Support Staff Research Articles

Initial Validation of the New Jersey School Climate Improvement Survey

School climate has a profound impact on the wellbeing of staff and students. Although existing measures are available to assess dimensions of school life (Bradshaw et al., 2021; Espelage et al., 2014), surveys that comprehensively assess components of school climate from multiple perspectives are needed. A rationale is presented for developing the New Jersey School Climate Improvement Survey for students, staff, and parents/caregivers, which varies from existing instruments in its measurement of unique domains; alignment of items across informant types; integration of diver­sity, equity, and inclusion items across domains; and ability to disaggregate by demographic characteristics, including student gender expansive categories. Internal consistency and structural validity were investigated using data from 5,504 students in grades 3-5, 16,280 students in grades 6-12, 5,464 staff, and 5,874 parents/caregivers. For each survey version, results support a correlated model structure and demonstrate strong internal reliability (e.g., omega coefficients above 0.70). Confirmatory factor analyses and Pearson correlations demonstrate strong internal structural validity across surveys. Implications are discussed, including how the instrument can inform a school climate improvement process that involves identifying strengths and needs, assessing the impact of interventions, and monitoring progress toward goals over time. Impact Statement This article advances an understanding of the reliability and validity of a new multi-informant school climate assessment known as the New Jersey School Climate Improvement (NJ SCI) Survey. The survey can be used by school support staff including school psychologists, to collect data used to inform school climate improvement to create supportive and equitable learning conditions in schools.

Academic and Support Staff Attitude on Students Satisfaction at Islamic University in Uganda Kampala Campus

Academic and Support Staff Attitude on Students Satisfaction at Islamic University in Uganda Kampala Campus

Hospital management and challenges during COVID-19 outbreaks: lessons from a level 1 hospital in the southeast of Iran-case study

BackgroundThe COVID-19 pandemic has presented unparalleled challenges to hospitals globally, particularly those in resource-limited settings. This case study elucidates the experiences and lessons from managing a 40-bed public hospital in Rask, Iran, during the pandemic.MethodsData were gathered through focus group discussions with the management team and key informants, supplemented by document analysis. Thematic analysis was employed to discern key themes and subthemes related to the challenges encountered and solutions implemented by the hospital.ResultsThe study underscores the necessity of a dynamic management team, effective external stakeholder communication, staff involvement in decision-making, and establishing connections with pre-hospital care units. It also emphasizes the need for adaptable protocols, comprehensive staff training, and infrastructure enhancements. Despite these strategies, the hospital grappled with unresolved issues such as inadequate disaster planning, ethical dilemmas, and poor inter-hospital coordination.ConclusionThis case study offers insights into managing a small hospital in a resource-limited setting during a health crisis, highlighting the importance of effective leadership, staff support, infrastructural flexibility, and community engagement. The lessons gleaned can guide the development of context-specific strategies to bolster the resilience and preparedness of similar hospitals. Further research is warranted to assess the long-term impacts of the pandemic on these hospitals and to explore the perspectives of frontline staff, patients, and families for a more comprehensive understanding of effective hospital management during health disasters.

Postpartum contraception provision across Europe: preliminary findings from a multi country survey

Introduction Looking after a baby and recovering from birth pose barriers to accessing and initiating effective contraception in the postpartum period. Another pregnancy at this time can end in abortion or a short interbirth interval. These are preventable if contraception is provided immediately from maternity settings. Our aim was to survey contraceptive experts across Europe about provision of postpartum contraception (PPC) in their country to develop a greater understanding of availability of and delivery of PPC services within the region. Materials and Methods Contraceptive experts across Europe were invited to participate in an anonymous mixed-methods online survey consisting of free text and fixed-response questions focusing on: (1) national guidelines/policy (2) antenatal contraceptive discussion and (3) immediate postpartum provision of methods. Respondents were asked to rate PPC provision in their region and detail perceived facilitators or barriers. Results Experts from 28 countries completed the survey. Fifteen (40%) reported their country had national guidelines for PPC provision, 40% reported that some antenatal contraceptive counselling was offered and 51% reported that contraceptive methods were provided in some (43%) or all (8%) maternity settings. Country-level PPC provision was reported as ‘poor’ or ‘very poor’ by 54% of respondents. Reported barriers to PPC provision included: cost, lack of policy/government support, awareness and training of maternity staff. Conclusions There is significant variation in PPC provision across Europe. Few countries offer antenatal contraceptive counselling or provide contraception from maternity settings. Introduction of supportive PPC policies, funding and training for staff could improve outcomes for mothers and babies.

Loneliness in Seriously Ill Nursing Home Residents During the COVID-19 Pandemic.

