Patient-centered Approach Research Articles

Gender identity in Klinefelter Syndrome: a patient-centered approach to treatment

Introduction There is increasing evidence that gender dysphoria (GD) is more prevalent in the Klinefelter Syndrome (KS) population than in males in the general population; however, the exact incidence is uncertain. The aim of this study was to further explore the prevalence of gender-related issues, the role that physical characteristics play in gender identity, and the issues surrounding Hormone Replacement Therapy (HRT) in KS. Methods As part of a registered Quality Improvement Project (QIP), one online 23-point questionnaire on KS patient attitudes toward gender identity was shared with members of the Klinefelter Syndrome Association (KSA). In total, 139 anonymous responses were collected between December 2021 and January 2023. The questionnaire was developed with the guidance of multiple clinicians (including gender psychiatrists, urologists, psychosexual medicine specialists, and endocrinologists) and patient Delphi rounds. Data was reviewed and analyzed by 4 independent researchers within the QIP team. Results Only 53% of KS patients responding to this survey fully identified as male and 19% stated that they did not enjoy living as the sex on their birth certificate, with 43% considering changing aspects of their physical appearance to better match their gender. Regarding HRT, 67% of respondents were receiving Testosterone Replacement Therapy (TRT). 63% wanted TRT and 17% wanted estrogen, including 6% of TRT users who would prefer estrogen instead. 36% that were currently receiving TRT did not identify as male, and 3 participants stated that they have GD. Conclusion These results indicate that a significant proportion of KS patients do not fully identify with the male gender and are unhappy living as the sex on their birth certificate. Although TRT worked for most, its use should be discussed carefully with those with gender identity concerns.

Comparative assessment of attitudes and expectations: Iranian patients versus urologists in the management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is common and presents as lower urinary tract symptoms (LUTS). Understanding patient concerns and treatment preferences is essential for effective management. This study aimed to investigate the attitudes, preferences, and expectations of Iranian patients with BPH, and compare them with those of urologists in addressing this condition. A cohort of patients diagnosed with BPH underwent assessment during their initial visit. Before any counseling, their attitudes, concerns, and expectations regarding benign prostate enlargement were evaluated using semi-structured interviews. Patient responses were analyzed based on educational levels and age. Additionally, correspondence was initiated with thirty urologists who graduated within the past twelve years to assess their attitudes toward BPH, concerns, and treatment approaches. Interview questions were constructed using the Delphi method, and their validity was confirmed. Responses from both groups were analyzed and compared. Descriptive statistics, independent t-test, Chi-squared test, Mann-Whitney U, and principal component analysis (PCA) with varimax rotation were used for statistical analysis. The study comprised 261 patients and 30 urologists. Findings revealed that 86.2% of patients and 86.7% of urologists perceived a lack of sufficient patient knowledge about BPH. Patients across all educational levels and age groups expressed a desire for more information about their condition. Primary concerns among patients included exacerbation of urinary symptoms, potential malignancy, and sexual dysfunction. While patients generally preferred pharmacological treatments, those older than 75 years showed a significantly higher preference for surgical options. Conversely, urologists exhibited greater concern for long-term clinical complications associated with BPH. Results indicated significant parallels between the attitudes of urologists and patients in assessing the multifaceted impact of BPH on patient well-being. This study enhances our understanding of patient attitudes and concerns regarding BPH, thereby facilitating more effective treatment strategies. Our findings encourage urologists to enhance patient perspectives by delivering comprehensive information. Furthermore, the comparison between patient and urologist attitudes towards BPH underscores the importance of tailored care and patient-centered approaches in optimizing outcomes for individuals with BPH.

Crafting the Future of Community-Based Medical Rehabilitation: Exploring Optimal Models for Non-Inpatient Rehabilitation Services through a Narrative Review.

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations.

Cognitive-motor interference in people with essential tremor

Adapting to different environments throughout daily activities requires flexibility in allocating attention. Compromised dual-tasking can hinder mobility, increase fall risk, and decrease functional independence in patients with essential tremor, who exhibit both mobility and cognitive impairments. We evaluated motor and cognitive dual-task effects and task prioritization in 15 people with Essential Tremor (ET) and 15 age-matched people without ET during a standard and more challenging water-carry TUG. Task-specific interference was evaluated by calculating motor and cognitive dual-task effects, whereas task prioritization was assessed by contrasting the cognitive dual-task effect with the motor dual-task effect. The simultaneous performance of two tasks did not differentially impact motor or cognitive performance in either group, and both groups prioritized cognitive task performance in standard and water-carry TUG assessments. This study enhances our understanding of motor-cognitive interactions in individuals with essential tremor. These insights could lead to patient-centered approaches to therapy to improve functional performance in dynamic daily environments.

