster non-randomized controlled trial.

Advancements in the treatment and management of patients with cancer have extended their survival period. To honor such patients' desire to live in their own homes, home-based supportive care programs have become an important medical practice. This study aims to investigate the effects of a multidimensional and integrated home-based supportive care program on patients with advanced cancer. SupporTive Care At Home Research is a cluster non-randomized controlled trial for patients with advanced cancer. This study tests the effects of the home-based supportive care program we developed versus standard oncology care. The home-based supportive care program is based on a specialized home-based medical team approach that includes (1) initial assessment and education for patients and their family caregivers, (2) home visits by nurses, (3) biweekly regular check-ups/evaluation and management, (4) telephone communication via a daytime access line, and (5) monthly multidisciplinary team meetings. The primary outcome measure is unplanned hospitalization within 6 months following enrollment. Healthcare service use; quality of life; pain and symptom control; emotional status; satisfaction with services; end-of-life care; advance planning; family caregivers' quality of life, care burden, and preparedness for caregiving; and medical expenses will be surveyed. We plan to recruit a total of 396 patients with advanced cancer from six institutions. Patients recruited from three institutions will constitute the intervention group, whereas those recruited from the other three institutions will comprise the control group.

Bias in team decision-making for advanced heart failure therapies: model application

ABSTRACT Bias in advanced heart failure therapy allocation results in inequitable outcomes for minoritized populations. The purpose of this study was to examine how bias is introduced during group decision-making with an interprofessional team using Breathett’s Model of Heart Failure Decision-Making. This was a secondary qualitative descriptive analysis from a study focused on bias in advanced heart failure therapy allocation. Team meetings were recorded and transcribed from four heart failure centers. Breathett’s Model was applied both deductively and inductively to transcripts (n = 12). Bias was identified during discussions about patient characteristics, clinical fragility, and prior clinical decision-making. Some patients were labeled as “good citizens” or as adherent/non-adherent while others benefited from strong advocacy from interprofessional team members. Social determinants of health also impacted therapy allocation. Interprofessional collaboration with advanced heart failure therapy allocation may be enhanced with the inclusion of patient advocates and limit of clinical decision-making using subjective data.

The patient's perspective on participation in a multidisciplinary team meeting: A phenomenological study.

In mental health care settings, inpatients are increasingly engaged in their care process, allowing them to participate in multidisciplinary team meetings. Research into how mental health patients (MHPs) experience participating in such meetings is, however, limited. This study aimed to explore inpatients' experiences when participating in multidisciplinary team meetings in a Belgian inpatient mental health unit. This study used a phenomenological design with data collection including semistructured interviews. Twelve individuals participated in the study. Participants were MHPs admitted to a mental health unit that works according to the model of recovery-oriented mental health practice. Findings were analysed utilising thematic analysis. Results showed that the MHPs' experiences were mainly positive but intense. Themes included: 'Feeling honoured to be invited', 'Sense of obligation', 'Feeling nervous', 'Transparency in team members' insights', 'Feeling supported by the (primary) nurse' and 'Duality about the presence of relatives'. By taking these findings into account, (mental) healthcare workers gain insight into the patient's lived experiences, allowing them to provide more person-centred care when inpatients participate in multidisciplinary team meetings. Moreover, these findings can support mental health units in implementing or optimising patient participation in multidisciplinary team meetings. Finally, other (mental health) patients can also benefit from these findings as it can help them to put feelings and thoughts into perspective when participating in a multidisciplinary team meeting during a hospital admittance.

Abstract PO5-11-01: Audit of multidisciplinary team meetings for improving breast cancer care

