Psychosocial Complexity Research Articles

An exploratory study of perceptions and utilization of genetic information in the intended parent experience of oocyte donor selection.

Utilization of oocyte donation has become an increasingly common practice in assisted reproductive technology (ART). Since the introduction of larger carrier screening (CS) panels and extended family medical histories (EFMH), studies have not examined how this information factors into the oocyte donor selection process. This exploratory, qualitative study provides further insight into what role, if any, donors' available genetic information (e.g., larger CS panels and EFMH) plays in selecting an oocyte donor. An online screening survey was distributed to individuals who have undergone or are currently in the process of selecting an oocyte donor through the RESOLVE network and Mayo Clinic's Reproductive Endocrinology and Infertility clinic. From 13 survey respondents, six oocyte recipients subsequently participated in semi-structured telephone interviews and discussed their experiences as oocyte recipients including their perceptions of donors' available genetic information and process in choosing an oocyte donor. Genetic information was seen as valuable and reassuring for participants, particularly EFMH, but did not play a significant role in the selection process for these participants. Supplemental emergent themes provide context on the psychosocial complexities of the oocyte recipient experience and possible explanations for why genetic information is not a decisional priority. Participants indicated genetic information was not extensively discussed or fully explained by providers. Results demonstrate how genetic counselors can be more involved in the pre-selection process to discuss the utility and limitations of genetic information, as well as address psychosocial issues common to the oocyte recipient experience.

Изучение психосоциальных факторов, влияющих на приверженность пациентов к лечению хронических заболеваний.

This research article scrutinises the psychosocial underpinnings that influence adherence to treatment among patients with chronic diseases, assuming that adherence is a multifaceted phenomenon shaped by a complex set of psychosocial factors. Purpose: the aim of the study is to uncover the complex relationship between these factors and adherence to treatment, using linear sampling to capture the dynamics and temporal evolution of adherence behaviour in the context of chronic illness. Materials and methods. Using a rigorous methodological framework, participants with many chronic conditions were included in the study, with inclusion and exclusion criteria carefully developed to ensure a representative and diverse group. The study utilised a range of validated psychometric tools to quantify psychosocial variables such as social support, stress levels and health beliefs, as well as a multifaceted approach to assess adherence combining self-report, pharmacy records and biometric measures. Advanced statistical analyses, including mixed-effects models and structural equation modelling, were used to identify relationships between psychosocial factors and adherence to treatment, taking into account the complexity and longitudinal nature of the data. Results. The findings highlight the critical role of social support in increasing treatment adherence as well as the detrimental effects of elevated stress levels, emphasising the critical interplay between individual psychological resilience and external support systems. The study also clarifies the influence of health beliefs and illness perceptions on adherence behaviour, advocating a better understanding of the cognitive and affective dimensions that determine patients’ engagement in treatment. Findings. The article concludes by arguing that a paradigm shift towards integrating psychosocial support mechanisms into holistic models of care is needed to increase adherence in chronic disease management. It calls for the implementation of health care policies and practices that not only address the biomedical aspects of chronic disease, but also the psychosocial complexities inherent in long-term disease management. Findings from the study encourage further research into specialised psychosocial interventions aimed at improving adherence and consequently quality of life for people coping with the challenges of chronic illness.

Interdisciplinary Pain Board for Managing Patients with Palliative Care Needs and Substance Use Disorder: A Pilot Study.

