Mixed Methods Pilot Study Research Articles

Feasibility of Whole-Body Resistance Training With Social Support Reinforcement for Older Adults Living Alone: A Mixed-Methods Pilot Study.

To examine the feasibility and acceptability of progressive whole-body resistance training with social support reinforcement for older adults living alone. This mixed methods single-group pilot study examined an intervention provided over 3 nonconsecutive days per week for 12 weeks. We evaluated quantitative data on recruitment, uptake, retention, and adherence, and measured pretest and posttest outcome scores on body composition, physical function, and psychosocial health. We conducted a focus group interview to collect qualitative data on participants' perspectives. Seven participants (five women and two men) completed the program (attendance rate = 88.9%). Physical function and psychosocial health improved, but soft lean and skeletal muscle mass decreased. Five themes emerged from the qualitative data. Results support the feasibility and benefits of this intervention program for older adults living alone despite challenges with recruitment and uptake. [Journal of Gerontological Nursing, 50(10), 34-41.].

A mixed methods evaluation of the music and psychology and social connections (MAPS) pilot - A dyadic intervention for couples affected by young-onset dementia.

People living with young-onset dementia and their care-partners are at risk of a range of adverse mental health outcomes and social isolation. There are few interventions aimed at supporting couples affected by young-onset dementia, which poses unique psychosocial challenges for younger people. This pre-post interventional mixed methods pilot study aimed to assess the feasibility and acceptability of an online group program for people with young-onset dementia and their care-partners living at home in Australia. The Music And Psychology and Social connections (MAPS) program aimed to address: (1) the challenges and changes associated with young-onset dementia; and (2) coping and wellbeing. The program involved six weekly two-hour sessions co-facilitated by a psychologist and music therapist, and a private Facebook group. The primary outcomes of feasibility and acceptability were assessed through a post-program focus group, separate individual feedback sessions with each couple, and a program evaluation questionnaire. Thematic analysis was conducted on the focus group transcripts and field notes from couple feedback sessions. We also examined the preliminary utility of MAPS in improving mental health and social connectedness, using quantitative pre-post-measures. Five couples completed the MAPS program. The most common dementia type was Alzheimer's Disease. Participant attendance was 87% across all sessions. Qualitative findings supported acceptability of the program with four emergent themes: being connected to others with shared experiences; reframing thoughts and feelings about dementia; music as a therapeutic tool; and benefits of MAPS. The high retention rate, qualitative findings and positive program evaluation suggest MAPS may be a promising, feasible and acceptable program for couples affected by young-onset dementia.

EHR Documentation and Referrals for Intimate Partner Violence and Sexual Assault.

Hospital settings provide a unique opportunity to screen for interpersonal violence (IPV) and sexual assault (SA) yet often lack health IT solutions for generating reliable and valid medico-legal documentation via forensic reports. The objective of the project was to evaluate a pilot, technology "tool" for documenting cases of IPV and SA that could support forensic nurse examiners and related stakeholders in generating high quality documentation and coordinating victim support services. The tool was a digital health intervention implemented for use among forensic nurse examiners, law enforcement, victim support organizations, and more within four counties of California. We conducted a mixed-methods pilot study that captured data around the adoption, use, and impact of having access to the newly implemented tool. The tool successfully went live in all four pilot counties at different time points with different proportions of use by county and form type: exams, referrals, addenda, risk assessments, and other. Participants were motivated to use the tool out of a perceived need for data handling functionalities that went beyond traditional manual (paper) means. Key functionalities included body mapping, data quality controls within validated forms, attaching addenda to already existing case reports, and the means to distribute data to external recipients. Further study and development are needed on functions to incorporate into body maps and forms, and understanding the information needs of law enforcement and victim support organizations. Our evaluation demonstrated the feasibility and acceptability of a health IT tool to support forensic nurse documentation of IPV and SA, and direct information to multiple legal and support-related stakeholders. Areas of future development include integrating IPV and SA-related data standards for digitized forms, enhancements to the body mapping feature, and understanding the needs of those who receive digital data from forensic nurse examiners within the tool.

