Patient Beliefs Research Articles

The Effect of Benson Relaxation and Dhikr on Decreasing Pain Scale in Active Phase I Delivery Mothers at Yosi Trihana Independent Midwifery Practice

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Pain management uses pharmacological and non-pharmacological approaches, to reduce pain by treating accompanying symptoms. One of the non-pharmacological pain treatments is Benson relaxation therapy and dhikr. Benson relaxation therapy is a non-pharmacological strategy that combines relaxation techniques with the patient's belief system. It aims to reduce pain and encourage calmness by focusing on Allah SWT and releasing all emotions to the mother. The purpose of this study was to determine the effect of Benson relaxation and dhikr on reducing the pain scale in mothers inpartu kala I active phase. The research method used is quantitative with a pre-experimental research design, with the type of research one group pre-post test. The research location was at the Yosi Trihana Independent Practice Midwife, Klaten Regency, Central Java. They were carried out in November 2023 to January 2024. The population used was all active mothers inpartu active phase I. The sampling technique was total sampling, so the research sample was 30 respondents. The research instrument used the Numeric Rating Scale (NRS) pain scale. Data analysis was performed using the Wilcoxon test, which was processed using SPSS software version 20.0. The results showed a significant relationship with a p-value = (0.000). There is a decrease in the intensity of pain experienced during the labour process in Yosi Trihana's Independent Midwife Practice. These findings indicate that benzene relaxation and dhikr significantly impact reducing pain levels during labour. It is recommended that nurses and other health workers use dhikr relaxation as a non-pharmacological technique to reduce pain during labour. </em><em></em></p><p> </p></td></tr></tbody></table></div><strong><em>Keywords: Benson Relaxation, Dhikr, Pain Intensity Scal</em></strong>

Using evidence-based co-design to develop a hybrid delivered exercise intervention that aims to increase confidence to exercise in people with haemophilia.

Due to advances in treatments, people with haemophilia (PWH) are living longer. They are not as active as the general population due to joint damage and lack confidence to be active due to concerns about further bleeds and pain. There is a need to facilitate healthy aging through promotion of physical activity (PA) and exercise. Changing patient beliefs and increasing physical literacy and confidence to move are thought to be key to helping PWH become more active. This paper describes the development of an exercise and behaviour change intervention to improve confidence to exercise in PWH. The 4-stage Medical Research Council framework for complex intervention development was used. Stakeholders included 17 PWH and 7 physiotherapists working in haemophilia. Seven online focus group meetings were held. The final intervention is a hybrid 12-week physiotherapist led progressive exercise programme. Classes are 45 min including Pilates, High intensity interval training and balance elements, together with discussion sessions focusing on PA recommendations, the types and benefits of different exercise styles and the effects of PA, together with the effects of aging for PWH. The COM-B model of behaviour change was used to develop the intervention. Co-design helps to produce an intervention that understands the stakeholders needs. Through this process the intervention developed to incorporate not only increasing PA but also confidence to exercise. The use of behaviour change theory identified the behaviour techniques included in the intervention and aims to increase physical literacy in this population.

Personality dimensions and treatment adherence among glaucoma patients: the role of self-transcendence

Background Cloninger’s psychobiosocial model of personality proposes that consistent patterns of health behavior are determined by the complex interaction of different neurobiological processes of the patient’s temperament and character dimensions. Poor medication adherence is a pervasive problem among glaucoma patients and can lead to increased morbidity and disability. The objective of the present study was to investigate the association between Cloninger’s personality dimensions and medication adherence among glaucoma patients. Methods The cross-sectional study was conducted among 113 primary open-angle glaucoma (POAG) patients. The treatment adherence was assessed through a valid and reliable self-administered questionnaire, the Culig Adherence Scale (CAS). Personality dimensions were evaluated using the abbreviated version of the Temperament and Character Inventory-Revised (TCI-140). Statistical analyses were performed using TIBCO Statistica 14.0.1. The study protocol was registered in the DRKS – German Clinical Trials Register; (DRKS-ID: DRKS00022081). Results According to CAS, only 39.8% of patients were adherent to glaucoma treatment. Adherence was significantly negatively related only to the character dimension of Self-Transcendence (p < 0.05). No other TCI-140 dimension was significantly associated with medication adherence (p > 0.05). Conclusions The results suggest that POAG patients with higher scores on the Self-Transcendent personality dimension are more likely to experience difficulties adhering to medication regimen. The study highlights the importance of a holistic approach to glaucoma treatment, which takes into account not only the biological aspects of disease but also the psychosocial factors that influence patient behavior. Healthcare providers may need to consider glaucoma patients’ personality dimensions, beliefs and values when developing treatment plans and strategies to improve medication adherence.

