Patient-centered Approach Research Articles

Involving Patients and/or Their Next of Kin in Serious Adverse Event Investigations: A Qualitative Study on Hospital Perspectives.

The involvement of patients or next of kin (P/N) after a serious adverse event (SAE) is evolving. Beyond providing mandatory information, there is growing recognition of the need to incorporate their interests. This study explores practical manifestations of P/N involvement and identifies significant considerations for hospitals. The data collection involved various qualitative research methods: 7 focus groups with 56 professionals from 37 hospitals, an interview with 2 representatives from the Dutch Association of Hospitals, and an interactive reflection seminar with over 60 participants from 34 hospitals. Before the focus groups, a brief questionnaire was sent out to survey participants' practices regarding into SAE investigations. After the study, another questionnaire was distributed to gather suggestions for future improvements and to identify their lessons learned. Thematic analysis was applied to the gathered data to identify key themes. Hospitals are increasingly acknowledging the interests and perspectives of P/N, recognizing their potential contributions to organizational learning and improvement. P/N involvement following SAEs includes active participation in different stages of the investigation process, not just passive information dissemination. Important factors influencing involvement are the provision of (emotional) support, identification of needs, and transparency of the SAE investigation. This study enhances understanding of evolving practices surrounding P/N involvement in the context of SAEs in Dutch hospitals. The findings highlight the importance of promoting meaningful involvement, recognizing the significance of P/N experiences, and fostering a culture of transparency and collaboration. By examining the dynamics of involvement, this research aims to inform policy development and facilitate the implementation of patient-centered approaches to post-SAE care.

Dental outpatient departments and patient safety: Priority for a safe care

Patient safety is an essential aspect of healthcare, including dentistry. Dental Outpatient Departments (OPDs) pose unique challenges, where the risk of infections, procedural errors, and patient discomfort can compromise safety. This review examines patient safety issues in dental OPDs, focusing on common hazards, preventive measures, and evolving strategies to ensure safer care. Infection control, medical emergencies, equipment sterilization, and patient data protection are key concerns. The complex interplay of patient management, dental procedures, and clinician awareness requires robust protocols to mitigate risks. Dental professionals must be vigilant in managing cross-contamination risks, such as through the use of personal protective equipment (PPE) and strict hand hygiene practices. Moreover, regular staff training in handling medical emergencies, such as allergic reactions or fainting, is crucial for effective management.This article also explores the role of technological advancements in enhancing patient safety, such as digital record-keeping, which minimizes documentation errors, and advanced diagnostic tools that reduce invasive procedures. Additionally, patient-centered approaches, including improved communication and informed consent practices, foster trust and reduce misunderstandings. The implementation of evidence-based guidelines and adherence to professional standards further contribute to a culture of safety. By synthesizing current research, this review aims to highlight best practices for improving patient safety in dental OPDs and underscores the importance of continuous monitoring and improvement in these settings. Addressing these safety concerns is critical not only to improve patient outcomes but also to ensure that dental OPDs remain a safe and trusted environment for all.

FAMILY-ORIENTED PHYSICAL THERAPY PROGRAM FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS

Family-centered physical therapy programs for children with autism involve the child, family members, and professionals working together. They aim to provide support, education, and resources that enable the family to understand and cope with the special needs associated with the rehabilitation of a child with autism. By involving the entire family in the therapy process, such programs help improve communication, enhance the quality of life for the entire family, help the child develop skills to participate in various activities with peers, strengthen family ties and provide a more holistic approach to child care. Aim. To substantiate the structure and program of family-oriented physical therapy for preschool children with autism spectrum disorders (ASD). Materials and methods. Analysis of literature sources, including clinical guidelines and recommendations, as well as scientific research on the rehabilitation of patients with autism spectrum disorders; systematic analysis and synthesis, methods of analogy, abstraction and generalization. The experience of rehabilitation and physical therapy of children with ASD, gained by the NGO Agape, which is engaged in the rehabilitation and habilitation of children with disabilities in Khmelnytskyi, was also taken into account. Results. A child's atypical development and disabilities affect the entire family. Caregivers and family members may develop feelings of vulnerability and guilt, or they may feel unable to care for their child. In addition, the patient-centered and biopsychosocial approach assumes that decisions about therapy are made by caregivers, as they are the best experts on their needs and abilities. There has also been a shift in emphasis from impairment of body structures and functions to the child's participation in family life and activities with the family, as well as from what the child cannot do to what the child can do. Supporting the child and family through this complex process of rehabilitation and physical therapy with this in mind, and recognizing the family's interests and values, is crucial and helps families feel stronger and more confident as they face daily challenges. Family-centered physical therapy takes all of these approaches into account. Family-centered physical therapy is a set of activities aimed at involving the family and the family environment in the child's physical therapy process to provide support, necessary skills and resources to both the patient and the family at each stage of therapy, ensuring the best possible results. All phases of physical therapy involve the child and family members in the evaluation, goal and objective setting, education, implementation of the planned intervention program, counseling and monitoring, and adjustment of the goal, objectives and physical therapy program. Conclusions. Family-centered service programs encourage therapists to move from focusing on an isolated impairment and the needs of the child alone to understanding disability within the social model of services and the context of the family and community. A family-centered physical therapy program for children with ASD involves close collaboration between physical therapists, the child, and parents and other family members. This ensures an individualized approach to therapy, increased effectiveness of the sessions, and improved quality of life for the child and the entire family. Active involvement of parents and providing them with the knowledge and skills to conduct sessions at home helps to achieve sustainable results in the child's development and strengthens family ties, increasing the overall level of satisfaction.