The ReSearching Identity Podcast Project: Developing a Brief and Inclusive Professional Identity Intervention for Higher Education

ABSTRACT In this study, we present the pilot implementation of the ReSearching Identity Podcast Project, an intervention targeting the professional identity development of students with and without marginalized identities in higher education. The objectives were to assess the intervention’s acceptability and feasibility, particularly focusing on its use of educational podcasting, and to explore preliminary effects on students’ professional identity, including identity centrality and the connectedness with social identities (i.e. cultural and gender identity). We conducted a mixed method pilot study with university students (N = 33; 88% female) in the Netherlands. Students completed online surveys before and after the pilot implementation, and students and their teacher participated in follow-up conversations. The results supported the acceptability and feasibility of the ReSearching Identity Podcast Project, with students and teachers appreciating the brevity of the intervention program, opportunities to learn about marginalized experiences of fellow students and professionals, and embeddedness in the curriculum. Also, students reported higher professional identity centrality and overall high connectedness of professional and other social identities after the intervention. We conclude by addressing the limitations, but also potential of the ReSearching Identity Podcast Project to address professional identity development with all students in higher education.

Telehealth for Goals of Care Conversations in Advanced CKD: A Mixed-Methods Pilot Study of US Veterans and Their Clinicians

Engaging patients with advanced chronic kidney disease (CKD) in goals of care (GOC) conversations is essential to align life-sustaining treatments with patient preferences. This pilot study described the feasibility of engaging older Veterans with advanced CKD in GOC conversations via telehealth by (1) comparing patient characteristics, including life-sustaining treatment note completion rates and preferences by visit modality, and (2) exploring Veteran and clinician perspectives surrounding telehealth GOC conversations. Mixed-method convergent design including a prospective, quantitative observational cohort analysis (n=40) and qualitative, semi-structured interviews with 4 clinicians and 11 Veterans. Descriptive statistics were used to describe the quantitative data. An inductive, rapid analytic approach and the constant comparison were used to analyze and interpret qualitative data. Quantitative and qualitative data were triangulated to identify practical suggestions to optimize GOC conversations via telehealth. Study participants included Veteran patients aged≥70 years with advanced CKD stage 4 or 5 from a Veterans Affairs hospital nephrology clinic. The cohort (n=40) had a high probability of death, hospitalization, or both occurring within 90 days or 1 year. Across visit modalities, patient characteristics did not differ significantly. Two interrelated themes emerged from interviews: (1) GOC conversation feasibility varies by key personal and environmental factors (barriers and facilitators) across visit modalities, although overarching barriers include lack of non-palliative care provider engagement and uncertainty or lack of understanding surrounding illness trajectory, and (2) engaging Veterans in GOC conversations has a positive impact by creating a sense of reassurance regardless of visit modality. The sample size was small (n=40), and the study was unable to detect statistically significant differences in patient characteristics and clinical outcomes between visit modalities. Furthermore, future studies with larger and more diverse samples may be better equipped to identify differences by demographic characteristics. The findings suggest that it is feasible to engage older patients with advanced CKD in GOC conversations via telehealth, as patients wishing to complete a telehealth GOC conversation were able to. Factors increasing the ease of accessing GOC conversations may also increase their benefits, irrespective of visit modality.

Accepting and committing to caregiving for schizophrenia—a mixed method pilot study

BackgroundEnd of traditional institutionalized psychiatric care, diagnostic complexities, and associated stigma often negatively impact the social networks of caregivers, making them experience social isolation. Not the “identified patients”, caregiver perspectives are typically overlooked further adding to anticipatory stigma resulting in social death among them. Caregiving experience results in developing coping skills, preventing carers from responding to the nuances of the context, and identifying the useful rules— “Experiential Avoidance”. Psycho-education is typically combined with other formal treatment programs for case conceptualization, and to provide a clear rationale for the treatment approach but less as a distinct psychotherapy. Borrowing the philosophy of Functional Contextualism, the present study developed a “Present-Moment Awareness” guided psychoeducational intervention. The aim was to reduce schizophrenia caregiver burden and anticipatory stigma and promote the value of caregiver participation as ‘experts by experience’.MethodFive family caregivers of remitted schizophrenia patients were recruited using purposive sampling. Pre-post measure was taken on caregiver burden, caregiving experience, sense of personal mastery, and caregiving competence. Results were analysed quantitatively and qualitatively.ResultsA significant decrease in caregiver burden, stigma, and negative effects on the family in post-intervention was observed. Self-compassion led to a rise in a sense of empowerment.ConclusionA caregiver-centred “Present-Moment Awareness” guided psycho-education for schizophrenia caregivers can be considered a possible means to address perceived stigma in caregivers and to reduce associated distress of carers.

