Members Of Care Team Research Articles

Role of a Pharmacist in Postdischarge Care for Patients With Kidney Disease: A Scoping Review.

The objective was to explore and describe the role of pharmacists in providing postdischarge care to patients with kidney disease. PubMed, Embase (Elsevier), CINAHL (Ebscohost), Web of Science Core Collection, and Scopus were searched on January 30, 2023. Publication date limits were not included. Search terms were identified based on 3 concepts: kidney disease, pharmacy services, and patient discharge. Experimental, quasi-experimental, observational, and qualitative studies, or study protocols, describing the pharmacist's role in providing postdischarge care for patients with kidney disease, excluding kidney transplant recipients, were eligible. Six unique interventions were described in 10 studies meeting inclusion criteria. Four interventions targeted patients with acute kidney injury (AKI) during hospitalization and 2 evaluated patients with pre-existing chronic kidney disease. Pharmacists were a multidisciplinary care team (MDCT) member in 5 interventions and were the sole provider in 1. Roles commonly identified include medication review, medication reconciliation, medication action plan formation, kidney function assessment, drug dose adjustments, and disease education. Some studies showed improvements in diagnostic coding, laboratory monitoring, medication therapy problem (MTP) resolution, and patient education; prevention of hospital readmission was inconsistent. Limitations include lack of standardized reporting of kidney disease, transitions of care processes, and differences in outcomes evaluated. This review identifies potential roles of a pharmacist as part of a postdischarge MDCT for patients with varying degrees of kidney disease. The pharmacist's role in providing postdischarge care to patients with kidney disease is inconsistent. Multidisciplinary care teams including a pharmacist provided consistent identification and resolution of MTPs, improved patient education, and increased self-awareness of diagnosis.

Psychosocial Distress Screening Among Interprofessional Palliative Care Teams: A Narrative Review

With increased need for palliative care and limited staffing resources, non-social workers are increasingly responsible for screening for urgent psychosocial distress. The National Consensus Project guidelines call for all palliative care team members to be competent in screening across domains. Yet, in contrast to an abundance of evidence-informed tools for palliative social work assessments, standardization for interprofessional psychosocial screening is lacking. This lack of standardized practice may lead to harmful disparities in care delivery. The purpose of this narrative review is to examine current literature on evidence-informed practices for psychosocial screening within palliative care. Google Scholar, a university Summon library search engine, and prominent palliative care journals were searched using the same phrases to locate articles for inclusion. Each article was reviewed and synthesized across common themes. Although an abundance of validated screening tools exists for outpatient oncology-specific settings, there is minimal guidance on psychosocial screening tools intended for specialty palliative care. The most oft-cited tools have been met with concern for validity across diverse palliative care populations and settings. Additional research is needed to operationalize and measure brief psychosocial screening tools that can be validated for use by interprofessional palliative care teams, a stepping-stone for increased equity in palliative care practice.

Remote Between Visit Monitoring in Inflammatory Bowel Disease Care: A Qualitative Study of CAPTURE-IBD Participants and Care Team Members.

We recently showed that CAPTURE-inflammatory bowel disease (IBD)-a care coordination intervention comprised of routine remote monitoring of patient-reported outcomes (PRO) and a care coordinator-triggered care pathway-was more effective at reducing symptom burden for patients with IBD compared to usual care. We aimed to understand how patients and care team providers experienced the intervention and evaluate purported mechanisms of action to plan for future implementation. In this study, 205 patients were randomized to CAPTURE-IBD (n = 100) or usual care(n = 105). We conducted semi-structured interviews with 16 of the 100 participants in the CAPTURE-IBD arm and 5 care team providers to achieve thematic saturation. We used qualitative rapid analysis to generate a broad understanding of experiences, perceived impact, the coordinator role, and suggested improvements. Findings highlight that the intervention was acceptable and user-friendly, despite concerns regarding increased nursing workload. Both participants and care team providers perceived the intervention as valuable in supporting symptom monitoring, psychosocial care, and between-visit action plans to improve IBD care and health outcomes. However, few participants leveraged the care coordinator as intended. Finally, participants reported that the intervention could be better tailored to capture day-to-day symptom changes and to meet the needs of patients with specific comorbid conditions (eg, ostomies). Remote PRO monitoring is acceptable and may be valuable in improving care management, promoting tight control, and supporting whole health in IBD. Future efforts should focus on testing and implementing refined versions of CAPTURE-IBD tailored to different clinical settings.