Usability of inhaler devices: a parameter currently misused.

Inhalation represents the most convenient route for delivering respiratory drugs. Delivery systems showed a huge technological progress and several pocket inhalers had been engineered over the last decades for clinical use. Despite the growing technological efforts aimed to simplify the inhalation procedures and optimize the therapeutic outcomes, the effectiveness of drug inhalation through inhalers still represents a major challenge in respiratory medicine. Patients may actually incur in different types of critical errors when using all inhalers and are not capable to inhale throughout all devices equally well. Therefore, the choice of the most suitable and convenient device to prescribe still is a critical issue in real life. Usability is the only comprehensive parameter consenting the effective and objective assessment of pocket inhalers' performance, and allowing their objective comparison and ranking. Unpredictable discrepancies are in fact easily detectable between inhalers (even belonging to the same class) in terms of Usability, independently of the patient's awareness. The reasons were described and discussed for each class of inhalers presently available. Usability is a multidimensional parameter that is much more multifaceted and complex than usually presumed. Usability takes origin from the integrated, balanced and objective assessment of the role played by several factors from different domains, such as: factors related to patient's beliefs, to patients' behavioural components, to device engineering and to the overall cost. Usability is the key parameter for assessing and optimizing the appropriateness of any inhalation treatment through whatever device. Usability would also represent a key investigational instrument for supporting the future development of -innovative and more performing inhaler devices objectively.

Factors Affecting Postoperative Pain Beliefs Among Surgical Patients in Türkiye: A Cross-Sectional Study

BackgroundFrequency, ability to cope, and severity of pain; the genetic structure of the individual affects their emotional and cultural characteristics, beliefs, and personal characteristics. It is stated that pain beliefs are one of the factors affecting emotional pain control and approach to pain. AimsThis study, it is aimed to determine the pain beliefs of individuals experiencing postoperative pain. MethodsCross-sectional descriptive study. Surgical services of a single secondary care hospital. 170 patients who were in the first week after surgery, experienced acute pain, were between the ages of 18–65, and did not have a psychiatric disorder were evaluated. Collection Tools: Postoperative pain levels of the patients were evaluated with a Visual Analog Scale. As the VAS score increases, the pain level increases. Pain beliefs were evaluated with the Pain Beliefs Scale. Pain Beliefs Scale increases in the score obtained from the sub-score of the scale indicate that the pain beliefs related to that test are high. A student T-Test was used for bivariate comparisons between groups. One-way ANOVA was used to compare trivariate groups. In addition, Spearman's Correlation analysis was performed. Statistically, a confidence interval of >95% was used. The statistical significance level was set as p < 0.05. ResultsIt was found that the pain levels of the patients participating in the study were low and the scores they received from the Pain Beliefs Scale subscales were moderate. It was determined that those with lower education levels had higher scale scores in the psychological beliefs sub-dimension of the Pain Beliefs Scale. In the organic beliefs sub-dimension, it was determined that those with lower income levels had higher organic beliefs. It was determined that the postoperative pain experienced did not affect pain beliefs (p > 0.05). ConclusionIt was concluded that there was no relationship between the pain level and pain beliefs of patients with low pain in the postoperative period. Individuals experiencing postoperative pain believe that pain occurs due to the influence of both organic and psychological factors. For this reason, it is recommended factors that nurses who care for individuals experiencing postoperative pain provide care for both organic and psychological sources of pain.