Abstract Introduction: Multidisciplinary team (MDT) meeting is a well-established method of optimising care for breast cancer patients. However, its effectiveness has not been proven yet. The present study aims to audit the functioning of MDT at a tertiary care hospital in a low-middle income country. Methods: This study examines the prospectively maintained database of patients being discussed in MDT meetings occurring from August 2018 till June 2023. The MDT was suspended for few months in between owing to the COVID pandemic. The analysis was done in terms of indications of discussion, referring department, modification in the pre-MDT plan, new investigation advised, radiological and pathological concordance, significant change in management strategy and interesting cases. The analysis is both qualitative and quantitative. Quantitative analysis involves percentages, mean and median. Results: MDT at our institute was conducted every Saturday at 12 noon as an in-person meeting. The MDT was suspended from May 2020 till June 2021 in view of the pandemic. It was restarted in July 2021, on an online platform and is continued as such. A total of 473 cases were discussed with 181 (38.2%) benign causes and rest were malignant. The most common indication of discussion for malignant cases was feasibility of breast conservation (59.9%) followed by ruling out recurrence/residual disease (17.4%). The indication for benign cases was rad-path concordance and ruling out phyllodes in a case of fibroepithelial lesion. In 31.4% of the cases the plan was modified from the pre-MDT plan and there was improved care. 34.7% cases were advised to get a new investigation done in form of contrast enhanced mammogram or MRI. Seventy nine percent cases were feasible for BCS, and it was done involving few complex surgeries as well. The most common indication for deferring BCS was extensive DCIS. The total number of man hours spent in preparation as well as MDT were analysed with improved clinical care and revealed the MDT to be a time intensive exercise with poor efficacy in terms of hours spent per patient. The time to decision making was increased at an average of 7.5 days for these patients. Conclusion: MDT helps to achieve goals of superior clinical care for both benign and malignant breast disorders at the cost of increased time to decision. It is labour intensive with capability of changing decision in one third of the cases. However, MDT needs regular audit to ensure optimum care with available resources. Citation Format: Kanika Sharma, Gopal Puri. Audit of multidisciplinary team meetings for improving breast cancer care [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-01.

Memorial Regional Hospital Placenta Accreta Spectrum Program: Quality Evaluation of Outcomes [ID 2683637

INTRODUCTION: Placenta accreta spectrum (PAS) affects 1/272 deliveries with a mortality rate of 7%, which is often related to life-threatening hemorrhage. Morbidity related to PAS is often due to complications such as hemorrhage requiring blood transfusion, intensive care unit (ICU) admission, and prolonged hospital stay. The American College of Obstetricians and Gynecologists supports a multidisciplinary approach to management of pregnancies complicated by PAS, and as such our protocol for management of PAS was started in 2016. Our approach to the management of PAS includes a high-risk navigation team, monthly multidisciplinary team meetings, early admission for surgical planning, a dedicated team with 24-hour coverage, blood bank specialist involvement at the time of surgery, the availability of backup surgeons, and coordination with other surgical subspecialties. METHODS: This project is a quality review of outcomes of 216 females between 2016 and 2023. Using linear regression analysis, we evaluated four primary outcomes: quantitative blood loss (QBL), blood products transfusion (BPT), length of stay (LOS), and ICU admissions. RESULTS: Linear regression outcomes showed that our QBL, BPT, and LOS among non-ICU patients is lower than the national average and within national average among those admitted to the ICU, with the exception of BPT. Finally, placenta pathology and location may not be a major factor negatively affecting surgical outcomes among PAS patients in a structured program and should be a factor considered when developing PAS centers. CONCLUSION: Our findings from our quality review support the use of a multidisciplinary and surgically structured approach for managing patients with PAS.

Time estimates in prognostic discussions: A conversation analytic study of hospice multidisciplinary team meetings

Background: Recommendations state that multidisciplinary team expertise should be utilised for more accurate survival predictions. How the multidisciplinary team discusses prognoses during meetings and how they reference time, is yet to be explored. Aim: To explore how temporality is conveyed in relation to patients’ prognoses during hospice multidisciplinary team meetings. Design: Video-recordings of 24 hospice multidisciplinary team meetings were transcribed and analysed using Conversation Analysis. Setting/participants: A total of 65 staff participating in multidisciplinary team meetings in a UK hospice from May to December 2021. Results: Team members conveyed temporality in three different ways. (i) Staff stated that a patient was dying as part of the patient’s current health status. These formulations did not include a time reference per se but described the patient’s current situation (as dying) instead. (ii) Staff used specific time period references where another specific reference had been provided previously that somehow constrained the timeframe. In these cases, the prognosis would conflict with other proposed care plans. (iii) Staff members used unspecific time period references where the reference appeared vague and there was greater uncertainty about when the patient was expected to die. Conclusions: Unspecific time period references are sufficient for achieving meaningful prognostic talk in multidisciplinary teams. In-depth discussion and accurate prediction of patient prognoses are not deemed a priority nor a necessity of these meetings. Providing precise predictions may be too difficult due to uncertainty and accountability. The lack of staff pursuing more specific time references implies shared knowledge between staff and a context-specific use of prognostic estimates.