Oral Health Epidemiological Investigation in an Urban Homeless Population.

The purpose of this clinical epidemiological investigation was to examine the oral health conditions of homeless people in the city of Rome, Italy. A total of 157 homeless subjects were subjected to a first dental visit, during which anamnestic information was recorded in a digital medical record. A diagnosis of dental disorders was performed by assessing oral hygiene conditions, periodontal health, the presence of caries and/or root residues, and the presence of partial and/or total edentulousness. Caries and missing teeth were evaluated by the DMFT index. The first major criticality was represented by poor or absent oral hygiene. The examined sample showed a major percentage of high DMFT (63.0%); the most common clinical condition was the presence of numerous root residues. Regarding periodontal health, 73.2% of patients had gingivitis, 21.6% periodontitis, while 11 patients had periodontal pathologies with tooth mobility (7%). Finally, 8.9% of patients had one or two missing elements, 22.9% had partial edentulousness, and 8.9% of the sample had total edentulism. This analysis provides an important basis for strengthening health promotion and the importance of accessible and effective care for this population. It will therefore be necessary to continue to adopt a patient-centered approach geared towards addressing the demands that this population faces in maintaining their oral health.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology.

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization. From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization. On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR]=3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR]=4.05, 95% CI: 1.72-9.11). While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious. Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed. Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable. Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.

What Matters to Patients: Community-Engaged Design for Healthcare-Related Serious Games

Narrative-based serious games are accessible, engaging technologies that connect users’ lived experiences to pedagogy. Despite having patient-centered goals, most narrative-based serious games are not designed alongside patients and communities, limiting their likelihood of acceptance, uptake, and impact. Literature reveals that many serious games intended for patients merely evaluate efficacy with end-users after game deployment and with a lack of consistent participatory design. This work aims to describe a patient-centered participatory approach to game development to teach self-advocacy skills to patients newly diagnosed with cancer. First, characters were developed based on panels that included patient advocates, cancer survivors, clinicians, and researchers. Second, storyline development created realistic story arcs, decision-points, and consequences based on qualitative interviews with patients, patient advocates, and cancer survivors. Third, game evaluation metrics (e.g., 1st vs. 3rd person perspective, game fail states that incentivize replaying the game, and provision of implicit or explicit feedback) were developed based on accessibility, usability, and patient preferences. Based on patients’ insights, we implemented changes accordingly to maximize the game’s efficacy and collected qualitative data on patients’ assessment of the game’s accessibility, relevance, and impact. During initial game development, patient and advocate feedback built relatable characters with a particular focus on providing sensitive information (e.g., palliative care) and inclusive storylines (e.g., diverse family situations). Following a prototype, patients and advocates suggested refinements to characters and additional storylines, including common and/or distressing experiences related to pain management, family dynamics, financial struggles, and disrespect from healthcare providers. Participants in a randomized trial of the game (N=34) found the scenarios relevant and realistic. Patients reported increased comfort speaking up, seeking support, and interacting with their families and healthcare team after playing the game. Our process demonstrates the essential role patients can inhabit in the development of narrative serious games, particularly in how patient input permeated every aspect of Strong Together's development, from initial design to evaluation. Such integration allows for adjustments to address patient concerns and refine patient-relevant metrics.