General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study.

To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians. To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women. A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany). Verbatim transcripts were analysed through inductive qualitative content analysis. We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation and shared decision making were seen as helpful in this process. We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.

Patient and physician decision-making dynamics in overactive bladder care: A mixed methods study.

Overactive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision-making. This study investigates patient and physician health beliefs surrounding decision-making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision-making in overactive bladder care. Patient and physician participants completed a questionnaire followed by a semi-structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi-structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies. Patients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences. While both patients and physicians desire to engage in a shared decision-making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.

"How Do I Test the Waters? How Do I Go Forward?": Codesigning a Supportive Pathway after Critical Illness.

Rationale: Long-term recovery after critical illness can be affected by post-intensive care syndrome (PICS), a significant burden, which can impact return to activities and work. There is a need for streamlined support for intensive care unit (ICU) patients in their recovery while enduring PICS symptoms. Objectives: To explore critical illness recovery from the experiences, perspectives, and beliefs of former ICU patients, their caregivers, and multidisciplinary clinicians to design a future rehabilitation intervention prototype to support ICU patients. Methods: This was an experience-based codesign (EBCD) study underpinned by the Behavior Change Wheel framework involving ICU patients (<5 years after illness), caregivers, and multidisciplinary clinicians with current clinical experience with ICU recovery at any point along the care continuum (ICU, acute, subacute, or community settings) from two metropolitan hospitals in Melbourne, Australia. Two rounds of experience-based codesign workshops were held between August 2021 and February 2022. Workshop content was analyzed via a reflective thematic approach to determine themes and develop an intervention. The intervention was mapped according to the template for intervention description and replication framework. Results: Forty people participated in the codesign process: 15 ICU patients, 2 caregivers, and 23 clinicians. Fifteen major themes were identified in the experience of ICU recovery. Returning home was a key time point for change, acceptance, and adjustment, with the burden of physical limitations and mental health problems becoming apparent. Most participants expressed that PICS was poorly understood in the community, and there was a lack of support to aid recovery. Based on these results, an intervention prototype was developed with a primary goal of improving care after hospital discharge. This was further refined in the second round of workshops. A resource toolkit was deemed most acceptable to end-users, including a hospital-directed support program involving psychology and physical therapy and an accompanying digital health package. Conclusions: A critical time point for more support in the recovery journey was the transition from hospital to home. To address this, a rehabilitation prototype including a physical and psychological support intervention and supporting digital health toolkit was codesigned. The intervention package will be developed and trialed with future ICU patients and their families. Clinical trial registered with www.clinicaltrials.gov (NCT05044221).

Culturally competent respect for the autonomy of Muslim patients: fostering patient agency by respecting justice.

Although Western biomedical ethics emphasizes respect for autonomy, the medical decision-making of Muslim patients interacting with Western healthcare systems is more likely to be motivated by relational ethical and religious commitments that reflect the ideals of equity, reciprocity, and justice. Based on an in-depth cross-cultural comparison of Islamic and Western systems of biomedical ethics and an assessment of conceptual alignments and differences, we argue that, when working with Muslim patients, an ethics of respect extends to facilitating decision-making grounded in the patient's justice-related customs, beliefs, and obligations. We offer an overview of the philosophical contestations of autonomy-enhancing practices from the Islamic tradition of biomedical ethics, and examples that demonstrate a recommended shift of emphasis from an autonomy-centered to a justice-focused approach to culturally competent agency-promotion.