The Role of the Athletic Trainer in Providing Care to Transgender and Gender-Diverse Patients: Considerations for Medical Affirmation-Part II.

Recently, with discriminatory legislation efforts and changing participation policies in organized sports, media attention surrounding transgender and gender-diverse (TGD) individuals has increased. These changes and the historical lack of competence and education regarding the transgender patient population have resulted in subpar patient care and a misunderstanding of the athletic trainer's (AT's) role within the health care and compliance systems. This literature review is the second part of a 2-paper series, and our objective was to educate ATs on the processes relevant to medical affirmation, including compliance considerations regarding medical eligibility, and to establish the AT's role. The gender affirmation framework includes social and legal components, which are discussed in part 1 of this literature, and the medical component is thoroughly discussed in part 2. All health care providers involved in the care of TGD individuals should work collaboratively on an interprofessional care team and have a general knowledge of the gender-affirmation process, including gender-affirming hormone therapy, surgical options, known risks and complications, and the general health needs of TGD patients. With this knowledge, ATs, as point-of-care providers and members of the interprofessional care team, are uniquely positioned to help reduce health and health care disparities. Furthermore, ATs can use their knowledge to facilitate medical compliance and eligibility in the evolving policies of sporting organizations.

ICU Care Team's Perception of Clinical Research in the ICU: A Cross-Sectional Study.

Adequate recruitment is essential for successful clinical research. ICU nurses play a crucial role in identifying eligible patients, introducing research teams, facilitating informed consent, and caring for enrolled patients. However, a larger group of multidisciplinary healthcare professionals (the ICU care team) is equally important in promoting clinical research participation.To describe the ICU care team's experiences in ongoing clinical research, identifying perceived barriers and enablers to their participation, and apply a behavior framework to enhance research engagement. Cross-sectional survey study. Four adult ICUs and one PICU between June 2021 and March 2023. We recruited nurses, physicians, nurse practitioners, allied health professionals, and unit clerks. We developed and validated a cross-sectional survey based on the Capability, Opportunity, Motivation, Behavior model. This survey included: 1) demographic questions (n = 7); 2) research experience questions (n = 6), 3) capability questions (n = 8); 4) opportunity questions (n = 11); 5) and motivation questions (n = 13).A total of 172 ICU care team members completed the survey. Results showed differences in capabilities, opportunities, and motivations among ICU care team members. For example, fellow/attending physicians and nurse practitioners reported higher confidence in discussing research with patients/families, while registered nurses and allied health professionals expressed less confidence. ICU care team members face multiple barriers that impact their involvement with the conduct of ICU research. To effectively engage healthcare professionals in this process, it is essential to address their capabilities (research knowledge and skills to communicate research with patients/families), create opportunities (collaboration/communication with research team, discuss research during multidisciplinary rounds), and motivate them (recognize their help and share the results of the research being conducted at their site) to improve ICU care team engagement in the conduct of ICU research.

The Optimization of Pharmacological and Non-pharmacological Interventions in a Case of Parkinson's Psychosis