Background: Loneliness and social isolation coexist, making it difficult to study each separately. The COVID-19 lockdown provided an unprecedented and ethically viable opportunity to study loneliness in seriously ill nursing home residents under uniformly imposed social isolation conditions. Objective: To understand the phenomenon of loneliness of the seriously ill nursing home patients under a uniform social isolation condition imposed by the COVID-19 pandemic lockdown. Design: Cross-sectional, semi-structured interviews were tape-recorded, transcribed verbatim, and analyzed qualitatively using an inductive thematic analysis. The University of California, Los Angeles (UCLA) Three-Item Loneliness Scale was used to measure loneliness and any relationships between self-reported loneliness and isolation were elucidated. Setting/Participants: Thirty seriously ill nursing home residents living in complete social isolation imposed by the COVID-19 pandemic lockdown. Results: Thematic analysis identified four key themes: (1) Diverse perceptions about the impact of the COVID-19 lockdown, (2) regret over the missed opportunities for spending time with friends and family, (3) using electronic communication to maintain connections with loved ones, and (4) the impact of nursing home staff. In total, 50% of the participants reported feeling socially isolated, 60% patients reported loneliness, and 70% reported being adversely impacted by the lockdown. Patients who felt socially isolated also reported experiencing loneliness (Kendall's Tau = 0.61, 95% confidence interval [CI] = 0.30, 0.89, p < 0.01, large effect size). Persons from communities of color had higher median loneliness scores compared to Non-Hispanic Whites. Participants in the last year of life also reported higher levels of loneliness. Conclusion: A study of loneliness under uniform social isolation conditions in seriously ill nursing home patients showed a high prevalence of loneliness and a strong correlation between self-reported loneliness and social isolation, especially in persons from minority communities and those in the last year of life. In-person support provided by nursing home staff and virtual support from family was helpful to patients.

Updating a conceptual model of effective symptom management in palliative care to include patient and carer perspective: a qualitative study

BackgroundA conceptual model of effective symptom management was previously developed from interviews with multidisciplinary healthcare professionals (HCP) working in English hospices. Here we aimed to answer the question; does a HCP data-derived model represent the experience of patients and carers of people with advanced cancer?MethodsSemi-structured interviews were undertaken with six patients with advanced cancer and six carers to gain an in-depth understanding of their experience of symptom management. Analysis was based on the framework method; transcription, familiarisation, coding, applying analytical framework (conceptual model), charting, interpretation. Inductive framework analysis was used to align data with themes in the existing model. A deductive approach was also used to identify new themes.ResultsThe experience of patients and carers aligned with key steps of engagement, decision making, partnership and delivery in the HCP-based model. The data aligned with 18 of 23 themes. These were; Role definition and boundaries, Multidisciplinary team decision making, Availability of services/staff, Clinician-Patient relationship/rapport, Patient preferences, Patient characteristics, Quality of life versus treatment need, Staff time/burden, Psychological support -informal, Appropriate understanding, expectations, acceptance and goals- patients, Appropriate understanding, expectations, acceptance and goals-HCPs, Appropriate understanding, expectations, acceptance and goals- family friends, carers, Professional, service and referral factors, Continuity of care, Multidisciplinary team working, Palliative care philosophy and culture, Physical environment and facilities, Referral process and delays. Four additional patient and carer-derived themes were identified: Carer Burden, Communication, Medicines management and COVID-19. Constructs that did not align were Experience (of staff), Training (of staff), Guidelines and evidence, Psychological support (for staff) and Formal psychological support (for patients).ConclusionsA healthcare professional-based conceptual model of effective symptom management aligned well with the experience of patients with advanced cancer and their carers. Additional domains were identified. We make four recommendations for change arising from this research. Routine appraisal and acknowledgement of carer burden, medicine management tasks and previous experience in healthcare roles; improved access to communication skills training for staff and review of patient communication needs. Further research should explore the symptom management experience of those living alone and how these people can be better supported.