Context: Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. Objectives: Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity. Methods: We conducted a retrospective analysis of cases presented at CPB between May 2021 and June 2022 and a cross-sectional analysis of CBP participant surveys. Results: Among 28 cases included for analysis, gastrointestinal cancers (n = 7, 25.9%) and multiple myeloma (n = 5, 18.5%) were the most frequent cancer diagnoses. Primary reasons for referral were SUD (n = 22, 78.6%) and provider/team distress (n = 13, 46.4%). The most frequent recommendations made at CBP were encouraging interdisciplinary collaboration (n = 18, 64.3%), maintaining healthy boundaries (n = 15, 53.6%), and SUD management (n = 13, 46.4%). Of 14 scheduled meetings, most meetings involved the presentation of ≥1 cases (n = 12, 86%). Among 40 CBP participant surveys, most attendees (n = 38, 95%) were likely or highly likely to continue to attend. Conclusion: CPB is a feasible and acceptable intervention that allows for palliative care clinicians to collaborate and receive interdisciplinary team feedback and peer support on the management of patients with cancer-related pain and concurrent SUD and/or psychosocial complexity in the ambulatory care setting. Key Message: A regular, interdisciplinary team meeting (CPB) is a feasible and acceptable intervention to help palliative care clinicians manage challenging cases involving patients with cancer and concurrent SUD and/or psychosocial complexity.

Psychosocial Perspectives on Child Mental Health in Custody Disputes: A Qualitative Study from Urban Bengaluru.

Divorce has become a common contemporary phenomenon in India. In this context, the child is pulled into the vortex of parental disputes over the child's custody. The spiteful and protracted nature of these legal cases adversely affects the child's mental health. Despite the growing research in the Western context, the understanding of this phenomenon and its psychosocial impact on children in India is still in its infancy. In this background, this study aimed to explore key child mental health and related psychosocial issues in the context of child custody cases in urban India. The study explored the psychosocial complexities of child custody cases by interviewing 24 key informants using a semi-structured interview guide. The key informants comprised seven mental health professionals and seven legal professionals working in the area of child custody and access. It also included 10 parents who were contesting parties in child custody cases. They were selected using a purposive sampling method over a period of 6 months. Seven themes identified using thematic analysis were: (a) parent-child relationship and interaction; (b) parenting dynamics; (c) parental mental health issues; (d) malicious acts by parents; (e) child's adjustment to changes in life; (f) issues in the school context; and (g) child mental health issues. This study highlighted the potential risk factors in the familial context that adversely affect the child's well-being and mental health in custody disputes. Therefore, interventions at the family level in the legal setting are crucial in the mitigation of these risks. In child custody cases, the coordination and liaison of child mental health professionals with the judicial system is crucial for child mental health promotion and safeguarding the best interests of the child.

Acceptability and feasibility of screening with a pediatric care provider-led social determinants of health identification tool

BackgroundComplex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings.MethodsThe framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). The tool consisted of three domains: biological, psychological, and social. Semi-structured interviews were conducted with health care providers in pediatric medical facilities in Ottawa, Canada. A low inference and iterative thematic synthesis approach was used to analyze the qualitative interview data specific to acceptability and feasibility.ResultsThirteen health care providers participated in interviews. Six overarching themes were identified: acceptability, logistics, feasibility, pros/cons, risk, and privacy. Overall, participants agreed that a routine, trained provider-led pediatric tool for the screening of social determinants of health is important (n = 10, 76.9%), acceptable (n = 11; 84.6%), and feasible (n = 7, 53.8%).InterpretationThough the importance of social determinants of health are widely recognized, there are limited systematic methods of assessing, describing, and communicating amongst health care providers about the biomedical and psychosocial complexities of pediatric patients. Based on this study’s findings, implementation of a brief provider-led screening tool into pediatric care practices may contribute to this gap.

Wide-ranging needs and recommendations following holistic sleep assessment and intervention, for children and young people with neurodevelopmental and psychosocial vulnerabilities

A service evaluation was conducted on a community-based, multidisciplinary sleep service for children and young people (CYP) with neurodevelopmental disorders (NDD) and psychosocial vulnerabilities. Referrals for 200 children were received over an 11-month period from two inner-city boroughs. 85.5% (171) of CYP presented with at least one neurodevelopmental disorder; most commonly Autism Spectrum Disorder (ASD) or Attention Deficit Hyperactive Disorder (ADHD). 55% (111) CYP also experienced at least one external psychosocial complexity such as: suboptimal housing conditions, safeguarding concerns, medical conditions, and social support. Each referral received a one-hour paediatrician-led holistic sleep assessment. Following this, 136 families were referred for psychologist-led psychoeducational parent workshop, and follow-up telephone contacts to support implementation of behavioural interventions or 1:1 psychologist-led support. 95% of families who engaged with the psychoeducational workshop reported improvement in sleep problems, and 86% of families that engaged with 1:1 psychologist-led support reported improved sleep. We believe the model could be easily replicated, adapting for local needs where necessary.