7609 Androgen Receptor Positive DCIS in a Transmasculine Individual on Testosterone Therapy

Abstract Disclosure: J. Kelly: None. B. Cohen: None. Introduction: The rate of breast cancer in transgender men is lower than in cisgender women, perhaps due to lower estrogen levels in the setting of suppression from exogenous testosterone, lack of clear guidelines on screening after top surgery, and increase in mastectomies. However, the impact of testosterone therapy on existing breast cancer is not known. Concerns regarding use of testosterone in patients with breast cancer include the potential for conversion of testosterone to estradiol, as well as direct androgen receptor (AR) stimulation. However, for some patients, hormone therapy is lifesaving and stopping gender affirming hormone therapy (GAHT) will negatively impact patient well-being. This creates a challenging clinical scenario when transgender patients on testosterone are diagnosed with breast cancer.Case Presentation: We present a case of a 29-year-old self-identified transmasculine nonbinary individual (assigned female at birth) who underwent chest reconstruction surgery after several months on daily transdermal testosterone therapy. A 4 cm DCIS ER+/AR+ with possible micro invasion was incidentally noted on pathology. They had no family history of breast cancer. The patient underwent chest MRI which was negative for persistent disease. The treating oncologist did not recommend Tamoxifen. The patient chose to discontinue testosterone therapy due to uncertainty regarding future breast cancer risk. However, due to worsening depression and fatigue, the patient chose to resume GAHT after receiving counseling of possible risk, though likely low, of cancer recurrence. Given that they had undergone bilateral mastectomy which, unlike chest reconstruction surgery where some breast tissue is left for contouring, all breast tissue was removed and given that chest MRI was negative for disease, cancer recurrence was felt to be low. Furthermore, though AR positivity was noted, the clinical implications are unclear and it is not known whether testosterone would stimulate tumor growth or potentially have antagonistic effects on ER signaling. Additionally, any stimulatory effects of AR signaling may be balanced by androgen suppression of gonadotroph production and reduction in estrogen production; this is more clearly associated with stimulatory effects on cancer growth. And finally, the potential risks of therapy must be weighed against the benefits provided to the patient’s well-being and mental health. Ultimately, the patient resumed testosterone therapy and has been doing well.Teaching Point: This case illustrates the uncertainties regarding the management of gender affirming testosterone therapy in patients with DCIS or breast cancer. It also highlights the need for a patient centered approach to decisions regarding changes to GAHT, to appropriately weigh the risks and benefits of continuing therapy. Presentation: 6/2/2024

The Underutilization of National Diabetes Prevention Program Among Women With a History of Gestational Diabetes Mellitus: An In-Depth Focus Group Analysis

IntroductionGestational Diabetes Mellitus (GDM) significantly increases the risk of developing Type 2 Diabetes Mellitus (T2DM) in women. However, the National Diabetes Prevention Program (NDPP), effective in reducing T2DM incidence, is underutilized among women with a history of GDM. This study aims to explore the factors contributing to this underutilization and propose strategies to increase NDPP's usage. MethodsA qualitative study with narrative methodology was employed, involving focus group discussions with 18 women ages between 29-43, who had a history of GDM. Participants were recruited from a GDM registry through University of California, San Diego's(UCSD) online platform. The discussions were aimed at understanding their awareness of T2DM risk post-GDM and their knowledge about the NDPP. ResultsThematic analysis of the discussions revealed four key themes: 1) Challenges in navigating health information post-GDM, 2) Perceived facilitators for NDPP participation, including peer support, personalized guidance, and virtual options, 3) Perceived barriers, such as time constraints, childcare responsibilities, and financial considerations, and 4) Insights into patient perspectives on GDM care. Despite awareness of their increased T2DM risk, there was a notable gap in knowledge about the NDPP among participants. ConclusionsThe study highlights the critical need for improved communication regarding post-GDM diabetes risk and the NDPP. Addressing communication gaps, offering personalized support, and accommodating the unique challenges faced by women with a history of GDM can enhance NDPP participation. The significance of a patient-centric approach in diabetes prevention is underscored, emphasizing that such an approach could significantly impact T2DM prevention in this high-risk population.

Experiences and impacts of side effects among contraceptive users in the UK: exploring individual narratives of contraceptive side effects

Purpose While many women worldwide use contraception, there is a paucity of research on individual experiences of side effects. To address this gap, we investigated individual’s contraception experiences. Methods Women aged 18 to 35, living in the UK were invited to participate in an online survey on contraception. Free text responses were collected. Through a directed content analysis approach, we developed a coding framework (based on existing literature and initial response review) including six themes; method(s) of contraception, side effect(s) experienced, impact of side effect(s), timing of side effect(s), interactions with healthcare practitioners, and trial-and-error. Results Overall, 337 participants provided free-text responses. Side effect experiences and impacts varied greatly between individuals and contraceptives. Most participants described negative effects, including mental health issues and bleeding problems. However, some shared positive experiences mainly related to bleeding management or the absence of side effects. Participants described how side effects often varied or appeared over time. Some participants felt unheard by healthcare practitioners. Conclusions This study highlights how specific contraceptive experience is to the individual. We advocate for a patient-centred approach to contraceptive counselling. Practitioners should play an active role in improving contraception prescription, acknowledging the diverse experiences and preferences of patients.