Mr. L is a 64 y.o. male with a history of Parkinson's disease s/p bilateral DBS who initially presented to the emergency room from an assisted living facility for altered mental status and increased combativeness with staff. Patient was found to be experiencing symptoms of Parkinson's Psychosis and had uncontrol behavioral disturbance. Psychiatry was consulted for recommendations for agitation and hallucinations. Mr. L was hospitalized for over a year due to the need for higher level of care, inability to obtain guardianship, and inability to obtain subsequent placement. The patient's medication regimen was optimized with use of multiple medications including clozapine, lorazepam, and trazodone. Though medications showed some efficacy, Mr. L continued to display symptoms of agitation requiring use of restraints and emergency medication. Non-pharmacological interventions were recommended and included a combination of specific approaches to help address his needs such as techniques for medication adherence and increasing environment and social stimulation to decrease agitation and confusion. After initiating and distributing behavioral plan to patient's team, he required less medication alterations, emergency treatment orders, and ultimately the quality of life for patient and treating care team members was improved. This case underlines the efficacy of medication initiation in combination with non-pharmacological interventions in the hospital setting to improve the quality of life of patients and staff providing long term care for patients. Data on behavioral intervention and standardization of behavioral intervention is limited and typically is utilized more often in outpatient settings. However, behavioral plans for complex patients with prolonged hospital stays may allow for less agitation, thus alleviating barriers to care and limiting patient discomfort while hospitalized without complicating patient care with adverse effects. Simultaneously, decreased use of restraints, emergency medications for agitation, and staff intervention can be useful for alleviating provider team and staff burnout.

Determinants of Patient Aligned Care Team (PACT) members’ burnout and its relationship with patient-centered care

Burnout is a prevalent issue among healthcare providers affecting up to 54% of physicians and 35% of nurses. Patient Aligned Care Teams (PACT) is a team-based primary care delivery model designed to assure the delivery of high-quality care while improving clinicians' well-being. Limited studies evaluated the relationship between work environment variables and PACT members' burnout and the relationship between PACT members' burnout and patient-centered care. This cross-sectional study is based on the 2018 Veterans Health Administration (VHA) national web-based PACT survey. Burnout was measured using a single-item question that was validated in previous studies. Descriptive statistics and logistic regression were used to analyze the data. Fifty-one percent of primary care providers and 40.12% of nurses reported high burnout. PACT members with a work environment characterized by high-quality team interaction, leadership support, and psychological safety experienced lower levels of burnout. PACT members' burnout explained 6% of the variance in PACT members' ability to deliver patient-centered care. Burnout among PACT members is attributed to multiple personal and occupational variables. This study identified modifiable work environment variables that can be used to inform burnout interventions.

Abstract 4848: An analysis of black women in the Deep South with triple negative breast cancer and the social determinants of health

Abstract Background: Triple negative breast cancer (TNBC) has a higher incidence both of diagnosis and mortality among Black women. This research aims to identify specific social determinants of health among African American women in the Deep South with breast cancer. The biological presentation of disease accounts for approximately forty percent of the Experience with the health care providers, access to greenspace, and the quality of infrastructure, such as sidewalks and streetlights evaluate environmental trends associated with the outcomes of Black women in the Deep South who have been diagnosed with TNBC. Methods: Survey data was derived from the All of Us Research Program Database with inclusion criteria of Black women from Alabama, Georgia, Mississippi, and Louisiana who are 18 or older, born a female, and have been diagnosed with TNBC. Selected questions from the SDoH survey examined infrastructure, interactions with healthcare providers, and perceptions of community dynamics. Participants were identified via the cohort selection tool and further subdivided based on zip codes within the target states. Python was used in Jupyter Notebook to analyze the data the AoURP Workbench, responses were organized according to their corresponding survey questions. Participant responses were then extracted and quantified, facilitating the interpretation of respondents’ answers on a larger scale. Results: Three hundred and twenty women met the criteria of being born female, being black, being diagnosed with TNBC, and living in the Deep South. Of the topics examined, infrastructure was the area where participants’ feedback indicated the largest socioeconomic deficit. Forty-eight and 49%, respectively. Indicated that did not have access to greenspace nor did not live within 10-15-minute walking distance of a transit stop. Thirty percent reported that their doctor or nurse does not listen to what they are saying. Conclusion: Quality of life and interaction with members of the health care team associated with poorer health outcomes for Black women in the Deep South. These preliminary results indicate that those diagnosed with TNBC are impacted by the social determinants of health, specifically, proximity to public transportation, quality healthcare, recreational facilities, and infrastructure which suggests that basic needs are not met. Citation Format: Lauren K. Evans, Ivan T. Jubilee, KiTani Parker Lemieux. An analysis of black women in the Deep South with triple negative breast cancer and the social determinants of health [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4848.