Features of Pathogenic Beliefs in the Context of Childhood Maltreatment: Implications for Therapeutic Empathy

ABSTRACT One reason why patients may seek therapy is to address constricting beliefs about themselves, others and the world that diminish the quality of their lives. These pathogenic beliefs interfere with the pursuit of personal goals and are often the source of considerable distress. In this paper, we discuss the perspective from Control-Mastery Theory that such beliefs were once adaptive in the context of earlier traumatic relational experience, and are often held in place by loyalties and attachment ties to important figures. Therapists can facilitate patients’ efforts to disconfirm these beliefs by empathically understanding the form and function of the patient’s pathogenic beliefs historically and in the present. Such understanding is termed “person empathy” and is found to contribute to positive therapeutic outcomes. With the aim of helping to facilitate therapists’ empathy regarding patients’ pathogenic beliefs, we describe in this paper some of the original functions and subsequent consequences of such beliefs in patients’ lives.

Association of Psychosocial Factors with Activation Among Patients with Glaucoma

To investigate the association of psychosocial factors with health self-management behaviors and beliefs among patients with POAG. Prospective cross-sectional cohort study. Patients (n=202) with mild, moderate, or advanced bilateral POAG. Patients (n=1,164) were identified from electronic medical records at a single academic medical center. Letters soliciting participation were mailed to 591 randomly selected potential participants. Psychometric measures and a determinants of health questionnaire were administered by phone to 202 study participants. The NEI VFQ-8 (NEI-VFQ), the Multidimensional Health Locus of Control (MHLC), the Perceived Medical Condition Self-Management Scale-4 (PMCSMS), the Patient Health Questionnaire-9 (PHQ), the Patient Activation Measure-13 (PAM), health literacy and a determinants of health questionnaire. For each increase in level of POAG severity, there was a decrease in mean NEI-VFQ score (p<0.001). For each unit increase in NEI-VFQ item 1, self-rated vision, mean PAM score increased (R2=5.3%, p=0.001; 95% CI= [0.077, 0.276]). For each unit increase in 'Internal 'on the MHLC, mean PAM score increased (R2=19.3%, 95% CI= [.649, 1.166], p<0.001). For each unit increase in 'Doctors' on the MHLC, mean PAM score increased (R2=11.0%, 95% CI= [1.555, 3.606], p<0.001). For each unit increase in 'Chance' on the MHLC, mean PAM score decreased (R2=2.6%, 95% CI= [-0.664,-0.051], p=0.023). On multivariate analysis adjusting for age, sex and race, for each unit increase in PHQ, mean PAM score decreased (95% CI = [0.061,1.35], p=0.032); for each unit increase in MHLC 'Doctors', mean PAM score increased (95% CI=[-1.448,3.453], p<0.001); for each unit increase in MHLC 'Internal', mean PAM score increased (95% CI=[0.639,1.137 ], p<0.001); for each unit increase in MHLC 'Chance' , mean PAM score decreased (95% CI=[-0.685,-0.098], p=0.009). We identified modifiable behavioral factors that could increase patients' self-perceived ability and confidence to manage their own eye care. Locus of control (MHLC), level of depression (PHQ), and self-rated functional vision (NEI-VFQ) were each associated with patient behaviors, attitudes and beliefs needed for health self-management (activation, assessed by the PAM) and may be important determinants of adherence behaviors. Targeting change in patients' care beliefs and behaviors may improve activation and treatment outcomes.

Review of literature and clinical practice experience for the therapeutic management of Morgellons disease.

Morgellons disease (MD) is a rare and contentious health condition characterized by dermatological symptoms including slow-healing skin lesions 'attributed' to fibres emerging from or under the skin. Patients also report sensations of crawling, biting and infestation with inanimate objects. This review examines the aetiology, patient characteristics, epidemiology, historical context, correlation with Lyme disease, role of internet, impact on quality of life and treatment approaches for MD. Despite ongoing debate, MD is not officially recognized in medical classifications, with differing views on its aetiology. Some link MD to Lyme disease, while others view it as a variant of delusional infestation. The literature suggests both psychiatric and environmental factors may contribute. The manuscript explores the association with substance abuse, psychiatric comorbidities, infectious agents and the role of internet communities in shaping perceptions. MD's impact on quality of life is significant, yet often overlooked. Treatment approaches are varied due to limited evidence, with low-dose antipsychotics being considered effective, but patient beliefs may influence adherence. A patient-centred, multidisciplinary approach is emphasized, considering both the physical and psychological dimensions of MD. Addressing the controversies surrounding MD while focusing on patient well-being remains a critical challenge for healthcare professionals.