Finding meaning in complex care nursing in a hospital setting.

This study explores the experiences of nurses that provide 'complex',generalisthealthcare in hospital settings. Complex care is described as care for patients experiencing acute issues additional to multimorbidity, ageingor psychosocial complexity. Nurses are the largest professional group of frontline healthcare workers and patients experiencing chronic conditions are overrepresented in acute care settings. Research exploring nurses' experiences of hospital-based complex care is limited, however. This study aims to add to what is known currently. Four 'complex care' nurses undertook in-depth semistructured interviews and their narratives were analysed using the conceptual framework of complex adaptive phenomenology. Two overarching themes constituting the 'essence' of complex care nursing were identified: Contextual factors and attribute/value-based elements. Creating meaningful patient outcomes and feeling part of a team were experienced as fulfilling, whereas time constraints, institutional settingsand systemic barriers to comprehensive caregiving diminished the experience of providing complex care. Overall, work meaning presented as a dynamic phenomenon, shaped by personal and professional values, local settingsand systemic factors. It is recommended that more expansive research be undertaken to explore the experience of complex care for nurses. Such knowledge can contribute to initiatives that draw a skilled, effectiveand engagedhospital-based complex care nursing workforce.

Capturing the clinical complexity in young people presenting to primary mental health services: a data-driven approach.

The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. This retrospective study involved analysis of headspace's clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors. A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a 'high complexity' group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing 'distress complexity' and 'psychosocial complexity' (about 20% each). Compared with the 'distress complexity' group, young people in the 'psychosocial complexity' group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services. The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.

Unplanned pregnancy at advanced maternal age: analysis in light of Transition Theory.

To analyze the experience of women aged 35 or over regarding the transition to unplanned motherhood. A descriptive qualitative study, with semi-structured interviews with six women in this age group, selected by convenience, carried out in a high-risk prenatal clinic between July 2022 and July 2023. Analysis was based on Transitions Theory. Three main categories were identified: Transition properties (attributes of late motherhood); Transition conditions (personal, social and community factors as facilitators or inhibitors); and Response patterns (coping and adaptation strategies). The results highlight the emotional and psychosocial complexity, including the impact of social stigma, health challenges and the duality of old age, which brings both challenges and maturity. The need for public policies and specialized support to promote mental health, well-being and social integration is emphasized, aiming for a healthier and more empowered transition to motherhood.

"And if my goal is never to leave Casey House?": The significance of place attachment for patients at a specialty HIV hospital in Toronto, Canada.

The current healthcare context prioritizes shorter hospital stays and fewer readmissions. However, these measures may not fully capture care experiences for people living with HIV, especially those experiencing medical, psychosocial, and economic complexity. As part of a larger study, we conducted seven focus groups with people living with HIV (n=52), who were current/former patients at a Toronto-based specialty hospital, examining their desires/needs for hospital programs. Using a novel place attachment lens, we conducted a thematic analysis focusing on the emotional bond between person (patient) and place (hospital). Our findings show that participants wanted an ongoing connection to hospital to fulfill their need(s) for control, security, restoration and belonging. Indeed, continual attachment to hospital may be beneficial for patients with complex care needs. Our research has implications for care engagement and retention frameworks.