Clinical Insights Into the Use of Speech Amplification Devices for Managing Hypophonia: Interviews With Speech-Language Pathologists.

The purpose of this qualitative interview study was to identify themes regarding considerations in the usage of speech amplification device usage for people with Parkinson's disease (PD) and hypophonia from the perspective of speech-language pathologists (SLPs). Eligible participants included SLPs currently practicing in the United States or Canada with experience working with clients with PD for at least 2 years. Ten SLPs participated in 60-min interviews conducted via Zoom. A semistructured interview guide was created prior to the interviews. The interviews were transcribed following their completion, and an iterative coding process was used to identify themes using thematic analysis. Three main themes were identified from the interviews. The first theme encapsulated how clinicians described amplification devices as a potential treatment tool, which highlighted the nuances that may impact selecting an amplification device as a treatment option such as increased hypophonia or dysarthria severity and cognitive decline. The second theme highlighted how device selection depends on the individual needs of the user. Individual client characteristics (such as disease symptoms and individual needs and preferences) may impact the choice of amplification device. The last theme outlined the importance of involving family members in all stages of device use and involving other health care team members on a case-by-case basis. The insights provided by the SLP participants help to understand the clinical decisions that are made when determining device candidacy, selecting a device, and evaluating device success. These insights can be used to improve research studies of augmentative management of hypophonia and guide more personalized management decisions.

Utilisation of palliative/ end-of-life care practice recommendations in the burn intensive care unit of a Ghanaian tertiary healthcare facility: An observational study

BackgroundThe need to integrate palliative/end-of-life care across healthcare systems is critical considering the increasing prevalence of health-related suffering. In burn care, however, a general lack of practice recommendations persists. Our burn unit developed practice recommendations to be implemented and this study aimed to examine the components of the practice recommendations that were utilised and aspects that were not to guide further training and collaborative efforts. MethodsWe employed a prospective clinical observation approach and chart review to ascertain the utilisation of the recommendations over a 3-year period for all burn patients. We formulated a set of trigger parametres based on existing literature and burn care staff consultation in our unit. Additionally, a checklist based on the practice recommendations was created to record the observations and chart review findings. All records were entered into a secure form on Google Forms following which we employed descriptive statistics in the form of counts and percentages to analyse the data. ResultsOf the 170 burn patients admitted, 66 (39%) persons died. Although several aspects of each practice recommendation were observed, post-bereavement support and collaboration across teams are still limited. Additionally, though the practice recommendations were comprehensive to support holistic care, a preponderance of delivering physical care was noted. The components of the practice recommendations that were not utilised include undertaking comprehensive assessment to identify and resolve patient needs (such as spiritual and psychosocial needs), supporting family members across the injury trajectory, involvement of a palliative care team member, and post-bereavement support for family members, and burn care staff. The components that were not utilised could have undoubtedly helped to achieve a comprehensive approach to care with greater family and palliative care input. ConclusionWe find a great need to equip burn care staff with general palliative care skills. Also, ongoing collaboration/ partnership between the burn care and palliative care teams need to be strengthened. Active family engagement, identifying, and resolving other patient needs beyond the physical aspect also needs further attention to ensure a comprehensive approach to end of life care in the burn unit.

Review of advanced practice nurse role in infection throughout the hematopoietic stem cell transplant journey.

Prolonged periods of immunosuppression during hematopoietic stem cell transplant (HSCT) can result in serious infectious complications and contribute to transplant-related morbidity and mortality. Adherence to standardized pre and postinfection screening guidelines, prescribed medications, and early identification of infectious symptoms through comprehensive patient and family education are crucial to minimizing infectious complications. Advanced practice nurses (APNs) are key members of the multidisciplinary care team in the HSCT specialty, maintaining a specialized skillset and scope of practice which includes a holistic based, preventative medicine and risk mitigation approach. This review sought to describe the role of the APN in HSCT care and to further examine existing APN led models of care which focus on infection prevention and education throughout the HSCT treatment journey. No studies specifically examined the APN role in infectious diseases risk assessment, screening, and management throughout the HSCT journey were identified throughout our review, however, there was considerable evidence to demonstrate the benefits of APN led care in the oncology and solid organ transplantation specialty which led to improvements in continuity of care, overall patient outcomes, and multidisciplinary team collaboration. The key themes identified in our review, were the role of the APN in the delivery of comprehensive patient and family education, the role of the APN in supporting, mentoring, and educating junior medical and nursing teams, the collaboration between the APN and the multidisciplinary care team, and the role of the APN in prompt recognition, triage, and management of treatment related complications, such as infection.