Nonpharmacological pain relief for labour pain: knowledge, attitude, and barriers among obstetric care providers.

Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia. A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression. Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p=0.000), (AOR = 3.942 (1.926-11.380), p=0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p=0.019), (AOR = 1.740 (1.188-2.548), p=0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p≤0.05). Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.

Pain Science in Practice (Part 6): How Does Descending Modulation of Pain Work?

To understand the neuroscience of pain relief, one must know about the descending pain modulatory system. Neuronal pathways that originate in the brainstem and project to the spinal cord to modulate spinal neuronal activity provide a well-documented perspective on the mechanisms of analgesia that underpin pharmacological and nonpharmacological treatment options for people with musculoskeletal pain. Peripheral stimuli or signals from the cortex and subcortical regions of the brain can trigger the descending pain modulatory system (DPMS). The system helps explain how counter-stimulation techniques (eg, acupuncture and manual therapy), the patients' expectations and beliefs, and social or contextual factors could influence how people experience pain. J Orthop Sports Phys Ther 2024;54(2):1-4. doi:10.2519/jospt.2024.12112.

Allopathic medicine practitioners' experiences with non-disclosure of traditional medicine use.

A pertinent issue impacting patient treatment outcomes is the nondisclosure of traditional medicine (TM) use to Allopathic medicine practitioners (AMPs). For years, TM has been a controversial practice, with patients often using it alongside allopathic medicine without disclosing their use. It is imperitive to learn and understand the experiences of AMPs regarding the disclosure of TM use in Gauteng province to enable them to provide the best possible treatment outcomes for patients who use TM. This study aimed to explore the experiences of AMPs regarding non-disclosure of TM use in Gauteng province. This study was conducted in four district hospitals where outpatient care and services are rendered in Gauteng Province. An interpretive phenomenological analysis (IPA) design was followed. Fourteen purposefully sampled AMPs participated in face-to-face, one-on-one, and semi-structured interviews. Interpretive phenomenological analysis in Atlas.ti was conducted. Three themes emerged: bedside manner of AMPs; stigmatising TM use; and individual belief systems. The belief of patients' disclosure hesitancy because of fear of judgment by the AMPs underpinned these themes. Allopathic medicine practitioners are aware that patients who use TM could feel guilty and stigmatised. They acknowledged that patients use TM because of cultural and ethnic reasons, which should not be disregarded. The study highlighted that patients do not disclose their TM use because of AMPs' attitudes, stigmatising TM use, and their prejudices against the cultural beliefs of patients. Allopathic medicine practitioners should establish good communication with patients by providing patient-centred communication to facilitate disclosure of TM use.

P980 Dietary perceptions and practices in patients with Inflammatory Bowel Disease