Radiation therapists' perceptions of participating in Professional Supervision - a pilot study.

Professional Supervision (PS) is a common approach used to reduce the fallout from stress and burnout. It involves monthly face-to-face meetings between a supervisor and supervisee to address well-being and professional goals. This pilot study examines 12 radiation therapists (RTs) perceptions of participating in PS. Conducted in the Christchurch Radiation Oncology Centre, this mixed-methods pilot study introduced PS in March 2022. In August 2023, 12 RTs completed a QUALTRICS online questionnaire consisting of 33 questions, including the Supervisor Working Alliance Inventory (SWAI). The SWAI assessed the alliance of supervision from a supervisee's perspective and comprised of 19 questions on a 7-point Likert scale and nine yes/no statements with optional comments. Five demographic questions were also included. All 12 RTs completed the questionnaire, with quantitative results indicating a positive alliance between supervisors and supervisees. RTs found PS to be a safe and comfortable space for reflective practice and support. Thematic analysis of qualitative data from additional comments revealed PS enabled RTs to reflect on career achievements, appreciate highlights of being an RT and consider future career paths within the profession. Radiation therapists responded positively to PS, suggesting its potential in managing workplace stressors, promoting career advancement and providing dedicated time for reflection, support and guidance. RTs endorsed the efficacy of PS in enhancing their practice and advocated for its widespread adoption among RTs.

Acceptability and potential benefit of a self-compassion intervention for people living with amyotrophic lateral sclerosis: a mixed methods pilot study

Objective: This proof-of-concept study aimed to explore the acceptability and potential benefit of a self-guided online self-compassion intervention to aid resilient coping and reduce emotional distress among patients and caregivers living with ALS. Methods: A single-arm pilot study was conducted in 20 adults living with ALS either as a patient or as a caregiver. Acceptability was examined using questionnaires (n = 20) and semi-structured interviews (n = 9). Potential benefit was assessed as changes in self-compassion, self-criticism and emotional distress, determined using psychological questionnaires at 3 and 6 weeks. Questionnaires were analyzed using linear mixed-effects models and interview data using inductive thematic analysis. Results: Out of 20 participants who started the intervention, 16 completed the study (80%). The majority of study completers (12/16) were satisfied with the intervention, but the data suggest room for improvement in terms of personalization. Qualitative data revealed multiple psychological benefits of using the intervention, including self-kindness, emotional self-awareness and savoring. Although not statistically significant, quantitative data showed positive trends with increased self-compassion (mean difference: 2.07; 95% CI: −.5.76 − 1.63) and reduced self-criticism (mean difference: −2.62; 95% CI: −.1.97 − 7.23) and emotional distress (mean difference: −2.49; 95% CI: −.51 − 5.50) at week 6 compared to baseline. Conclusions: The findings suggest that a self-compassion intervention is acceptable to people living with ALS, but its beneficial effects and the mechanisms involved have yet to be established in larger and more diverse samples, using controlled designs.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BackgroundLow physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.MethodsParticipants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.ResultsAn average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.ConclusionsThe digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.Trial registrationThe trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Preventing Surgeon Work-Related Musculoskeletal Disorders: A Pilot Study of the Comprehensive Operating Room Ergonomics (CORE) Program.