Exploring perceptions of and decision-making about CFTR modulators.

Cystic fibrosis (CF)treatment has increasingly focused on highly effective modulators. Despite measurable benefits of modulators, there is little guidance for CF care team members on providing education and support to patients regarding initiation of these therapies. We aimed to explore patient, caregiver, and clinician perceptions of modulators and influences on decisions about starting cystic fibrosis transmembrane regulator (CFTR) modulators. We conducted semistructured interviews with CF clinicians, adults with CF, and caregivers of children with CF. We reviewed audio recordings and coded responses to identify central themes. We interviewed 8 CF clinicians, 9 adults with CF, and 11 caregivers of children with CF. Themes centered on emotional responses to modulator availability, influences on decision-making, concerns about side effects, impact of modulators on planning for the future, the benefits of the multidisciplinary CF care team in supporting treatment decisions, and the unique needs of people with CF who are not eligible for modulators. Clinicians described changes in conversations about modulators since the approval of elexacaftor/tezacaftor/ivacaftor, specifically greater willingness to prescribe with less nuanced conversations with patients and/or caregivers regarding their use. Based on perspectives and experiences of CF clinicians, adults with CF, and caregivers of children with CF, we suggest clinicians approach conversations about CFTR modulators thoughtfully and thoroughly, utilizing the multidisciplinary model of CF care in exploring patient and caregiver emotions while filling in knowledge gaps, asking about treatment goals beyond potential clinical benefit, and having compassionate conversations with those who are ineligible for modulators.

Abstract B043: The caregiver burden of patients with Glioblastoma multiforme (GBM) and feeling of regret for treatment decisions associated with GBM standard of care using qualitative analysis

Abstract The purpose of this study was to identify areas where caregivers of patients with Glioblastoma multiforme (GBM) experienced feelings of regret in association to the treatment decisions related to standard of care. The standard of care for GBM consists of maximal surgical resection, chemotherapy, and radiation. This often leads to physical, cognitive, and physiological deficits. Due to the rapid onset and disease progression, patients and their caregivers must quickly make medical decisions regarding whether to pursue treatment and to what extent to continue treatment. The study sample included 101 letters written by female caregivers belonging to a Facebook group, “We are the wives of GBM and this is our story.” Members of the Facebook group were recruited to write letters to GBM healthcare providers describing their experiences as caregivers for spouses/partners of patients with GBM. This study was a secondary analysis of the narratives in the letters (UNCW IRB 22-0103) focusing on treatment decision-making. The research approach used in this study was Reflexive Thematic Analysis using NVivo qualitative data management software. Team members individually and collaboratively completed the six phases of reflexive thematic analysis: 1) data familiarization, 2) systematic data coding, 3) generating initial themes, 4) developing and reviewing themes, 5) refining and naming themes, and 6) writing the report to provide insight into study participants’ experiences. Six main themes were identified: 1) communication with different providers, 2) disease trajectory communication, 3) involvement with palliative care, 4) reliance on peer-to-peer communication, 5) description of side effects, 6) reflection on treatment decisions. Of 101 letters analyzed, 7 caregiver/patient dyads decided against treatment and 10 caregivers expressed regret in pursuing treatment. Nearly 40% of the letters indicated struggles by caregivers when communicating with health care team members about the disease, treatments, and their anticipated side effects. Nineteen caregivers relied on information from other caregivers (peer-to-peer communication) likely due to difficulties in getting information directly from health care providers. When describing care teams, only 20% of the letters mentioned palliative care as part of care teams. These caregivers struggled to obtain proper disease trajectory information, information about side effects of treatment options, and expressed patterns of miscommunication or low communication with providers. The lack information by providers about the GBM disease trajectory, its impacts on the patient and their families, and the fact that caregivers relied on peer-peer communication suggests the caregivers did not receive adequate information about the GBM disease trajectory and progression from their health care team which limited their understanding. This data suggests caregivers may have advocated for different treatment decisions and options if they had received adequate information from the health care team. Citation Format: Marlee S. Wallace, Megan P. Chard, Elizabeth A. James, Barbara J. Lutz, Laurie A. Minns. The caregiver burden of patients with Glioblastoma multiforme (GBM) and feeling of regret for treatment decisions associated with GBM standard of care using qualitative analysis [abstract]. In: Proceedings of the AACR Special Conference on Brain Cancer; 2023 Oct 19-22; Minneapolis, Minnesota. Philadelphia (PA): AACR; Cancer Res 2024;84(5 Suppl_1):Abstract nr B043.

