Person-centred Care Approach Research Articles

Hospitality in dementia-friendly environments is significant to caregivers during hospitalisation of their loved ones. Aqualitative study.

To explore what is meaningful to caregivers in relation to a dementia-friendly environment during hospitalisation of their loved ones with dementia or cognitive impairment. Implementation of dementia-friendly initiatives and person-centred care approach have shaped the political agenda within Danish society. Patients with dementia or cognitive impairment and their accompanying caregivers are challenged when admitted to hospital. During hospitalisation, caregivers find themselves in a vulnerable state of mind. Thus, the implementation of a dementia-friendly environment and adherence to person-centred care in hospital settings leaves room for improvement. This study was guided by a qualitative and explorative approach. Data were collected through 17 semi-structured interviews with caregivers at a subacute neurological ward. Thematic analysis was employed to interpret data. The study reports according to the COREQ checklist. The following three themes were identified: 1) Being a watchful bystander. 2) Visiting an undefined and foreign environment. 3) Longing for kindness. Hospitality expressed by staff towards caregivers is significant in allowing caregivers to experience hospital environments as "friendly." Dementia-friendly environments embrace existential aspects that go far beyond physical spaces; hence, experiences of kind acts shape caregivers' sense of safety and comfort during hospitalisation. Hospitality is an essential part of nursing in dementia care because caregivers are contextually vulnerable. Our study sheds new light on the provision of person-centred care to people with dementia and their families in healthcare. Nurses need to be aware that caregivers experience vulnerability and to involve caregivers in the care provided for patients with dementia. We recommend that a permanent contact person be appointed to follow patients throughout their admission period. Furthermore, systematic interventions focusing on phenomena such as hospitality and kindness may serve to form a person-centred clinical culture; an issue that warrants further investigation.

Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan.

To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class. Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; 22: 516-522.

Shared decision-making and person-centred care approaches in three African regions

Five years ago, we published a ‘wake-up’ paper on shared decision-making (SDM) in West Africa. In the current paper, our overview has been expanded to more African regions (central and north, in addition to the west) as well as to person-centred care (PCC) approaches. While these concepts are known in all regions to varying degrees, results indicate that most known SDM and PCC efforts originate from West Africa. In general, the focus seems to be predominantly on partnership-driven healthcare programs, such as COVID-19 infection; HIV/AIDS and maternal/neonatal care; and patient-provider communication and patient participation instead of comprehensive SDM approaches. The findings also indicate the absence of SDM training for African health professionals beyond specific healthcare programs, but some education on decision-making or critical appraisal of health information in primary or undergraduate health schools is carried out in certain African countries. Building on these sectoral initiatives, future directions include developing research and training programs in the perspective of scaling effective approaches.

Living on a razor's edge: Experiences of mothers caring for a son on synthetic cannabinoids in Malta.

Various studies have explored collectively the experiences of carers of individuals using illicit substances. Yet such experiences vary by gender, by relationship status to the substance user, by type of drug taken and whether the substance user lives within the same household. A hermeneutic phenomenological design was undertaken with five mothers of sons on synthetic cannabinoids (SC). These sons were receiving community mental health care following admission to hospital for episodes of drug-induced psychosis. Interview data were collected between August and October 2019. The transcribed texts were analysed using interpretative phenomenological analysis and interpreted using the Common-sense model. The superordinate theme 'Living on a Razor's edge' was extracted and consisted of two themes: 'A living Calvary' and 'Fighting a Lone battle'. The findings highlight the intense psycho-emotional suffering of the mothers, who experienced anxiety and fear relating to their welfare and that of the family; helplessness at not being able to communicate their concerns to their son and shame triggered by the judgmental attitude of others. Carers primarily associated the effects of SC such as psychotic episodes, to their sons being vulnerable individuals with mental health challenges rather than due to their drug habit. The mothers expressed feeling isolated as they could not turn to any family member or friends for support. The highly volatile and impulsive nature of their son further introduced a wedge between the female carer and her spouse, children, extended family and friends. Caring for a son on SC has a significant psycho-emotional and social impact on the mothers as informal carers. Hence, there is a need for a person-centred care approach to be provided, in which the shared understandings of the mothers narratives are explored and where their needs and concerns are integrated and addressed within a care plan.