7117 Cushings Conundrum: Taming The Hormone Hurricane

Abstract Disclosure: S. Syed: None. A. Poloju: None. A. Krueger: None. C. O'connor: None. Ectopic ACTH syndrome is a rare disease that presents with severe hypercortisolism that can be challenging to treat. This case reviews a patient with high- grade metastatic neuroendocrine tumor causing ectopic ACTH-related Cushing's syndrome and describes navigating these treatment challenges with an evidence-based and patient centered strategy to try to optimize care.Clinical case: This 32-year-old male, with a history of metastatic pancreatic neuroendocrine tumor and liver metastases, initially presented with dyspnea, hyperglycemia, and metabolic derangements. Agitated, with a systolic blood pressure of 190mm Hg, he exhibited notable hypokalemia (2.5mmol/L), hyperglycemia (508mg/dL), and elevated beta-hydroxybutyrate (3.60mmol/L). Random cortisol was 85.9ug/dL and ACTH 472pg/ml. Urgent cortisol control prompted etomidate infusion, lowering cortisol to 27ug/dL in 24 hours. Ketoconazole was initiated but discontinued later due to rising liver enzymes, Metyrapone and spironolactone were initiated and etomidate infusion titrated off. Hemorrhagic shock, DKA, and mental status changes complicated his course.Interventional radiology-guided hepatic artery embolization was performed. Post-procedure cortisol levels improved, metyrapone and spironolactone were stopped. Dexamethasone was initiated given concern for relative adrenal insufficiency during this time and was later switched to hydrocortisone, and eventually discontinued with normalizing cortisol levels. Octreotide and later lanreotide maintained stability for a year. He was readmitted with uncontrolled diabetes, hypertension, and vertebral compression fractures, requiring rapid control with etomidate infusion again. Metyrapone was reintroduced, facilitating etomidate tapering. Spironolactone was re-initiated. Bilateral adrenalectomy was discussed as definitive treatment for the ectopic ACTH syndrome (neuroendocrine cancer was deemed incurable, however he was considered elevated risk for surgery given other co-morbidities. Even with normalization of cortisol, he intermittently refused cares/medications. Conclusion: Managing ACTH-producing neuroendocrine tumors necessitates a multidisciplinary approach. In severe Cushing’s syndrome, etomidate infusion quickly normalizes cortisol but requires intensive care due to sedation risks. Ketoconazole and levoketoconazole carry a hepatotoxicity risk. Metyrapone and mitotane are alternatives but supply challenges exist. Osilodrostat, studied for short-term use, has limited data in ectopic ACTH syndromes. Bilateral adrenalectomy is an option if surgical risks are acceptable. Patient history influences therapeutic decisions, highlighting the need for a patient-centered approach. Presentation: 6/3/2024

Lifestyle Medicine Implementation in Family Medicine Clinic.

Background: Lifestyle medicine, a patient-centered approach promoting healthy lifestyle behaviors, is an evidence-based tool for preventing and treating chronic diseases. It has been shown to reduce the burden of physical and psychological diseases. Despite this, clinical implementation is lagging, with physicians facing barriers effectively encouraging lifestyle change. Objective: This project studies the Lifestyle Medicine Assessment (LMA) tool regarding ease of implementation and influence on patient motivation, perception of lifestyle changes, and satisfaction. Methods: A two-pronged approach was conducted. First, the implementation time was recorded for multiple encounters (N = 42). Next, a different subset of patients (N = 22) receiving the LMA completed a pre- and post-encounter survey about their motivation to change, perception of lifestyle changes on well-being, and visit satisfaction. A control group (N = 21) also received these surveys. Results: The average time of application was 7.12min. Intragroup scores for motivation to change were significantly higher in the LMA group post-intervention (p LMA = .001), but not in the control group. Conclusion: These results show the potential benefits of the LMA tool in a clinical setting, demonstrating realistically achievable implementation times and increased patient motivation regarding better lifestyle choices. Providers should consider using the LMA tool to promote lifestyle change within their practice.

Fertility Concerns Related to Surgery for Colorectal Cancer: An Under-Discussed Topic.