Abstract Background Patients with Inflammatory bowel disease (IBD) have a strong interest in the role that diet can play in the disease.However, studies evaluating the perception of diet in Tunisian patients are lacking.The aim of this study was to investigate the dietary beliefs and behaviours of adult patients with IBD. Methods We conducted a longitudinal study using a self-administered questionnaire distributed online to the «Association Tunisienne des Maladies de Crohn et de RCH» group. Through 17 items, we collected data assessing the dietary behaviours and beliefs of patients with Crohn's disease (CD) or ulcerative colitis (UC). Results A total of 121 patients (CD: 59%,UC 41%)were enrolled, with a mean age of 38.1±11.4 years and a sex ratio of M/F= 0.73.Twenty-three patients were active smokers. At the time of the enrollment, 26.4% of patients had an active disease. Eighty-three patients believed that diet was a trigger for the disease, with a male predominance(80% versus 60.8%, p=0.02) but no difference between the UC and CD groups was found(p=0.61). Fourty-one patients felt that diet was more important than medical treatment for disease control, with equal importance for 47 patients and no impact for 6 patients. Ninety-two patients thought that diet could induce a relapse of the disease, with 86.8% resorting to an exclusion diet, and 76% thought that a change in diet could induce remission of the disease. The most frequently avoided were spices(33.1%),and gluten(17.4%). Spicy foods were considered to be the main responsible for IBD flares by 90.1% of patients,followed by fast foods(75.9%), citrus fruits(70.4%) and legumes(64.7%). Respectively 57% and 34.7% of the patients believed that milk and dairy products could induce or worsen disease symptoms. Around half of our patients thought that pasta had no impact on the disease course, while rice was considered to be the major aliment able to prevent relapse and improve symptoms by 47.7% of patients. On the other hand, 52.2% of patients considered high fiber vegetables to be potentially responsible for relapses. Fourty-two percent of the patients believed that fruits could have a negative impact on IBD while 20.4% thought they have a positive effect. Around half the patients thought that red meats and coffee had no impact on the course of the underlying disease. Fifty-five percent of the patients believed that fasting could prevent relapses, while 53 patients felt that it had no significant effect. Half of our patients had at least once consumed nutritional supplements, with a medical prescription noted in 65.6%. Conclusion Our study underlines the importance of a holistic approach to the treatment of IBD, taking into account both traditional medical treatments and appropriate dietary education.

P757 Patient attitudes, perceptions, and beliefs on the role of diet and nutrition in inflammatory bowel diseases. A scoping review

Abstract Background Despite substantial evidence implicating diet in the development and management of inflammatory bowel disease (IBD), we still lack widely agreeable recommendations for dietary therapy. As a result, patients often self-manage their disease symptoms following a range of dietary regimes, including elimination diets and specific nutrient supplementation. The aim of this in-depth scoping review is to characterise the perception of patients in the role of diet in IBD. Methods An extensive literature search was undertaken on PubMed (inception to August ‘23), including MeSH terms ("Inflammatory Bowel Disease" OR IBD OR Crohn's OR Colitis) AND (belief OR perception OR opinion OR views OR attitude) AND (diet OR food OR nutrition). Eligible studies included primary research exploring attitudes, perceptions, or beliefs of adults and children with IBD and/or their carers towards the role of diet in IBD onset, progression or management. We excluded animal, in vitro and non-English articles (Table 1). Results 1,649 records were identified. After full-text review of 162, 42 papers fulfilled eligibility criteria. Another 6 papers were identified after cross-checking reference lists from included papers, resulting in final inclusion of 48 articles. All articles described that diet perceptions relate with behaviour. In 17 studies a significant percentage of participants considered diet an initiating factor for their IBD diagnosis (Median,IQR: 32%,28%-45%). In 39 studies, patients listed foods they perceived to trigger or benefit their symptoms or inflammation. Most of these studies listed foods affecting the disease for IBD in general (n=29), while fewer studies described trigger and beneficial foods for Crohn’s disease (n=13) and ulcerative colitis (n=16), separately. Spicy food, dairy, alcohol, and coffee were the most perceived as disease-trigger foods, whereas rice, chicken, gluten free products and fish were perceived as beneficial (Fig 1A). Interestingly, 23 studies described patients’ most frequent sources of diet and nutrition information for IBD management (Fig 1B). The top-ranked being patient’s own experience with diet(82%), gastroenterologists(40%), other physicians(35%) and internet(35%). Only 25% of participants reported dietitians as their source of information. Conclusion There is a strong belief among patients with IBD that diet is important in disease development and management. It is possible that such beliefs translate to disease management practices, hence increasing restrictive eating, diminish quality or life, including food related quality of life. Until further evidence is produced to pinpoint the exact role of diet in IBD management, it is imperative that HCPs initiate such discussions and advise their patients accordingly.