Factors influencing effective data sharing between health care and social care regarding the care of older people: a qualitative evidence synthesis.

Sharing data about patients between health and social care organisations and professionals, such as details of their medication, is essential to provide co-ordinated and person-centred care. While professionals can share data in a number of ways - for example, through shared electronic record systems or multidisciplinary team meetings - there are many factors that make sharing data across the health and social care boundary difficult. These include professional hierarchies, inaccessible electronic systems and concerns around confidentiality. Data-sharing is particularly important for the care of older people, as they are more likely to have multiple or long-term conditions; understanding is needed on how to enable effective data-sharing. To identify factors perceived as influencing effective data-sharing, including the successful adoption of interventions to improve data-sharing, between healthcare and social care organisations and professionals regarding the care of older people. MEDLINE and seven further databases were searched (in March 2023) for qualitative and mixed-methods studies. Relevant websites were searched and citation-chasing completed on included studies. Studies were included if they focused on older people, as defined by the study, and data-sharing, defined as the transfer of information between healthcare and social care organisations, or care professionals, regarding a patient, and were conducted in the United Kingdom. Purposive sampling was used to obtain a final set of studies which were analysed using framework synthesis. Quality appraisal was conducted using the Wallace checklist. Stakeholder and public and patient involvement groups were consulted throughout the project. Twenty-four studies were included; most scored highly on the quality appraisal checklist. Four main themes were identified. Within Goals, we found five purposes of data-sharing: joint (health and social care) assessment, integrated case management, transitions from hospital to home, for residents of care homes, and for palliative care. In Relationships, building interprofessional relationships, and therefore trust and respect, between professionals supported data-sharing, while the presence of professional prejudices and mistrust hindered it. Interorganisational Processes and procedures, such as a shared vision of care and operationalisation of formal agreements, for example data governance, supported data-sharing. Within Technology and infrastructure, the use of technology as a tool supported data-sharing, as did professionals' awareness of the wider care system. There were also specific factors influencing data-sharing related to its purpose; for example, there was a lack of legal frameworks in the area of palliative care. Data-sharing was usually discussed in the context of wider initiatives, for example integrated care, which meant the information provided was often limited. The COVID-19 pandemic has had significant impacts on ways of working; none of our included studies were conducted during or since the pandemic. Our findings indicate the importance of building interprofessional relationships and ensuring that professionals are able to share data in multiple ways. Exploration of the impact of new technologies and ways of working adopted as a result of the COVID-19 pandemic on data-sharing is needed. Additionally, research should explore patient experience and the prevention of digital exclusion among health and social care professionals. The protocol was registered on PROSPERO CRD42023416621. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR135660), as part of a series of evidence syntheses under award NIHR130538, and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 12. See the NIHR Funding and Awards website for further award information.

Exploring the role of the pharmacist within the Hospital@Home team at a tertiary centre in England