As the incidence of colorectal cancer (CRC) increases among younger adults, the need for discussions regarding treatment-related infertility is growing. The negative impacts of gonadotoxic chemotherapy and pelvic radiation are well documented, but the role that surgical intervention for CRC plays in infertility is less clear. Additionally, treatment-related infertility counseling occurs infrequently. This review provides an overview of the connection between abdominal and pelvic surgery on male and female infertility and elucidates the role of surgeons in counseling to alleviate psychological distress in newly diagnosed patients. A review of the literature revealed that pelvic surgery leads to increased adhesion formation, which is known to be associated with female infertility. Furthermore, nerve damage from pelvic surgery has significant implications for ejaculatory issues in males and sexual dysfunction in both males and females, which ultimately impact pregnancy success. Patients have significant distress related to treatment-related infertility, and pre-treatment fertility counseling has been shown to alleviate some of this psychological burden. Nevertheless, many patients do not receive counseling, particularly in surgical clinics, despite surgeons often being the first providers to see newly diagnosed non-metastatic patients. Efforts should be made to enact protocols that ensure fertility conversations are being had with patients in surgical clinics and that patients are being referred to fertility specialists appropriately. This patient-centered approach will lessen the psychological burden placed on patients during a vulnerable time in their lives.

LGGL-02 NURSING CONSIDERATIONS FOR PEDIATRIC PATIENTS WITH PONTINE GLIOMAS: A COMPARATIVE ANALYSIS BETWEEN THE NAIROBI HOSPITAL AND KENYA

Abstract INTRODUCTION Pontine gliomas, aggressive brain tumors predominantly affecting pediatric patients, pose limited treatment options and a grim prognosis, emphasizing the crucial role of nursing care for comprehensive patient and family support. This abstract explores nursing considerations for pediatric pontine glioma patients at The Nairobi Hospital, contrasting them with broader healthcare practices in Kenya. METHODS A thorough literature review focused on nursing practices for pediatric pontine glioma patients, utilizing peer-reviewed journals, healthcare guidelines, expert opinions, and textbooks. Key areas included vital observations, parental support strategies, patient and family empowerment initiatives, palliative care approaches, and nursing intervention impact on outcomes and family satisfaction. RESULTS The analysis highlighted nursing considerations at The Nairobi Hospital, where a patient-centered approach and proactive vital observations were evident. Nurses monitored health status pre-radiotherapy, adjusting care plans promptly. End-of-life care showcased comprehensive palliative support and bereavement guidance, contrasting varied national practices, underscoring the need for standardized protocols and enhanced training nationwide CONCLUSION Nursing care’s pivotal role in optimizing outcomes and quality of life for pediatric pontine glioma patients and families was emphasized. The study’s implications extend to healthcare policy, education, and practice, stressing collaborative efforts to improve standards and patient outcomes.

Exploring the patients' and family members' perspectives on home-based palliative care.

Healthcare at home is considered a partial substitute for institutional long-term care, because patients and families with known poor prognoses prefer to stay home with their loved ones and are unable to pay for hospital care at the end of life in some countries. To explore patients' and family members' perspectives and experiences of receiving home-based palliative care services. This was a qualitative exploratory study conducted in Karachi, targeting patients and family members receiving home-based palliative care services. The data collection was done via interviews, and simultaneously, the interviewer recorded field notes, which were all carried out within the confines of the participants' homes. Moreover, the subjects were recruited through purposive sampling, resulting in a total of six patients and six family members. The final number of participants was determined based on data saturation. The inclusion criteria encompassed individuals of all genders, aged 18 and above, and residents of Karachi, Pakistan. Those who were not able to provide information, due to any reason, were excluded from the study. The study adhered strictly to ethical considerations. The study uncovered several significant themes that provide valuable insights, including caregivers' availability, patients' inclusiveness, improved dietary pattern, psychological wellbeing, and rapid recovery in home-based care. Furthermore, the study identified themes on providing home-based palliative care, like family members' education and keeping back-ups for unforeseen situations. In contrast, the themes identified as home-based care preference over hospital care were: experienced compromised care, hospital anxiety, restricted to the available resources and higher hospital living expenses for patients and family members. The study underscored the importance of adopting a patient-centric approach. It has become evident that the comfort and familiarity of one's home environment provide a conducive backdrop for holistic healing and wellbeing.

Patients’ understanding of treatment decisions: Impact on major quality metrics and patient informed decision-making at end of life.