Occupational therapists’ perspectives on assistive technology services provision for older adult’s clients: A literature review

ABSTRACT Occupational therapists (OTs) play a significant role in assistive technology (AT) services. The personal perspective of OTs could affect the provision of AT services. Understanding the relationship between the perspectives of OTs and the provision of AT services to older adult clients is crucial to this study. The study was conducted in the form of rapid narrative analysis. Seven articles of four categories were found and analyzed. The categories are perspective on practice, facilitators, barriers, and needs. OTs provide AT services to older adult clients as part of a person-centred care approach; however, limited follow-up care, timing, and awareness were cited as barriers to AT services delivery. Caregiver involvement is a potential factor for AT services delivery. Although, education and training on the use of the AT are required. It’s important to note that, there is no relevant data from low and middle-income countries.

Home care for patients with dirty homes: a qualitative study of the problems experienced by nurses and possible solutions

BackgroundHome-care nurses are often the first care professionals to enter a dirty home. The perceived problems and support needs of home-care nurses in these situations are largely unknown.ObjectiveTo examine the problems home-care nurses encounter in caring for patients living in dirty homes, and possible solutions for these problems.DesignQualitative descriptive research.SettingCommunities across the Netherlands.ParticipantsTwenty-three participants to investigate the problems or needs experienced, and 20 participants to investigate solutions. Participants included patients, home-care nurses and other professionals working in the community.MethodsSemi-structured interviews were conducted with 23 participants and analysed according to the principles of deductive thematic analysis. Subsequently, in interviews with 4 (representatives of) patients and four focus-group sessions with 16 professionals, the problems found were validated and solutions to the problems discussed.ResultsTen subthemes emerged that were clustered into three main themes: ‘dilemmas arise in choosing the right nursing care’; ‘cooperation and an integrated approach are often necessary, but lacking’; ‘home-care nurses have insufficient competencies’. Seven possible solutions were found: (1) strengthening collaboration between organizations in the community; (2) involving others sooner; (3) case management; (4) person-centred care; (5) taking more time; (6) providing home-care nurses with tools and support services; and (7) strengthening the competencies of nurses.ConclusionsCare for patients with a dirty home is complex. An integrated person-centred care approach is often necessary and home-care nurses need extra support to provide such care. Interventions should not only focus on patients, but address the nurses, the organization, and the collaboration between organizations in the community.

Care home practitioners' perceptions of the barriers and facilitators for using off-the-shelf gaming technology with people with dementia.

Background: Off-the-shelf digital gaming technology has been shown to support the well-being of people with dementia. Yet, to date, it is rarely adopted within dementia care practice, particularly within care homes. Drawing on a descriptive, qualitative approach, this is the first study that has sought to explore care home practitioners’ perceptions of the barriers and facilitators for using gaming technology within their workplace. Method: Data were collected across eight focus groups in the south of England with a total of 39 care home workers. These were analysed inductively following the 6-stage thematic process as outlined by Braun and Clarke (2006). Findings: Three themes, constructed from the data suggested, the care environment, staff knowledge and skills for inclusive gaming, and staff perceptions about capabilities (their own and those of people with dementia) inhibited or facilitated the use of gaming technology in care homes. The findings were interpreted through a combination of the Capability, Opportunity, Motivation and Behaviour model and the Theoretical Domains Framework to provide theory-based insights into the mechanisms for supporting behaviour change and implementation within the care home context. Conclusions: We argue for the need to target wider institutional barriers alongside providing inclusive training for care staff on incorporating gaming technology within their person-centred care approaches. Through these mechanisms, they can be provided with the capabilities, opportunities and motivation to integrate gaming technology within their practice, and thus facilitate the process of culture change within care homes.

Technology-Mediated Enrichment in Aged Care: Survey and Interview Study.

BackgroundDigital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings.ObjectiveThis study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care.MethodsA web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis.ResultsThe survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance.ConclusionsThis study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment.

Systematic review: Development of a person-centered care framework within the context of HIV treatment settings in sub-Saharan Africa.

ObjectivesPerson‐centred care (PCC) meets the needs of individuals by increasing convenience, providing supportive and culturally appropriate services to diverse populations, and engaging families, communities, and stakeholders in planning and provision of care. While the evidence demonstrates that PCC approaches can lead to clinical improvements across the HIV care continuum, it is not yet well defined in the context of HIV service delivery.MethodsA systematic review was conducted to define PCC practices for HIV treatment services in health facilities in sub‐Saharan Africa. Data synthesis led to the development of a PCC framework including domain and sub‐domain development. The study team used the Effective Public Health Project Practice tool for quantitative studies to assess the quality of the included studies.ResultsThirty‐one studies from 12 countries met the inclusion criteria, including 56,586 study participants (females 42%–100% and males 0%—58%), resulting in three major domains and 11 sub‐domains. These include staffing (sub‐domains of composition, availability, and competency); service delivery standards (sub‐domains of client feedback mechanisms; service efficiency and integration; convenience and access; and digital health worker support tools); and direct client support services (sub‐domains of psychosocial services, logistics support, client‐agency, and digital client support tools). Twenty‐five of the person‐centred interventions within these domains resulted in improvements in linkage to care, treatment retention, and/or viral suppression.ConclusionsThe PCC framework can help to provide a more consistent classification of HIV treatment interventions and will support improved assessment of these interventions to ensure that people receive personalised care.