Nursing Team Composition and Mortality Following Acute Hospital Admission

Many studies show the adverse consequences of insufficient nurse staffing in hospitals, but safe and effective staffing is unlikely to be just about staff numbers. There are considerable areas of uncertainty, including whether temporary staff can safely make up shortfalls in permanent staff and whether using experienced staff can mitigate the effect of staff shortages. To explore the association of the composition of the nursing team with the risk of patient deaths. This patient-level longitudinal observational study was conducted in 185 wards in 4 acute hospital trusts in England between April 2015 and March 2020. Eligible participants were patients with an overnight stay and nursing staff on adult inpatient wards. Data analysis was conducted from month April 2022 to June 2023. Naturally occurring variation during the first 5 days of hospital admission in exposure to days of low staffing from registered nurses (RNs) and nursing support (NS) staff, the proportion of RNs, proportion of senior staff, and proportion of hospital-employed (bank) and agency temporary staff. The primary outcome was death within 30 days of admission. Mixed-effect Cox proportional hazards survival models were used. Data from 626 313 admissions (319 518 aged ≥65 years [51.0%]; 348 464 female [55.6%]) were included. Risk of death was increased when patients were exposed to low staffing from RNs (adjusted hazard ratio [aHR], 1.08; 95% CI 1.07-1.09) and NS staff (aHR, 1.07; 95% CI, 1.06-1.08). A 10% increase in the proportion of temporary RNs was associated with a 2.3% increase in the risk of death, with no difference between agency (aHR, 1.023; 95% CI, 1.01-1.04) and bank staff (aHR, 1.02; 95% CI, 1.01-1.04). A 10% increase in the proportion of agency NS was associated with a 4% increase in risk of death (aHR, 1.04; 95% CI, 1.02-1.06). Evidence on the seniority of staff was mixed. Model coefficients were used to estimate the association of using temporary staff to avoid low staffing and found that risk was reduced but remained elevated compared with baseline. This cohort study found that having senior nurses in the nursing team did not mitigate the adverse outcomes associated with low nurse staffing. These findings indicate that while the benefits of avoiding low staffing may be greater than the harms associated with using temporary staff, particularly for RNs, risk remains elevated if temporary staff are used to fill staffing shortages, which challenges the assumption that temporary staff are a cost-effective long-term solution to maintaining patient safety.

Perceptions of menstrual cycle tracking among elite rugby players

ABSTRACT The purpose of the current study was to understand female rugby players’ perceptions of menstrual cycle (MC) tracking and identify the impact of MC tracking for the players. Interpretive descriptive methodology was adopted. Interviews were conducted with 12 elite female rugby players (age 25.2 ± 4.3 years), who were all naturally menstruating. Data were analysed following the four stages recommended within Interpretive Description. Results identified that athletes obtain personal benefits from MC tracking by; enhancing understanding of their MC and symptoms, and responding to their MC and symptoms. Athletes also reported that the process of tracking their MC enhanced relationships by; improving communication and interactions with coaches and support staff, and by facilitating team support. Specifically, using tracking increased the opportunities for open conversations with coaches, support staff and teammates regarding their MC. Overall, the findings highlight benefits of menstrual cycle tracking within this group of naturally menstruating rugby players, particularly in helping players and coaches understand the individual nature of the MC, engage in conversations, and establish support from teammates.

Destitute and dying: interventions and models of palliative and end of life care for homeless adults – a systematic review

BackgroundHomeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with...

The relationship of the three “As” of adaptation: Acculturation, adjustment, and academic engagement of Ukrainian war refugees in Estonia’s schools

The article reports on a qualitative study of how schools in Estonia were incorporating Ukrainian war refugee students in the spring of 2023. Observations and interviews were conducted in 7 schools with teachers, school administrators, psychological support staff, refugee students in grades 7–12, and their parents. The study found that schools were balancing three overlapping goals: (1) to ensure psychological adjustment of the refugee students by creating a safe, supportive, and welcoming school environment; (2) to provide students with opportunities to learn and be academically successful, and (3) to facilitate acculturation of refugees into Estonian culture and language. These three “A’s”: adjustment, academics, and acculturation were important in all schools in the study. As schools engaged in implementing the three goals, they found that at times they were in conflict with one another, requiring them to prioritize some and de-emphasize others. The Ukrainian secondary school was created specifically for these students and prioritized adjustment but faced challenges motivating students to engage academically and learn the Estonian language. Russian-medium schools provided the easiest access to the academic curriculum in Russian, without the need to acculturate; but students experienced some anti-Ukraine attitudes from peers and teachers. In Estonian-medium schools, students had the best opportunity to learn Estonian but felt socially isolated and were unable to engage with the Estonian-language curriculum. The study highlights the need for schools to balance these different goals and work to resolve contradictions as they arise in their unique context.

Promoting Positive School Climate Among Newcomer Immigrant Adolescents: A Qualitative Exploration of Perceptions and Recommendations

Despite various strengths, newcomer immigrant adolescents (NIA) are exposed to stressors that can negatively impact their adjustment to U.S. schools, resulting in social-emotional and academic concerns. School climate has been identified as a crucial system-level intervention for NIA. While there is consensus regarding supporting NIAs’ adjustment to U.S. schools, specific recommendations within the school climate literature are lacking. This study used semi-structured interviews to explore NIAs’ (N = 15) perceptions of school climate and recommendations for improving school climate. Interview data were analyzed using a grounded theory approach. Four themes emerged: (a) academic placement impacts learning, (b) the cultural and linguistic background of peers is relevant to NIA peer relationships, (c) supportive school staff consider unique NIA needs, and (d) recommendations offered to foster adjustment to U.S. schools. The results of this study can inform what aspects of school climate are most critical to improving academic and social emotional outcomes of NIA. Impact Statement Newcomer immigrant adolescents (NIA) are a growing group of youth in U.S. schools. This paper examined NIAs’ perceptions of school climate and elicited recommendations to improve school climate.