Malpractice litigation in multidisciplinary cancer care: Navigating medico-legal challenges and shared decision making in India

Healthcare professionals participating in multidisciplinary team (MDT) cancer meetings may not have a comprehensive understanding of their medicolegal responsibilities in current times. This article aims to delineate the principal medicolegal issues pertinent to multidisciplinary cancer care and offer recommendations for future implementation. Key concerns highlighted in this literature encompass patient consent and privacy during MDT meetings, professional liability, the formal expression of dissenting views and the duty of care. The analysis of existing literature prioritizes several recommendations for addressing these issues. Given the limited precedent available for formulating recommendations, this article identifies foundational evidence that can inform the practicing clinicians of these concerns in future MDT practices.Navigating decision-making processes in cancer care poses significant challenges for patients. This article seeks to elucidate the significance of shared decision making (SDM) within the Indian clinical context while pin pointing disparities compared to Western practices. Through a systematic search conducted in Medline and Google Scholar from 2000 to 2019, approximately 400 articles were screened, resulting in the selection of 43 relevant articles (5 from India and 38 from Western sources). The literature underscores a scarcity of information on shared decision making in India as compared to Western contexts, potentially leading to adverse physical, psychological and financial consequences reported by patients. According to one study, While Western data demonstrate extensive involvement of both patients and physicians in consensus-building for treatment decisions, such engagement in India is predominantly observed in tertiary care settings, academic institutions or cases with high therapy costs. Cultural beliefs and biases further influence patient engagement, while communication breakdowns correlate strongly with medicolegal malpractice litigations. Future research endeavours are warranted to explore strategies for integrating shared decision making into routine oncology practice in India. Physicians must actively involve patients or their immediate family members in decision-making processes to ensure a patient-centric approach, thereby mitigating the risks of un-informed decision-making or mistrust in the treating physician's expertise. Efforts such as physician and patient education, tool development, policy formulation, widespread implementation and periodic assessments hold promise for advancing the practice of shared decision making.

NEXT-GEN Medicine: Designing Drugs to Fit Patient Profiles

Abstract: Personalized medicine, with its focus on tailoring drug formulations to individual patient profiles, has made significant strides in healthcare. The integration of genomics, biomarkers, nanotechnology, 3D printing, and real-time monitoring provides a comprehensive approach to optimizing drug therapies on an individual basis. This review aims to highlight the recent advancements in personalized medicine and its applications in various diseases, such as cancer, cardiovascular diseases, diabetes mellitus, and neurodegenerative diseases. The review explores the integration of multiple technologies in the field of personalized medicine, including genomics, biomarkers, nanotechnology, 3D printing, and real-time monitoring. As these technologies continue to evolve, we are entering an era of truly personalized medicine that promises improved treatment outcomes, reduced adverse effects, and a more patient-centric approach to healthcare. The advancements in personalized medicine hold great promise for improving patient outcomes and reducing adverse effects, heralding a new era in patient-centric healthcare.