Hospitality through negotiations: The performing of everyday meal activities among nursing staff and meal hosts. A qualitative study

Mealtimes are an important part of the hospital stay for patients and have significance for the patients' recovery and treatment as well as for their overall experience of their hospital stay. However, more knowledge is needed to understand the activities performed for the benefit of the patients and what the staff experience and describe to be meaningful or challenging when serving patients their meals. This study investigates the notion of hospitality in understanding the everyday activity of serving meals to older adult patients. The study is based on 20 semi-structured interviews with assistant nurses, registered nurses, and meal hosts at two hospitals in Sweden. Through thematic analysis, four themes were identified that capture the everyday activities of serving meals to older adult patients from the staff's perspectives: Managing the patient's best interest, Managing time, Managing the food service frame and Managing the meal environment. The findings suggest that hospitality is performed when these are managed, and that hospitality therefore is performed in negotiation with and within the given organisational frames in the hospitals. When these frames are stretched, the staff do more than is expected and carry out a caring and knowing performance that complements the already person-centred care approach in place. Essentially, the staff find that when having time, but also when taking time with the patients during the mealtime, they are able to increase the patients' food intake and create positive mealtime moments, hence emphasising the need for studying welcoming organisational structures that can enable the staff to perform hospitable mealtimes for the older adult patients.

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

BackgroundIndividuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views.MethodsWe used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach.FindingsMain themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support.DiscussionOverall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that best practice care is provided for people with CEN. Particularly prominent is the need to put in place systemwide training and support for clinicians working with CEN, encompassing generic and specialist services, and to challenge the stigma still experienced throughout the system.ConclusionsStaff working with this service user group report that delivering best practice care requires services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.

Sosiaali- ja terveydenhuollon ammattilaisten geneerinen osaaminen – kyselytutkimus sairaanhoitajille ja terveydenhoitajille

Social and health care professionals’ generic competence – survey to registered and public health nurses The aim of this study was to assess self-evaluated competence of nurses in delivering optimal services in social sector and primary health care. We assessed the relationship of on the job training to competence, too. To explore the competences of the nurses as an important professional group we constructed an electronic worksheet for nurses with statements about central issues in integrated customer service in social sector and public health care. Conclusions: Nurses mainly estimated their competences good in person-centred care approach. Better knowledge and ability of fitting various services together is needed as well as deeper understanding of the roles of other professionals. Continuous professional development at work needs to be secured. The nurses with little work experience should especially be included in the training.

Steps towards equitable care: creating web pages to highlight diversity for Australia&#x2019;s aged care and end of life care workforce.

The impact of Australia's diverse population on the aged care sector has been acknowledged, with the Royal Commission into Aged Care Quality and Safetyfindings providing evidence of the importance of population diversity for consumer-directed and person-centred care. Similarly, the Aged Care Quality Standards and Aged Care Diversity Framework acknowledge the diversity of Australia's ageing population and potential implications for equitable access to care and the ensuing importance of culturally appropriate and culturally safe care. This paper reports on the development of informational web pages and utilisation findings for use by the aged care workforce supporting diverse populations. Content was created for the End of Life Directions for Aged Care website, based on rapid review findings relating to barriers and limitations for people accessing equitable care in the aged care and palliative care sectors. Website pages containing embedded links to useful content and resources for health professionals and care workers who work with older diverse adults are shown to be well received among users. As Australia's future population will age with increasing diversity markers, with implications for aged care and palliative care service provision, workforce access to up-to-date, relevant and evidence-informed information on best practice non-clinical support for individuals from diverse backgrounds towards the end of life promotes a person-centred care approach. Access data shows that the website content is being utilised increasingly over time and suggests that it is filling a gap in comprehensive and accessible end of life resources that have been missing from the Australian aged care and palliative care workforce.