Abstract Introduction Hospital@Home (H@H) is an emerging healthcare model providing hospital-level care within patients’ homes (1). Despite its global presence for three decades, H@H adoption remains limited in the United Kingdom. The COVID-19 pandemic prompted National Health Service (NHS) England to promote virtual wards, including H@H, as an innovative care alternative (2). Among the pivotal functions in H@H are prescribing, administering, or stopping medications, where pharmacists play a critical role, undertaking these tasks along with the multidisciplinary team (MDT). However, there has been little research that investigates pharmacists’ scope of practice in H@H. Aim To explore the role of the pharmacist within the H@H team at a tertiary centre in England. Methods A qualitive study was conducted using 1) online (via Microsoft Teams) or in-person audio-recorded semi-structured interviews with pharmacists working in the tertiary centre’s H@H team, and 2) non-participant observations of purposively sampled MDT H@H team meetings; heart failure, general care and antibiotic. Pharmacists’ collaboration with MDT members, tasks they performed and how the MDT made decisions were the focus of the observations. Interview transcripts and observation field notes were concurrently analysed inductively to generate key themes. All three H@H pharmacists were approached to take part in the study. All members of the respective MDTs were recruited to take part in the observations. All participants gave informed consent. Results All three H@H pharmacists participated in interviews. Six MDT meetings were observed, attended by doctors (n=7), nurses (n=8) and pharmacists (n=3). Interviews lasted approximately 45 minutes each and MDT meetings lasted 30-120 minutes. Four main themes were generated from the analysis: 1. Scope of practice extends beyond a “traditional” pharmacist. 2. Being open-minded to a changing scope of practice. 3. Active collaboration with MDT members underpins and expands role. 4. Is intentional about, and advocates for the provision of patient-centered care. Pharmacists’ varied scope of practice (e.g. participating/co-leading MDT meetings and conducting home visits) placed them in pivotal roles in patient care coordination, treatment planning, and decision-making. Pharmacists were open-minded and proactive in expanding the scope of H@H care, and their role. They continuously acquired new skills as they encounter and provide diverse care scenarios. Their specialised knowledge and skillsets were viewed by the MDT as an asset. Pharmacists were reflective practitioners, saw patients as complex individuals with specific needs to care for and advocated for their needs. Conclusion To our knowledge, this is the first study exploring the role of the H@H pharmacist in England, adding to the knowledge base in this emerging service delivery; pharmacists undertake non-traditional clinical roles in the team, work collaboratively with others to expand the service and their own skillset, to advocate for the need of patients. Although only three pharmacists were interviewed, this was the entire available sample. The study did not include home visit observations, which could provide insights into pharmacists’ interactions with patients in their homes. Future research can focus on complementing the findings of this study with in-depth exploration of the pharmacist’s role in H@H settings.

Impact of the new rectal cancer definition on multimodality treatment and interhospital variability: Results from a nationwide cross-sectional study.

This study aimed to determine the consequences of the new definition of rectal cancer for decision-making in multidisciplinary team meetings (MDT). The new definition of rectal cancer, the lower border of the tumour is located below the sigmoid take-off (STO), was implemented in the Dutch guideline in 2019 after an international Delphi consensus meeting to reduce interhospital variations. All patients with rectal cancer according to the local MDT, who underwent resection in 2016 in the Netherlands were eligible for this nationwide collaborative cross-sectional study. MRI-images were rereviewed, and the tumours were classified as above or on/below the STO. This study registered 3107 of the eligible 3178 patients (98%), of which 2784 patients had an evaluable MRI. In 314 patients, the tumour was located above the STO (11%), with interhospital variation between 0% and 36%. Based on TN-stage, 175 reclassified patients with colon cancer (6%) would have received different treatment (e.g., omitting neoadjuvant radiotherapy, candidate for adjuvant chemotherapy). Tumour location above the STO was independently associated with lower risk of 4-year locoregional recurrence (HR 0.529; p = 0.030) and higher 4-year overall survival (HR 0.732; p = 0.037) compared to location under the STO. By using the STO, 11% of the prior MDT-based diagnosis of rectal cancer were redefined as sigmoid cancer, with potential implications for multimodality treatment and prognostic value. Given the substantial interhospital variation in proportion of redefined cancers, the use of the STO will contribute to standardisation and comparability of outcomes in both daily practice and trial settings.

Unlocking success: The power of critical thinking in the group facilitation, coaching and team meetings

The absence of a unique and coordinated effort to adapt the promoting of the old philosophical principle to the present need of the people has inspired me to come up with a possible viable solution that I present for your further consideration. I propose two main ideas as the objectives of the paper that, later on, the reader can evaluate which is the best approach to maximize the usage of philosophical services and consulting for the general public. The first idea is to present the impact of mixt approaches between critical thinking and group coaching or group facilitating and the second idea is to target the companies as priority clients and their providers as secondary clients. I present three conflicts, five perspectives and two instruments that can be enhanced by elements of critical thinking in order to achieve the objectives above. What is the utility of philosophical skills in other fields and how should we promote philosophical practice so that philosophy can return to the people in the agora. What I propose is to focus on a bigger market - the profitable companies around us that could provide a big steady source of income - and to look at the other suppliers of services as therapy, coaching, training as partners and not as competitors. These suppliers could and should also become our paying clients and we should work with all of them and not compete against them for some individual residual clients. The practical applications from using philosophical skills in other fields are: controlling emotions using elements of critical thinking, facilitating or managing groups using philosophical counseling principles, increasing communication skills using elements of critical thinking skills, increasing coaching methods using elements of critical thinking skills and facilitating better meetings using elements of critical thinking. It doesn’t matter who was first - Philosophical Practice, critical thinking or coaching, mentoring, therapy or any other. We all know that philosophy was the root of all scientific branches that exist in our days. What really matters is whether all of these approaches can help each other grow and change people’s lives and the way they think about themselves and the world.