Work-related musculoskeletal disorders (WMSDs) among surgeons are markedly increasing. Several proposed interventions to reduce WMSDs among surgeons have been studied, but few follow an occupational therapy-oriented approach addressing biomechanical, psychophysical, and psychosocial risk factors. To design, implement, and assess the potential of the Comprehensive Operating Room Ergonomics (CORE) program for surgeons, a holistic evidence-based ergonomics and wellness intervention grounded in occupational therapy principles. Mixed-methods pilot study with the quantitative strand embedded in the qualitative strand. University-affiliated hospital. Six laparoscopic surgeons. CORE program outcomes were assessed using qualitative and quantitative data to indicate changes in posture, physical discomfort, sense of wellness, and operating room (OR) ergonomic performance. The Rapid Upper Limb Assessment (RULA) was used to quantify surgeons' WMSD risk level before and after intervention. There were 12 baseline observations (two for each participant), and two or three post-CORE implementation observations. A statistically significant difference, F(1, 6) = 8.57, p = .03, was found between pre- and post-occupational therapy intervention RULA scores. Thematic analysis of surgeon feedback, which was overwhelmingly positive, identified five themes: postural alignment, areas of commonly reported physical pain or discomfort, setup of the OR environment, surgical ergonomics training, and ergonomics in everyday life. The CORE program effectively decreased ergonomic risk factors to optimize surgeons' occupational performance in the OR. This study demonstrates a potential solution to how occupational therapists can holistically support surgeons and health care providers who are at risk for WMSDs. Plain-Language Summary: By 2025, a surgeon shortage is expected, partly because of the increase in surgeons' work-related musculoskeletal disorders, which affect their health and job continuity. This pilot study shows that the Comprehensive Operating Room Ergonomics program effectively addresses these problems. The study also serves as a framework for occupational therapy professionals to work with health care providers on ergonomics, benefiting population health. Results suggest that this approach could enhance surgeons' work conditions, supporting the American Occupational Therapy Association's Vision 2025 to improve health and quality of life.

“I have to breathe”: A Mixed-Methods Pilot Study to Assess the Feasibility, Acceptability, Cost, and Effectiveness of an Intervention for Post-Tuberculosis Lung Disease

“I have to breathe”: A Mixed-Methods Pilot Study to Assess the Feasibility, Acceptability, Cost, and Effectiveness of an Intervention for Post-Tuberculosis Lung Disease

The impact of a student death doula service-learning experience in palliative care settings on nursing students: A pilot mixed-methods study

Through a mixed-methods approach (randomized controlled trial and thematic analysis of pre and post-service-learning reflections), this study evaluated the impact of a student death doula service-learning experience on nursing students’ palliative competencies and learning experiences. The intervention group underwent a 2-day student death doula training workshop followed by a 6-month service-learning experience, while the control group received standard palliative care education. Attitudes toward the care of the dying significantly improved for the intervention group but not for compassion competence and palliative care knowledge. Six themes were developed: (1) Motivations for being a student death doula, (2) Improved perceptions of palliative care patients, (3) Perceptions of a good death, (4) Confidence in caring for palliative care patients, (5) Understanding the multifaceted nature of palliative care, and (6) Joys and challenges during service-learning. Service-learning helped students to understand palliative care patients and acquire confidence in engaging with them.

Potential Impacts of Heartfulness Relaxation on Interpreting Performance: A Pilot Study

This mixed-methods pilot study investigates the effects of a brief seven-minute heartfulness relaxation intervention on interpreting students’ cognitive performance, perceived stress, and consecutive interpreting skills. Seven participants completed pre- and post-intervention measures, including the Stroop test, Perceived Stress Scale (PSS-10), and consecutive interpreting tasks. Qualitative data were collected through participant interviews and analyzed using thematic analysis. The quantitative results revealed significant improvements in executive function (p<.001), perceived stress (p=.078), and Chinese to English and English to Chinese consecutive interpreting (p=.028) following the intervention. The qualitative findings indicated predominantly positive effects on interpreting performance, concentration, and focus, with mixed responses regarding relaxation, environmental factors, and effect sustainability. The convergence of the qualitative themes and quantitative improvements suggested that the heartfulness relaxation intervention enhanced the participants’ cognitive function, reduced fatigue, and optimized essential skills. These findings highlight the potential benefits of incorporating a brief relaxation practice into interpreter training and professional development. Limitations and future research directions are discussed, emphasizing the need for larger controlled trials to confirm the generalizability and long-term effects of the intervention. Overall, this pilot study provides a foundation for further investigations into the application of the brief heartfulness relaxation technique in the interpreting field.