Doctor, let us not tell her about the porcine implant.

With the proliferation of pharmaceuticals and advances in innovative medical technologies, use of animal-derived products is widespread in the healthcare industry. The use of these products sometimes conflicts with the religious beliefs of patients. I was involved in an ethical dilemma during reoperative abdominal hernia surgery. I engaged with the patient's next-of-kin via an intraoperative phone discussion regarding the possible use of a porcine-derived biological mesh implant. Here, I reflect on the experience to help clinicians who seek ethical competence alongside clinical competence.

Adaptation of the brainwriting premortem technique to inform the co-creation of COVID-19 testing strategies in underserved communities in South San Diego

IntroductionMeaningful engagement of partners in co-creating and refining health-related programs can increase the initial uptake, sustained implementation, broad reach, and effectiveness of these programs. This is especially important for underserved communities where resources are limited and need to be prioritized. Brainwriting premortem is a novel qualitative approach to partner engagement that combines the strengths of individual idea generation with the concept of premortem exercise that addresses failure points prior to the implementation of new programs.MethodsAn adapted form of brainwriting premortem was used to inform iterative refinements to a COVID-19 testing program at a Federally Qualified Health Center (FQHC) in San Diego. Patients and providers from the FQHC participated in interviews at two time points (early- and mid-implementation of the program). Interview data were transcribed, translated, and analyzed using a rapid qualitative approach. Key themes and sub-themes were identified and used to inform refinements to the program.ResultsA total of 11 patients (7 Spanish- and 4 English-speaking) and 8 providers participated in the brainwriting premortem interviews. Key themes related to possible reasons for COVID-19 testing program failure: advertising/sharing information; access to testing; handling of test results; staff and patient safety; patient beliefs and views regarding the SARS-CoV-2 virus; and COVID-19 testing options offered. Proposed solutions were offered for the key failures except for patient beliefs and views regarding the SARS-CoV-2 virus. Additional solutions offered were related to education, physical operations, and recruitment strategies. Real-time changes to the program flow and components were made in response to 7 suggestions from patients and 11 from providers. Changes related to the process of returning results were the most common, and included sending results via email with distinct workflows based on the test result.ConclusionThe implementation of the adapted brainwriting premortem technique allowed us to incorporate the perspective of key partners in the delivery and iterative refinement of the COVID-19 testing program. This was an effective tool in the context of an FQHC and can be a promising and approach to incorporate iterative input from patients and providers to ensure successful program implementation. Future studies, particularly those requiring rapid response to public health emergencies, should consider the use of this technique.

Management of chronic non-cancer pain by primary care physicians: A qualitative study.

Chronic non-cancer pain is a highly prevalent health issue with personal and societal consequences. Patients suffering from chronic non-cancer pain are mainly cared for by primary care physicians, but research shows that the latter perceive treating chronic pain as difficult. This qualitative descriptive study aimed to explore how primary care physicians in Switzerland manage patients with chronic non-cancer pain and what factors influence patient management. Data were collected through semi-structured interviews amongst primary care physicians in the German speaking part of Switzerland. A thematic analysis of the interviews allowed to identify four main themes: Investigation of chronic pain; patient-provider relationship; patient characteristics, and medical recommendations. These themes were closely interconnected and influenced each other. Physicians not only enquired about the origin of pain but also about the patients' beliefs and expectations towards it. They stressed the role of communication in fostering a good patient-physician relationship and to help patients cope with their pain. In addition to purely medical considerations, the psychological, social and economic situation of their patients and their possible impacts on the management of chronic non-cancer pain played a crucial role when recommending a treatment. This study highlighted the complexity of chronic pain management, which entails that primary care physicians need to figure out a unique strategy for each patient. By integrating patients' values and beliefs, as well as socioeconomic aspects, primary care physicians are in a position to take the lead in chronic non-cancer pain management. However, considering the burden of this disease, more continuous medical education on chronic pain is needed for primary care physicians, especially to better take into account the social determinants of pain.