P009 Improving axial spondyloarthritis time to diagnosis: a quality improvement project

Abstract Background/Aims The average UK time to diagnosis for axial spondyloarthritis (axSpA) remains unacceptably long, i.e., 8.3 years, with high economic costs and impact on patients' outcomes. Until October 2021, the Rheumatology department at Ipswich Hospital did not have an axSpA service, no specific referral pathways, no dedicated clinics, and no standardized patient journey. The main objective was to develop an axSpA service from scratch and to raise awareness on axSpA amongst health professionals. A more specific quantifiable objective was to reduce the time from patient presentation in primary and secondary care to axSpA diagnosis in rheumatology. Methods For the first year since service inception (November 2021 to February 2022), we have set up the ambitious aim of developing an axSpA service, focusing on designing a referral pathway, on establishing connections with primary and secondary care, and on providing education on axSpA. To evaluate improvement in time from patient presentation in primary/ secondary care to axSpA diagnosis, we have audited all new suspected axSpA cases in the first three months of service inception (November 2021 - February 2022) and compared data from the same period of time, a year later (October 2022 - February 2023). The Plan-Do-Study-Act (PDSA) methodology was used. The quality improvement project is part of Aspiring to Excellence programme (endorsed by National Axial Spondyloarthritis Society/NASS). Results Our axSpA service was established in November 2021. We initially established connections with primary and secondary care. Within a year, we have developed an axSpA referral pathway for primary care which was designed to reflect NICE guidelines. All suspected axSpA referrals were triaged in rheumatology as urgent rather than routine and booked into a dedicated axSpA clinic running once weekly. All patients benefited from a specialized physiotherapy review. Formal and informal referral patwhays were also developed with secondary care. Additionally, we have established monthly multidisciplinary team meetings with dermatology, ophthalmology, spinal team, as well as community physiotherapy. Regular education sessions were delivered to primary care. A specific radiology- MRI pathway was also established. The audit on time until diagnosis included a total of 94 patients with suspected axSpA. The waiting time from initial presentation in primary/ secondary care to rheumatology first appointment decreased from a median of 17 weeks to 5 weeks; the time from first rheumatology appointment to diagnosis decreased from 17 weeks to 7 weeks. Overall, patients with axSpA had to wait a median of 13 weeks from initial presentation to diagnosis in rheumatology versus 29 weeks at service inception. Conclusion In only a year, we have established an axSpA service de novo with clear and standardized pathways. There was a significant improvement in waiting times for patients waiting to be referred and diagnosed with axSpA. Disclosure S. Voules: None. C. Kelly: None. M. Alcala: None. S. Premraj: None. T. Gudu: None.

Co-Creando Rituales / Co-Creating Rituals to Hold Our Work as Anti-Oppressive Counselors and Researchers

Counselors and qualitative researchers have the honor of hearing peoples’ stories and thus have a great responsibility to explore and use clinical and research methodologies that are anti-oppressive, liberatory, and healing. Therefore, in 2019 we began a photovoice project alongside seven queer womxn of color (QWoC) that collaboratively explored their experiences of microaggressions in counseling. Through this journey, we recognized that to be fully present with the “co-researchers’” (participants’) narratives and experiences, we needed to remain attuned and grounded. We engaged in what we now call “rituals” before research team meetings to support our work as counselors and anti-oppressive researchers throughout this photovoice project. These intentional, emotional, embodied, and spiritual practices allowed us to be open with ourselves and with the co-researchers during the research process. In this article, we discuss several rituals we created that helped us engage in critical reflexivity, [un]learn extractive research practices, and explore our intentions, thus allowing us to connect with our embodied experiences and co-researchers’ narratives in a deeper and more meaningful way.