Collective Intelligence-Based Participatory COVID-19 Surveillance in Accra, Ghana: Pilot Mixed Methods Study.

Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)-based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual "stocks" with payoffs tied to a future event. This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana. We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ≥18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19-related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant's percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants' user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once. Of the 105 eligible participants invited, 21 (84%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19-related information mainly from television and radio was associated with less likelihood of trading (marginal effect: -0.184). Individuals aged <30 years traded 7.5 times more and earned GH ¢134.1 (US $11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers. Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use.

Inequities in food access during the COVID19 pandemic: a multilevel, mixed methods pilot study.

Innovative data integration may serve to inform rapid, local responses to community needs. We conducted a mixed methods pilot study among communities of color or low-income in the San Francisco Bay Area amid the COVID-19 pandemic to assess a hypothesized data model to inform rapid response efforts. Between 2020-2021, we collected (1) qualitative data through neighborhood reports submitted via Streetwyze, a mobile neighborhood mapping platform; (2) survey data on social and economic circumstances; and (3) geospatial data among residents of three counties. Qualitative data were coded and then integrated with survey and geospatial data. We used descriptive analyses to examine participants' experiences with food in their neighborhoods. Seventy percent of participants reported food insecurity before and after the pandemic began in March 2020. Within neighborhood reports, food was the most frequently occurring sub-theme within the Goods and Resources parent themes (68% and 49% of reports, respectively). Security (88%), resource programs (88%), outdoor space (84%), and equity (83%) were more likely to be mentioned by participants who were food insecure compared to those who were not (12%, 12%, 16%, 17%, respectively). Mentions of food in neighborhood reports more often occurred in census tracts with lower socioeconomic status and more area-level food insecurity. Individuals who were food insecure reported a constellation of needs beyond food, including needs related to safety and greater social equity. Our data model illustrates the potential for rapid assessment of community residents' experiences to provide enhanced understanding of community-level needs and effective support in the face of changing circumstances.

Student-generated questions: An exploration of an instructional strategy with young children

Student-generated questions enhance deeper learning and empower active participation and critical thinking. Researchers have extensively explored teacher questions, but a notable gap persists in how to teach young children to ask questions effectively. This mixed-methods pilot study examined the impact of teaching questioning skills using the Question Formulation Technique (QFT) in an early childhood summer program for children from under-resourced areas. Pre-post oral language assessment scores from 33 children were analyzed to determine the impact of the QFT. Results reveal that using this method, teachers can effectively guide young students to ask more and better questions. Students involved in the research exhibited a substantial increase in the number of questions posed. They demonstrated a qualitative improvement in their approach to questioning, significantly increasing the number of wonderment questions (high-level questions). Conclusions indicate that using the QFT in early childhood classrooms can encourage young children to generate questions. Based on these findings, the authors conclude that teaching learners to ask meaningful questions can enhance their engagement, comprehension, and overall academic performance in diverse populations.

238 Clinician experience with an AI-enhanced target delineation workflow: a mixed-methods pilot study

238 Clinician experience with an AI-enhanced target delineation workflow: a mixed-methods pilot study

Differences in Person-Centered Care in Fetal Care Centers: Results from the U.S. Pilot Study of the PCC-FCC Scale.