Managing responsive behaviours of care home residents with dementia during the COVID‐19 pandemic

BackgroundMost care home residents with dementia exhibit responsive behaviours including aggression, agitation and wandering (Cerejeira et al., 2012). Psychotropic drugs are often prescribed to manage responsive behaviours but contravene guidance as they increase the rate of strokes and death in people with dementia (Gustafsson et al., 2013). However, the use of psychotropic drugs for behaviour management may potentially increase during the COVID‐19 pandemic (Howard et al., 2020). Therefore, it is imperative to understand how responsive behaviours are managed to identify facilitators and barriers to implementing non‐pharmacological approaches.MethodDuring the Covid‐19 pandemic, 25 interviews were conducted with managers, nurses and care assistants from 21 care homes across Ireland. All participants provided written informed consent. Themes emerging from thematic analysis (Braun & Clarke, 2006) conceptualised understanding of how care home staff managed responsive behaviours during the COVID‐19 pandemic. Ethics approval was obtained from Lancaster University Faculty of Health and Medicine Research Ethics Committee (FHMREC20099).ResultResidents with dementia were perceived to be more depressed during the COVID‐19 pandemic due to the absence of family visits. However, care home staff reported that psychotropic drugs were not used more frequently for behaviour management than before the pandemic and that a person‐centred care approach was taken which involved supporting residents to participate in activities in smaller groups. Maintaining adequate staffing levels was challenging due to recruitment of nurses and care assistants from private care homes to acute public hospitals during the pandemic. Moreover, psychiatry and mental health support were difficult to access in rural regions of Ireland during COVID‐19 restrictions. Another emerging theme demonstrated that care assistants rarely contributed to equitable decision‐making, posing a barrier to implementing non‐pharmacological strategies to manage responsive behaviours.ConclusionThis study recommends that care homes should be prioritised in public health planning for Covid‐19, particularly to ensure optimal staffing levels and access to mental health support. In addition, care assistants should be provided with opportunities to contribute to decision‐making including case conferences. These recommendations will inform development of Department of Health policy and dementia care guidelines to facilitate implementation of non‐pharmacological strategies to manage responsive behaviours in dementia.

Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures

ObjectivesWe aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an...

Effectiveness of nurse-led counselling and education on self-efficacy of patients with acute coronary syndrome: A randomized controlled trial.

AimAdherence to lifestyle recommendations, medical regimens and cardiac rehabilitation is poor among patients with acute coronary syndrome. The aim of this study was to examine the effect of nurse‐led counselling and education using a person‐centred care approach on short‐term cardiac self‐efficacy in patients with acute coronary syndrome.DesignA parallel, two‐armed, randomized controlled trial was conducted.MethodsOne hundred twenty patients who were hospitalized with diagnosis of acute coronary syndrome were selected and randomly assigned into intervention (n = 60) or control (n = 60) groups. In the intervention group, in addition to routine care, the nurse‐led counselling and education programme included two face‐to‐face sessions, two telephone counselling and education sessions, using the person‐centred care approach. Participants in the control group received only routine care. Data were collected using the cardiac self‐efficacy scale before the intervention and 1 month after discharge.ResultsAfter the intervention, we found that cardiac self‐efficacy, including the perceived self‐efficacy to control symptoms and maintain function, was statistically significantly higher in the intervention group than the control group.

Applying the Social-Ecological Approach to Evaluate Diabetes Medication Management in Older People.

Glucagonlike peptide-1 receptor agonist is a common antidiabetic medication class to lower HbA1c, weight, and cardiovascular risk. This case study describes the challenges a patient with uncontrolled diabetes faced after receiving a prescription for liraglutide because of multiple levels of influence, including individual, family, institutional, and policy level barriers. The case highlights the importance of utilizing a person-centered care approach by evaluating patient's preferences, visual and motor coordination, cognitive function, psychological stress, and medication cost before prescribing injectable products for elderly patients.

Substance use and misuse of older adults living in residential care facilities: a scoping review from a person-centred care approach

AbstractPerson-centred care (PCC) in residential care facilities (RCFs) is valuable but creates challenges for care professionals balancing involvement and a partnership approach for residents while considering the health and safety outcomes of all residents. This review evaluates what is known about the substance use and misuse of residents living in RCFs and what is important to study in future research to enhance PCC, especially in cases in which residents wish to choose unhealthy behaviours. A scoping review was conducted and exclusion criteria were set. The included papers were assessed on methodological quality using the Mixed Methods Appraisal Tool and the results were qualitatively analysed. The included papers consisted of studies regarding alcohol, tobacco and illicit drugs. The results showed that care professionals are involved in facilitating and regulating alcohol and tobacco. The focus of the included papers is on alcohol and tobacco. Five of the 16 papers assessed the residents’ perspective. This review highlights the importance of incorporating the perspectives of residents, care professionals and the organisation to enhance PCC and enable residents to make shared and well-informed decisions in dialogue with care professionals. Future research should also assess the distinction between substance use and misuse, and how this affects implementing PCC in RCFs.