170 Background: Blue Ridge Cancer Care (BRCC) is a community oncology practice in rural Virginia and West Virginia. BRCC is an ASCO-certified practice and participates in multiple value-based care programs to ensure a quality improvement and patient-centered approach. BRCC serves regions with low health literacy (LHL) which impacts a patient’s ability to self-manage their disease, make informed health-related decisions, and navigate the health system. The top indicators of LHL are being over 65 years old, having less than any college education, and being insured by Medicare or Medicaid which is 63% of BRCC’s patient population. Methods: BRCC conducted a retrospective analysis of our 2023 end-of-life (EOL) quality measures and 1,682 unique National Comprehensive Cancer Network (NCCN) Distress Tool & Problem List assessments. We then matched the results with each patient’s demographics and disease course. Additional research revealed that LHL levels have the greatest impact on patients engaging in their care and ability to make informed decisions at end of life. Results: 21% of patients reported concerns with understanding treatment decisions (n=353) and they had vastly different outcomes compared to patients that did not have concerns (n=1329). A chi-square test was performed to examine the relation between these events, all outcomes were found to be statistically significant. Detailed outcomes are shown (Table). Conclusions: In our review, patients reporting concerns with or understanding treatment decisions had more aggressive EOL care and used more resources from health care systems. BRCC plans to deepen our understanding of this population by using an evidence-based tool that assess a patient’s understanding of their disease severity, perceived curability, and treatment options to identify gaps in a patient’s prognostic understanding and enhance communication between the care team and better support patients informed decision-making at EOL. Population Reported Concerns with/understanding Treatment Decisions = 21% No Concerns with Treatment Decisions = 79% > 3 Emergency department visits in 1 year 19% 8% Chemotherapy in the last 14 days of life 38% 19% Enrolled in Hospice 14% 54%

Treatment strategies for erosive genital lichen planus: A systematic review of therapeutic modalities and emerging breakthroughs.

Erosive genital lichen planus (EGLP) is a severe form of lichen planus characterized by painful erosions in the genital area, leading to significant distress and complications. This review aims to provide a thorough examination of EGLP, focusing on its clinical manifestations, diagnostic challenges, and various treatment strategies, with an emphasis on patient-centered care. Adhering to PRISMA guidelines, we conducted a systematic review of 26 studies that explored dermatological treatments for EGLP. Our literature search was comprehensive, covering PubMed, Scopus, and Web of Science. Data were extracted systematically using established tools to ensure a robust analysis of the treatment modalities. EGLP presents with a range of symptoms, including severe pain, itching, and sexual dysfunction. Treatment options include topical corticosteroids, systemic medications, and surgical interventions. Despite the availability of various therapies, many cases are refractory to treatment, resulting in chronic symptoms and reduced quality of life. Emerging therapies show promise but are not yet established as standard practice. Management of EGLP requires a tailored, multidimensional approach. While topical corticosteroids remain essential, the development of new therapies offers hope for improved outcomes. A patient-centered approach is vital to address both the physical and psychosocial impacts of EGLP. Continued research is necessary to refine treatment protocols and enhance patient care.

Functional Medicine in Nursing.

Functional medicine is a patient-centered approach that seeks to address the underlying causes of disease rather than focusing on managing the symptoms. This article explains the core principles of functional medicine and explores the potential for nurses to learn and incorporate functional medicine into their practice. By adopting a functional medicine approach, nurses can promote a more personalized and collaborative health care environment that can improve patient outcomes and empower patients to take an active role in their own health journey.

The nurse consultant in remote medical monitoring: an innovative, patient-centered approach

Telemedical monitoring of heart failure patients is revolutionizing the traditional approach to care, thanks to the crucial role played by nurse consultants. Based on two years' experience in a telemonitoring unit, where the practice model is outside the conventional nursing context, we aim to highlight this innovative method, which is helping to improve the care and benefits of patients with chronic pathologies. This patient-centered approach offers holistic, individualized care through personalized remote monitoring, fostering a relationship of trust and encouraging patient autonomy.

Comprehensive geriatric assessment and palliative care.

The geriatric vision of palliative care is based on a multidisciplinary, patient-centered approach, looking for a balance between human dignity and medical treatments with a particular focus on the social and ethical aspects. In order to develop the best care models, there is a rising need for a tighter collaboration of all the involved players (i.e., doctors, nurses, social workers). Indeed, the idea of a fragmented system without considering the patient or his/her family is not at all applicable to older patients with chronic disease. The causes of death, the phase of death changes, and the extend of last period of life could be a long phase characterized by complicated treatment decisions, difficult management of symptoms, multiple psychosocial problems, and complex spiritual distress. Recently, Italian guidelines on Comprehensive Geriatric Assessment (CGA) have been published. However, none of the identified studies on patients in hospice and other palliative care facilities met the criteria for inclusion. These findings underscore the need for further research to determine the potential benefits of a multidimensional approach for patients in hospice and other palliative care settings. Our reflections and suggestions on the CGA use for older persons in palliative care may be a starting point for an open and continuous dialogue with all the operators concerned.