Examining the Mental Health Care Needs and Outcomes of Young People Transitioning from Out-of-Home Care (OOHC) in Australia

Young people transitioning from out-of-home care (OOHC), often called care leavers, are known to experience mental health challenges. This article presents a scoping review of research studies completed on the mental health care needs and outcomes of care leavers in Australia from 2015 to 2021. Incorporating 17 studies consisting of six peer-reviewed papers and 11 grey literature reports, the review identified several common concerns pertaining to high levels of poor mental health and psychosocial complexity. These concerns were attributed to a number of factors including placement instability, inadequate access to specialist mental health support services, and limited workforce skills and training. Some sub-groups of care leavers such as young parents, those leaving residential care, Aboriginal and Torres Strait Islander care leavers, and an older cohort who had experience of institutional OOHC in earlier decades, were noted to be at particular risk. Nevertheless, some strategies for improving policy and practice were highlighted including more concrete transition planning that established links with support services prior to leaving care, an extension of OOHC till at least 21 years of age, provision of further supports such as trauma-informed approaches targeted towards the specific needs of this vulnerable population and culturally responsive programs for Indigenous youth. A limitation of the review was that most studies included were completed before the introduction of extended OOHC in all Australian jurisdictions, and hence do not reflect the positive influence of extended care on transition pathways including mental health. Future research should specifically examine the impact of extended care models on mental health care needs and outcomes.

Increasing Treatment Rates for Hepatitis C in Primary Care.

Despite antiviral agents that can cure the disease, many individuals with Hepatitis C Virus (HCV) remain untreated. Primary care clinicians can play an important role in HCV treatment but often feel they do not have the requisite skills. We implemented a population-based improvement intervention over 10 months to support treatment of HCV in a primary care setting. The intervention included a decision-support tool, education for clinicians, enhanced interprofessional team supports, mentorship, and proactive patient outreach. We used process and outcome measures to understand the impact on the proportion of patients who initiated treatment and achieved Sustained Virologic Response (SVR). We used physician focus groups and pharmacist interviews to understand the context and mechanisms influencing the impact of the intervention. Between December 2018 and June 2020, the percentage of HCV RNA positive patients who started treatment rose from 66.0% (354/536) to 75.5% (401/531) with 92.5% (371/401) of those starting treatment achieving SVR. Qualitative findings highlighted that the intervention helped raise awareness and confidence among physicians for treating HCV in primary care. A collaborative team environment, education, mentorship, and a decision-support tool integrated into the electronic record were all enablers of success although patient psychosocial complexity remained a barrier to engagement in treatment. A multifaceted primary care improvement initiative increased clinician confidence and was associated with an increase in the proportion of HCV RNA positive patients who initiated curative treatment.

Medical provider satisfaction with integrated care in a pediatric gastroenterology clinic.

Benefits of behavioral health (BH) integrated care (IC) in pediatric primary care have been demonstrated (Asarnow et al., 2015). Pediatric subspecialty care treats patients with high levels of medical and psychosocial vulnerability and complexity (Samsel et al., 2017), underscoring the need for increased IC. Medical provider satisfaction (MPS) with IC is highly relevant for the utilization and expansion of these services. The purpose of this preliminary study was to examine MPS related to BH IC services in a pediatric gastroenterology clinic. Eight pediatric gastroenterology providers working in an outpatient clinic completed a 32-item survey (adapted from Corso et al., 2016) assessing their satisfaction with integrated BH care services. Descriptive statistics were utilized to examine and summarize provider satisfaction data. Pediatric gastroenterology medical providers reported high levels of satisfaction with existing IC services and a preference for embedded versus colocated IC. They perceived provider-related and clinical benefits of IC, felt that addressing BH issues is important, and believed IC is a valued service. Medical providers expressed that they wanted expanded IC services, including an embedded psychologist at more locations, BH screenings for younger patients, and an electronic psychosocial screening process. The results of this study align with research findings regarding high medical provider satisfaction with IC in primary care and a preference for embedded BH services (Asarnow et al., 2015). While this preliminary study is small in scale, it is an important initial step to better understand MPS with IC in pediatric subspecialty care. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Bridging the Information Gap in Polycystic Ovary Syndrome: A Narrative Review with Systematic Approach.