Heart Failure Patients with type II diabetes still require more focus

Abstract Funding Acknowledgements Type of funding sources: None. Background A bidirectional relationship exists between heart failure and diabetes; heart failure is a risk factor for type II diabetes and type II diabetes is a risk factor for heart failure. The prevalence of both chronic conditions is on a continuous upward rise. Heart failure has a poorer prognosis than diabetes and therefore heart failure patients with diabetes should be also managed at a heart failure centre. It has been shown that heart failure medication is of benefit to patients with or without diabetes. Purpose With new advances in heart failure medication this retrospective and prospective analysis examines if patients with or without type II diabetes receiving similar care at a heart failure centre will have similar outcomes. Methods A retrospective and prospective cohort analyses was performed on 50 patients attending a single centre heart failure clinic over a 12-month period. LVEF, NT Pro BNP and NYHA was examined pre- and post-receiving similar heart failure care. Results 50 patients were recruited for this study. There were 25 patients in the type II diabetes cohort (10 female: 15 male. Average age 77 years old) and 25 patients in the non-diabetes cohort (7 female:18 male. Average age 79 years old). In the type II diabetes cohort average LVEF pre care 27%: post care 33% (difference 6%), average NT Pro BNP pre care 3558 pg/ml: post care 2564 pg/ml (difference 994 pg/ml), average NYHA pre care II: post care I-II (difference of 0.5). In the non-diabetic cohort average LVEF pre care 26%: post care 37% (difference 11%), average NT Pro BNP pre care 1679 pg/ml: post care 1135 pg/ml (difference 544 pg/ml), average NYHA pre care II: post care I-II (difference 0.5). Conclusion Both cohorts of patients had similar NYHA functional class outcomes. The patients in the type II diabetes cohort had higher NT Pro BNP levels pre care and higher reduction in NT Pro BNP post care than the non-diabetic cohort. Both cohorts had similar LVEF pre care, but the non-diabetic cohort had better improvement post care, with possible avoidance of need for implantable cardiac devices compared to the type II diabetes cohort. This study shows that heart failure nurses should be aware that heart failure patients with type II diabetes carry a higher risk profile and should be actively identified as part of an individualised, person-centred care approach. Heart failure patients with type II diabetes need to have vigilant scrutiny of their care to optimise their outcomes.

Factors Influencing Care Pathways for Breast and Prostate Cancer in a Hospital Setting.

Breast cancer (BCa) and prostate cancer (PCa) are the most prevalent types of cancers. We aimed to understand and analyze the care pathways for BCa and PCa patients followed at a hospital setting by analyzing their different treatment lines. We evaluated the association between different treatment lines and the lifestyle and demographic characteristics of these patients. Two datasets were created using the electronic health records (EHRs) and information collected through semi-structured one-on-one interviews. Statistical analysis was performed to examine which variable had an impact on the treatment each patient followed. In total, 83 patients participated in the study that ran between January and November 2018 in Beacon Hospital. Results show that chemotherapy cycles indicate if a patient would have other treatments, i.e., patients who have targeted therapy (25/46) have more chemotherapy cycles (95% CI 4.66–9.52, p = 0.012), the same is observed with endocrine therapy (95% CI 4.77–13.59, p = 0.044). Patients who had bisphosphonate (11/46), an indication of bone metastasis, had more chemotherapy cycles (95% CI 5.19–6.60, p = 0.012). PCa patients with tall height (95% CI 176.70–183.85, p = 0.005), heavier (95% CI 85.80–99.57, p < 0.001), and a BMI above 25 (95% CI 1.85–2.62, p = 0.017) had chemotherapy compared to patients who were shorter, lighter and with BMI less than 25. Initial prostate-specific antigen level (PSA level) indicated if a patient would be treated with bisphosphonate or not (95% CI 45.51–96.14, p = 0.002). Lifestyle variables such as diet (95% CI 1.46–1.85, p = 0.016), and exercise (95% CI 1.20–1.96, p = 0.029) indicated that healthier and active BCa patients had undergone surgeries. Our findings show that chemotherapy cycles and lifestyle for BCa, and tallness and weight for PCa may indicate the rest of treatment plan for these patients. Understanding factors that influence care pathways allow a more person-centered care approach and the redesign of care processes.