We report findings from a U.S. mixed-methods pilot study of the Person-Centered Care in Fetal Care Centers (PCC-FCC) Scale. Participants, who received care at a U.S. Fetal Care Center (FCC) between 2017 and 2021, completed an online questionnaire providing sociodemographic details, specifics about the care received, qualitative experiences, and scores from the PCC-FCC Scale. Participants' (n = 247) PCC-FCC scores and qualitative feedback indicate high perceived person-centered care (PCC), particularly in areas of care coordination, respectful care, and patient education. However, 8% scored below the midpoint, and 38% of comments were negative, especially regarding expectation setting, preparation for post-intervention maternal health, and psychosocial support. Public insurance was associated with higher total PCC-FCC (p = 0.03) and Factor 2 scores (p = 0.02) compared to those with private insurance. The qualitative themes trust, clarity, comprehensive care, compassion, and belonging further elucidate the concept of PCC in FCCs. The PCC-FCC Scale pilot study revealed strong overall PCC in FCCs, yet variability in patient experiences suggests areas needing improvement, including expectation setting, preparation for post-intervention maternal health, and psychosocial support. Future research must prioritize diverse samples and continued mixed methodologies to better understand the role of insurance and identify other potential disparities, ensuring comprehensive representation of the FCC patient population.

Virtual Reality for Subacute Pain After Orthopedic Traumatic Musculoskeletal Injuries: A Mixed Methods Pilot Study.

Acute orthopedic traumatic musculoskeletal injuries are prevalent, costly, and often lead to persistent pain and functional limitations. Psychological risk factors (eg, pain catastrophizing and anxiety) exacerbate these outcomes but are often overlooked in acute orthopedic care. Addressing gaps in current treatment approaches, this mixed-methods pilot study explored the use of a therapeutic virtual reality (VR; RelieVRx ), integrating principles of mindfulness and cognitive-behavioral therapy, for pain self-management at home following orthopedic injury. We enrolled 10 adults with acute orthopedic injuries and elevated pain catastrophizing or pain anxiety from Level 1 Trauma Clinics within the Mass General Brigham health care system. Participants completed daily RelieVRx sessions at home for 8 weeks, which included pain education, relaxation, mindfulness, games, and dynamic breathing biofeedback. Primary outcomes were a priori feasibility, appropriateness, acceptability, satisfaction, and safety. Secondary outcomes were pre-post measures of pain, physical function, sleep, depression, and hypothesized mechanisms (pain self-efficacy, mindfulness, and coping). The VR and study procedures met or exceeded all benchmarks. We observed preliminary improvements in pain, physical functioning, sleep, depression, and mechanisms. Qualitative exit interviews confirmed high satisfaction with RelieVRx and yielded recommendations for promoting VR-based trials with orthopedic patients. The results support a larger randomized clinical trial of RelieVRx versus a sham placebo control to replicate the findings and explore mechanisms. There is potential for self-guided VR to promote evidence-based pain management strategies and address the critical mental health care gap for patients following acute orthopedic injuries.

Development of a Patient-Centered Pathway of Care for Retinoblastoma Patients: A Mixed-Methods Pilot Study.

Introduction Retinoblastoma treatment and follow-up is complex and varies between patients. Pathways of care can enhance quality of care, patient outcomes, safety, satisfaction, and resource optimization. Developing a pathway of care for retinoblastoma was identified as a top research priority by the retinoblastoma community. This study aimed to co-design and pilot a pathway of care called the "Retinoblastoma Journey Map" tailored for caregivers of newly diagnosed children with retinoblastoma. Methods A working group of patients, health professionals and researchers used human-centred design to ideate, prototype and refine the Retinoblastoma Journey Map. Caregivers of affected children were recruited to use and evaluate the Map. Mixed-methods data was collected on feasibility, acceptability, usability and perceived impact on communication, self-efficacy, anxiety, depression, and the quality of physician-patient interaction. Results The Retinoblastoma Journey Map consisted of an illustrated roadmap with 25 child-friendly stickers covering clinical treatment, medical education and milestones. Quantitative analysis revealed that the Map was feasible, acceptable, and usable; however, no significant effect on communication, self-efficacy, anxiety, depression or quality of physician-patient interaction was observed. Qualitative analysis identified 6 themes: Primary Use, Challenges, Impact, Limitations, Feasibility, Acceptability and Usability, and Unmet Needs. Conclusion A pathway of care for retinoblastoma, co-designed by researchers, health professionals and patients, was usable, acceptable, and feasible by caregivers of children with retinoblastoma. While significant effects on communication and physician-patient interaction were not observed, 'legacy building' - documentation of the pathway of care by families for later education of their child - emerged as an unanticipated yet important use of the Retinoblastoma Journey Map.