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy with wide-ranging implications for affected individuals. Literature has shown that patients with PCOS are dissatisfied with the health information provided to them and that healthcare professionals lack adequate knowledge. In this narrative review with systematic approach, we explored the unmet information needs in PCOS care for both patients and healthcare professionals. A comprehensive search of databases yielded 41 relevant studies, predominantly of observational and qualitative design. Adults and adolescents with PCOS desire wide ranging health information and express a keen desire for weight management guidance. Importantly, discussions surrounding weight should be addressed knowledgeably and without weight bias. Therefore, healthcare professionals should facilitate access to comprehensive evidence-based resources. Lack of information drives PCOS-related online searches. Referral to support groups that promote individual agency in the self-management aspects of PCOS can furthermore guide patient resource acquisition. Patients prefer guidance from professionals that understand the psychosocial complexity of PCOS and can empathize with experiences of stigmatization or even marginalization depending on the cultural context of the individual. The findings informed the 2023 International Evidence-Based PCOS Guideline, recommending patient-centered communication, evidence-based information resources, and culturally sensitive approaches to optimize PCOS care.

Characterizing patients hospitalized without an acute care indication: A retrospective cohort study.

Hospitalizations by patients who do not meet acute inpatient criteria are common and overburden healthcare systems. Studies have characterized these alternate levels of care (ALC) but have not delineated prolonged (pALC) versus short ALC (sALC) stays. To descriptively compare pALC and sALC hospitalizations-groups we hypothesize have unique needs. A retrospective study of hospitalizations from March-April 2018 at an academic safety-net hospital. Levels of care for pALC (>3 days) and sALC (1-3 days) were determined using InterQual©, an industry standard utilization review tool for determining the clinical appropriateness of hospitalization. We examined sociodemographic and clinical characteristics. Of 2365 hospitalizations, 215 (9.1%) were pALC, 277 (11.7%) were sALC, and 1873 (79.2%) had no ALC days. There were 17,683 hospital days included, and 28.3% (n = 5006) were considered ALC. Compared to patients with sALC, those with pALC were older and more likely to be publicly insured, experience homelessness, and have substance use or psychiatric comorbidities. Patients with pALC were more likely to be admitted for care meeting inpatient criteria (89.3% vs. 66.8%, p < .001), had significantly more ALC days (median 8 vs. 1 day, p < .001), and were less likely to be discharged to the community (p < .001). Patients with prolonged ALC stays were more likely to be admitted for acute care, had greater psychosocial complexity, significantly longer lengths of stay, and unique discharge needs. Given the complexity and needs for hospitalizations with pALC days, intensive interdisciplinary coordination and resource mobilization are necessary.

Developing a specialty transition clinic: Inaugural clinical and financial operations

PurposeFew examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services. Design and methodsA transition clinic, guided by Got Transition’s Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob’s Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TRxANSITION Index) were billed fee-for-service or under a bundled payment managed care model. We present data on patient characteristics, clinic operations, finances, and patient/parent satisfaction (online survey) in the clinic’s first year of operation (March 2021-February 2022). ResultsIn Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%−100%). The average billed per patient was $498 (in 2021–2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9–33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered. ConclusionsTransition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital’s subspecialty clinics and we show it is possible to receive some funding from insurers.

An updated audit of the patient selection process for pain management programmes in a speciality care service before and during the COVID-19 pandemic.

The provision of pain management programmes (PMPs) changed substantially in response to the COVID-19 pandemic with virtual delivery implemented in many services. Little is known about patient selection processes for virtual PMPs and how this might differ from in-person programmes. The aim of this audit was to document the patient selection process for PMPs at a speciality pain service prior to and during the pandemic. This retrospective audit used data from consecutive patients attending a multidisciplinary assessment to determine the suitability of a PMP. Anonymized data were extracted from assessment letters and hospital records in the months prior to the pandemic (n =168) and during the start of the pandemic once the service began delivering virtual PMPs (n =171). For the standard pain management pathway, most patients were offered a PMP option within the service before and during the pandemic, although a greater proportion of patients were offered treatment during the pandemic. For the neuromodulation pathway, most patients were offered a pre-neuromodulation PMP option, and this was similar before and during the pandemic. Psychosocial complexities and unwillingness to engage in a pain management approach that does not principally focus on pain reduction were the most common reasons that patients were not offered a programme. This audit points to a pattern of more inclusive assessment outcomes within our service over time and particularly during the pandemic. Offering a range of in-person and virtual PMPs can meet a wider range of patient need. Research is needed to understand how to best assess and match patients with the breadth of treatment delivery formats now available.