Discursive Positioning in Practitioner-Parent-Child Communication in Traditional Chinese Medicine Consultations

ABSTRACT This study examines practitioner-parent-child communication in Traditional Chinese Medicine (TCM) consultations. Employing the theoretical framework of positioning theory, this discourse study investigates the interactions among Chinese medicine practitioners, parents, and child patients. The data, recordings of 21 pediatric consultation sessions, were gathered from the Department of Chinese Medicine at a hospital in China. The findings reveal that parents position themselves as representatives of their child patients, who, conversely, play a passive role with limited participation in consultations. This phenomenon is consistent with previous studies on doctor-parent-patient communication in Western medicine settings. As caretakers, parents also position themselves as experts in their child’s health, articulating the child’s health conditions and demonstrating some familiarity with TCM. Emphasizing the importance of lifestyle changes for the child’s health and recovery, practitioners strategically position themselves as both medical professionals and parenting advisors and give direct advice to parents. This study argues that the positioning of parents may diminish child patients’ participation. The study enhances our understanding of doctor-parent-child communication in the context of TCM by elucidating the positioning of the participants. It concludes by discussing the significance of child patients’ engagement and the implementation of a patient-centered approach in TCM consultations.

A qualitative exploration of policy interventions to improve the health-related quality of life of people living with HIV AIDS and co-morbidities of hypertension and/or diabetes in Ghana.

The intersection of infectious diseases, such as HIV, with chronic conditions like hypertension and diabetes poses a significant challenge in global health. While advancements in antiretroviral therapy have transformed HIV into a manageable chronic condition, a growing number of individuals with HIV now grapple with coexisting non-communicable diseases, impacting their Health-Related Quality of Life (HRQoL). Despite strides in HIV care, there is a notable policy gap that undermines efforts to address HIV-associated co-morbidities, particularly hypertension and diabetes, especially efforts to improve access, early detection, and ultimately HRQoL for individuals with HIV and co-morbidities. This study seeks to explore policy interventions aimed at improving the quality of life of HIV patients with hypertension or diabetes. The study utilized a qualitative descriptive design to explore the experiences and perspectives of healthcare professionals and support staff regarding policy interventions for managing HIV patients with hypertension and/or diabetes co-morbidities in three regions of Ghana. The research was conducted in the Upper West, Ashanti, and Greater Accra regions among 11 participants, chosen purposively from professions involved in HIV patient care to understand their views on the implementation of policy interventions to HRQoL for individuals with HIV and co-morbidities. In-depth interviews were conducted face-to-face and tape-recorded. Thematic analysis approach was used to analyze the data. The study involved 11 participants from three regions with varied years of experience. Implemented policies that potentially improve the HRQoL for individuals with HIV and co-morbidities involve support groups, home visits, provision of free drugs, and counselling. Barriers to policy implementation included non-adherence to medication, stigma, cost of non-communicable diseases (NCDs) medications, accessibility issues to NCDs services, lack of interest or understanding among implementers, and high staff turnover. Facilitators encompassed in-service training, guidelines in common platforms, knowledge sharing, external resources, regular check-ups, and motivational packages for patients. Individuals with HIV and comorbidities face complex challenges impacting their HRQoL, including emotional and financial dimensions. The study identifies critical policies and barriers, underscoring the need for tailored, patient-centered approaches. Facilitators like in-service training and regular check-ups offer actionable insights for effective policy implementation, emphasizing improved health outcomes for those with comorbid conditions. The study recommends integrated care approach and adherence support programs that address the unique challenges faced by people living with HIV.

Understanding and enhancing post-stroke recovery: Insights from a nested qualitative study within the MindFit Project randomized clinical trial

BackgroundStroke survivors experience a wide range of physical, cognitive, and emotional challenges. In the MindFit Project, a randomized clinical trial, 141 chronic stroke patients were divided into three groups: mindfulness-based stress reduction (MBSR) with computerized cognitive training (CCT), physical exercise (PE) with CCT, and CCT alone. The interventions were conducted remotely over 12 weeks, including online group and individual sessions. ObjectiveThis exploratory nested qualitative study aimed to investigate chronic stroke survivors’ experiences, opinions, and perceived changes due to the interventions within the MindFit Project. The secondary objective was to describe the broader experience of their recovery journey. MethodsTwenty-seven participants were recruited through purposive sampling and engaged in semi-structured one-on-one interviews. Twelve received MBSR+CCT, nine received PE+CCT, and six received CCT-only. The interviews were recorded, transcribed, and analyzed using thematic analysis. ResultsParticipants shared insights into their lives after stroke, including emotional and physical challenges, coping mechanisms, and the impact of societal perceptions. The interventions were generally positively valued, with MBSR aiding in emotional regulation, PE enhancing physical capabilities, and CCT improving cognition. The group setting provided valuable peer support and motivation, although some participants noted challenges owing to the heterogeneity. The telematic format was also appreciated for its accessibility, although it posed challenges to personal interaction and intervention supervision. ConclusionsOur study emphasizes the complexity of stroke recovery and the importance of holistic, patient-centered rehabilitation approaches. It also highlights the value of combining physical and non-physical interventions in a group setting, along with the potential of remote platforms to enhance the accessibility of rehabilitation programs. These findings generate hypotheses for future randomized clinical trials aimed at improving post-stroke recovery.