Patient Education Practices and Preferences of Radiation Oncologists and Interprofessional Radiation Therapy Care Teams: A Mixed-Methods Study Exploring Strategies for Effective Patient Education Delivery

Purpose/ObjectivesPatients’ understanding of radiotherapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. Materials/MethodsAn anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group (ROECSG) members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. Fisher's exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. Results113 ROECSG members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices amongst radiation oncologists differed according to RT clinical workflow timing (consultation vs simulation vs first RT, respectively): one-on-one teaching: 88.5% vs 49.4% vs 56.3%, p<0.01 and paper handouts: 69.0% vs 28.7% vs 16.1%, p<0.01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. ConclusionsRadiation oncologists and interprofessional RO team members engage in PE, with most utilizing institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery.

Parent and Provider Differences in Ratings of Mental Health and Neurodevelopmental Concerns in Children with Neurologic Disorders

Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0–17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ = .324), better agreement for neurodevelopmental concerns (κ = .511), and low sensitivity of referring providers (Se = .326) and parents (Se = .366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders.

Racism, Equity, and Inclusion: Can Clinical Simulation Train Health Care Workers to Build an Anti-Racism Culture?

Clinical care delivery continues to suffer from biased social norms, stigma, and racism. Innovative approaches to being prepared for these experiences when they arise are needed. The goal of the HealthPartners Institute’s Clinical Simulation program is, in part, to train clinicians and newly graduated registered nurses entering clinical practice to be prepared for racist care delivery encounters and to implement anti-racism interventions as part of their daily work. A component of the initiative is an educational, instructor-led clinical simulation modality that includes a curriculum with application scenarios. In addition, after the simulation scenarios, a debrief session ensures the opportunity for reflection (as individuals and care team members), discussion (to tease apart distinct ideas/elements), and dialogue (to bring together insights for a shared perspective). Participants express support for this simulation methodology in trainings designed to support anti-racism as well as other stigmas and biases.

Achieving Goals of Care Decisions in Chronic Critical Illness: A Multi-Institutional Qualitative Study

BACKGROUNDClinicians, patients, and families alike perceive a need to improve how goals of care (GOC) decisions occur in chronic critical illness (CCI) but little is currently known about this decision making process. RESEARCH QUESTIONHow do intensivists from various health systems facilitate decision-making about GOC for patients with CCI? What are barriers to, and facilitators of, this decision-making process? STUDY DESIGNAND METHODS: We conducted semi-structured interviews with a purposeful sample of intensivists from the United States and Canada using a ‘mental models’ approach adapted from decision science. We analyzed transcripts inductively using qualitative description. RESULTSWe interviewed 29 intensivists from six institutions. Participants across all sites described GOC decision-making in CCI as a complex, longitudinal, and iterative process that involved substantial preparatory work, numerous stakeholders, and multiple family meetings. Intensivists required considerable time to collect information on prior events and conversations, and to arrive at a prognostic consensus with other involved clinicians prior to meeting with families. Many intensivists stressed the importance of scheduling multiple family meetings to build trust and relationships prior to explicitly discussing GOC. Physician-identified barriers to GOC decision-making included one week staffing models, limited time and cognitive bandwidth, difficulty eliciting patient values, and interpersonal challenges with care team members or families. Potential facilitators included scheduled family meetings at regular intervals, greater interprofessional involvement in decisions, and consistent messaging from care team members. INTERPRETATIONIntensivists described a complex time and labor-intensive group process to achieve GOC decision-making in CCI. System-level interventions that improve how information is shared between clinicians and decrease logistical and relational barriers to timely and consistent communication are key to improving goals-of-care decision making in chronic critical illness.