Preventive Medicine via Lifestyle Medicine Implementation Practices Should Consider Individuals' Complex Psychosocial Profile.

Noncommunicable chronic diseases are associated with lifestyle behaviors. Psychological and social factors may influence the adoption of such behaviors. Being mentally and physically energized or fatigued may influence the intention-behavior gap of healthy lifestyle adoption accordingly. We investigated the associations of age, sex, lifestyle behaviors, mood, and mental and physical energy and fatigue at both the trait and state levels. The participants (N = 670) completed questionnaires assessing their sleep, mood, mental and physical state energy and fatigue, physical activity, mental workload, and diet. The ordinary least squares regression models revealed an overlap between the mental state and trait energy levels for males who consume polyphenols, have a high mental workload, and sleep well. Being younger, having a high stress level, bad sleep habits, and being confused and depressed were associated with high mental fatigue. Physical energy and fatigue shared the same commonalities with the previous results, with greater discrepancies observed between the state and trait indicators compared to that between mental energy and fatigue. Diet and stress management seem to be predictors of high physical energy, and females report higher physical fatigue levels. Health care professionals should consider this psychosocial complex profiling in their differential diagnosis and when one is implementing lifestyle behavioral changes to address the facets of preventive medicine, wellness, and health promotion.

Primary Care Physician Perspectives on the Influence of Patient Values, Health Priorities, and Preferences on Clinical Decision-Making for Complex Patients with Multimorbidity: A Qualitative Study.

The prevalence of patients with multimorbidity (ie, multiple chronic conditions) is increasing. Clinical decision-making guided by patients' values, health priorities and goals, and treatment preferences is particularly important in the context of interacting diseases and psychosocial needs. Physicians face challenges incorporating patient perspectives into care plans. We examined primary care physician (PCP) views on the influence of patients' values, health priorities and goals, and preferences on clinical decisions for patients with multimorbidity and increased psychosocial complexity. We conducted semi-structured telephone interviews with 23 PCPs within patient-centered medical home teams in a nationally integrated health system in the United States between May and July 2020. Data were analyzed via thematic analysis with deductive and inductive coding. Three major themes emerged: 1. Patient personal values were rarely explicitly discussed in routine clinical encounters but informed more commonly discussed concepts of patient priorities, goals, and preferences; 2. Patient values, health priorities and goals, and preferences were sources of divergent views about care plans between healthcare teams, patients, and families; 3. Physicians used explicit strategies to communicate and negotiate about patient values, health priorities and goals, and preferences when developing care plans, including trust-building; devoting extra effort to individualizing care; connecting patient values to healthcare recommendations; deliberate elicitation and acknowledgement of patient concerns; providing "space" for patient perspectives; incorporating family into care planning; pairing physician to patient priorities; and collaborative teamwork. Primary care physicians perceive patient values, health priorities and goals, and preferences as influential during clinical decision-making for complex patients with multimorbidity. Participants used concrete strategies to negotiate alignment of these aspects when physician-patient divergence occurred. While rarely discussed directly in clinical encounters, personal values affected patient health priorities, goals, and preferences during care planning, suggesting a clinical role for more deliberate elicitation and discussion of patient values for this population.

Information and Communication Technologies (ICTs) enabling integrated primary care for complex patients: a protocol for a scoping review

IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings.MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by six research team members.DiscussionThe key findings of the study will be thematically analyzed to describe the implemented ICTs aimed for complex patients within the integrated primary care model. The finding will highlight what types of ICTs are being put in place to support these models, and how these ICTs are enabling care integration. This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.