At a glance: urinary catheterisation in males and females.

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation.

Development and Psychometric Properties of the Therapeutic Relationship Assessment Scale-Patient (TRAS-Patient).

The therapeutic relationship plays a crucial role in nursing care for people with mental illness. Adopting a systemic and person-centred approach that considers the individual experiences and needs of the person is paramount. However, no instruments were found in the literature designed to evaluate the nurse-patient therapeutic relationship from the perspective of a person with mental illness. This study aimed to develop and evaluate the psychometric properties of an instrument for assessing the quality of the nurse-patient therapeutic relationship from the patient's perspective. An e-Delphi study was conducted to develop the assessment tool, and a psychometric study was carried out to examine its psychometric properties. The sample comprised 240 adults with mental illness. Internal consistency was assessed using Cronbach's alpha and the Omega coefficient. The final structure of the assessment instrument included 24 items distributed across two factors, explaining 64.2% of the variance. Cronbach's alpha was 0.94, and the Omega coefficient was 0.96. The intraclass correlation coefficient was 0.84 (95% CI: 0.66-0.92). The therapeutic relationship assessment scale (TRAS-Patient) shows good psychometric properties. This is a relevant tool for assessing the quality of the nurse-patient therapeutic relationship from the patient's perspective, thus promoting a patient-centred approach and responding to the patient's needs. Mental health nurses can access a tool for evaluating the nurse-patient therapeutic relationship centred on disciplinary knowledge. This enables patient involvement in care, enhanced care and person-centred practice.

The prevalence of patient-reported cognitive complaints and dementia risk factors in the audiology clinic

Background Hearing-dementia research mainly focuses on determining the causal direction of this association. Little is known about the prevalence of cognitive problems in a representative audiology patient population. Aim To examine the occurrence of self-reported cognitive complaints (SCC) and dementia risk factors (RF) in an audiology patient population. Materials and methods Patients visiting audiology clinics (n = 1100, 51% female and avg. age 61yrs) were administered an online intake tool based on the International Classification of Functioning Disability and Health. Domains extracted for analyses were memory and concentration (SCC) and loneliness, depression, sleep and vision (dementia RF) and self-reported hearing problems (SHP). Prevalence rates and associations with demographic variables and SHP were examined. Results SCC were highly prevalent, with over half of the patients reporting memory or concentration problems. Regarding dementia RF, 68% reported sleeping problems and > 50% reported sadness, anxiety or depressed mood. SHP correlated significantly with self-reported memory problems, loneliness, and vision problems. Conclusion This descriptive cohort-study suggests a high risk of cognitive issues within the audiology clinic population, indicated by the high prevalence of SCC and some dementia RF. Our findings underscore the importance of considering closer cooperation between care pathways like audiology and neurology and use of a holistic patient-centered approach.

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.

Longitudinal benefit:risk analysis through the desirability of outcome ranking (DOOR) with application to ACTT-1 Trial

A clinical trial aims to uncover high-quality evidence for both efficacy and safety for an experimental treatment. Traditionally, statisticians evaluate the two aspects marginally, where, for example, efficacy considers the proportion of patients cured and safety considers the proportion of patients not showing adverse events. However, separate analyses could end up with misleading results, as the cumulative nature of clinical outcomes and the correlation between efficacy and safety endpoints are neglected. The desirability of outcome ranking (DOOR) method addresses such issues and provides a patient-centric approach to benefit:risk evaluation. A patient’s outcome is ranked based on pre-specified clinical criteria, where the most desirable rank represents a good outcome with no side effects and the least desirable rank is the worst possible clinical outcome. As the DOOR outcome is a temporal state that can have repeated measures, we propose a longitudinal approach that estimates and infers the temporal treatment effects. We develop a methodology for constructing simultaneous confidence bands by accounting for the correlations across time points. Additionally, we propose a weighted Mann-Whitney-U statistic to evaluate the treatment effect over the entire trial period. The performance of the proposed methodologies is examined through simulations and an application to a COVID-19 trial.

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