Barriers and Facilitators to Teledermatology and Tele-Eye Care in Department of Veterans Affairs Provider Settings: Qualitative Content Analysis.

Veterans Affairs health care systems have been early adopters of asynchronous telemedicine to provide access to timely and high-quality specialty care services in primary care settings for veterans living in rural areas. Scant research has examined how to expand primary care team members' engagement in telespecialty care. This qualitative study aimed to explore implementation process barriers and facilitators to using asynchronous telespecialty care (teledermatology and tele-eye care services). In total, 30 participants including primary care providers, nurses, telehealth clinical technicians, medical and program support assistants, and administrators from 2 community-based outpatient clinics were interviewed. Semistructured interviews were conducted using an interview guide, digitally recorded, and transcribed. Interview transcripts were analyzed using a qualitative content analysis summative approach. Two coders reviewed transcripts independently. Discrepancies were resolved by consensus discussion. In total, 3 themes were identified from participants' experiences: positive perception of telespecialty care, concerns and challenges of implementation, and suggestions for service refinement. Participants voiced that the telemedicine visits saved commute and waiting times and provided veterans in rural areas more access to timely medical care. The mentioned concerns were technical challenges and equipment failure, staffing shortages to cover both in-person and telehealth visit needs, overbooked schedules leading to delayed referrals, the need for a more standardized operation protocol, and more hands-on training with formative feedback among supporting staff. Participants also faced challenges with appointment cancellations and struggled to find ways to efficiently manage both telehealth and in-person visits to streamline patient flow. Nonetheless, most participants feel motivated and confident in implementing telespecialty care going forward. This study provided important insights into the positive perceptions and ongoing challenges in telespecialty care implementation. Feedback from primary care teams is needed to improve telespecialty care service delivery for rural veterans.

Single-Item Instruments to Measure Aspects of Whole Person Care for an Inpatient Palliative Care Chaplain's Clinical Note: An Examination of Tools

As members of the palliative care team, chaplains’ clinical notes in the electronic health record reflect their encounters with patients. Along with their specialized spiritual assessment included within these notes, chaplains document whole-person aspects of the patient attending to such matters as quality of life. This article examines the psychometric properties of single-item instruments that could measure specific whole-person care components to be documented within a palliative care chaplain's clinical note. A literature search discovered three single-item tools, one related to patient-perceived quality of care and two addressing quality of life. While continued work is needed developing single-item measures, the quality of care question, “Heard and Understood,” and the quality of life question, “How satisfied are you currently with your physical and emotional well-being?,” show promise for current use. Additional investigations are needed to develop single-item measures contributing to comprehensive palliative patient care.

Cytotechnology schools: Future outlook.

Recent changes in the standard and guidelines governing the education of cytotechnologists herald in a new era of cytology education. The long-discussed move to master level education and name change of the professional to cytologist signifies an alignment with current and projected scope of mid-level diagnostic cytology practice. Cytotechnology programs going forward are charged with implementing curricular changes that prepare practitioners to perform tasks such as computer assisted screening, and cell block interpretation as well as to perform evidence-based research methods. Cytotechnology education programs are sure to face challenges particularly in student recruitment and the hiring of expert faculty. There are however opportunities for programs to develop innovative teaching techniques, recruit from underrepresented groups and collaborate to develop needed curricular resources. The future outlook for cytotechnology programs is that they are at a turning point, poised to educate the next generation of pathology extenders who will continue to be integral members of the patient care team.