2284 NHS staff experiences of racism from patients and carers: survey from a London older persons service

Abstract Introduction There is growing awareness of the harms caused by racial abuse and discrimination from patients towards healthcare professionals, including anecdotal reports of patients ‘requesting a white doctor’ (Kline, BMJ Opinion, 2020); yet there is limited understanding of the impact in Geriatric settings. We conducted a survey in an inpatient Older Persons Service (OPS) on the prevalence, impact and actions taken in response to patient racism towards staff. Methods A cross-sectional survey (Total N = 47; Black and Minority Ethnic (BME) staff: N = 32; White staff: N = 15) of staff experiences of racist behaviour from patients and carers (July 2021) in a tertiary level inpatient OPS in an ethnically diverse London borough, both in terms of patients and staff, in the United Kingdom. The survey was developed in collaboration with OPS staff and the BME network. The anonymous survey was offered to all nurses, doctors, allied healthcare professionals and non-clinical staff on two 26-bed wards. Results Sixty-nine percent (22/32) of BME staff had personally experienced racist behaviour from older patients, while witnessing racism towards colleagues was reported by 62% (18/29) of BME staff and 80% (12/15) of White Staff. Sixty-seven percent (30/45) of respondents had witnessed a patient request a different ethnicity of healthcare professional. The majority of racist incidents went unchallenged and unreported with only 39.1% challenging the patient or carer, 21.7% reporting to a senior and 8.7% reporting via the electronic incident reporting system. The impact of such incidents on staff well-being included self-reported depression (56%, n = 11/21), anxiety about work (28%, n = 6/21) and insomnia (14%, n = 3/21). Conclusion With an ageing population, staff recruitment and retention in Geriatrics is critical. Comprehensive policies that have a zero-tolerance approach to racism, support staff and encourage reporting are crucial. Future research that considers the impact of mental capacity and cognitive impairment would be beneficial.

Comparing South Dakota Pharmacist Perspectives of Pharmacy Services in Rural versus Urban settings

BackgroundAccess to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role. ObjectiveThe objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota. MethodsThis qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers. ResultsParticipants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators. ConclusionsNext steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Implementation of a digital distress detection system in palliative care: qualitative data on perspectives of a multiprofessional palliative care team

BackgroundDigital health technologies such as sensor systems are intended to support healthcare staff in providing adequate patient care. In the Department of Palliative Medicine (University Medical Center Freiburg), we developed and implemented a noninvasive, bed-based sensor system in a pilot study. The aim was to detect distress in patients who were no longer able to express themselves by monitoring heart and respiratory rates, vocalizations, and movement measurements. The sensor system was intended to supplement standard care, which generally cannot guarantee constant monitoring. As there is a lack of data on how healthcare professionals experience such a techno-digital innovation, the aim of this study was to explore how the multiprofessional palliative care team who piloted the sensor system perceived its potential benefits and limitations, and how they experienced the broader context of healthcare technology and research in palliative care.MethodsWe conducted a qualitative interview study with 20 members of the palliative care team and analyzed the recorded, verbatim transcribed interviews using qualitative content analysis.ResultsThe sensor system was described as easy to use and as helpful support for patients, care staff, and relatives, especially against the backdrop of demographic change. However, it could not replace human interpretation of stress and subsequent treatment decisions: this remained the expertise of the nursing staff. A potential reduction in personnel was expected to be a risk of a digital monitoring system. The special conditions of research and digital health technologies in an end-of-life context also became clear. Specifically, healthcare staff were open to health technologies if they benefited the patient and were compatible with professional nursing and/or palliative care attitudes. Additionally, a patient-protective attitude and possible interprofessional differences in priorities and the resulting challenges for the team became apparent.ConclusionsA potential digital solution for distress monitoring was considered useful by palliative care practitioners. However, interprofessional differences and compatibility with existing palliative care practices need to be considered before implementing such a system. To increase user acceptability, the perspectives of healthcare professionals should be included in the implementation of technological innovations in palliative care.

Development, implementation and usefulness of an intervention to support psychological resilience during the COVID-19 pandemic: a study from a Swedish hospital based on interviews, documents and a survey

ObjectivesA range of interventions to support psychological resilience among healthcare workers were provided in hospitals during the COVID-19 pandemic. Most research has focused on the content and experience of these...

Training Load Monitoring in Elite Youth Women's Artistic Gymnasts: A Pilot Study.

Women's artistic gymnastics (WAG) is a complex aesthetic sport in which athletes start at a young age and are exposed to high loads during their careers. Little is known about the external and internal training load characteristics among elite young gymnasts. High training loads, with variations over the weeks, are expected. There is a relationship between external and internal load variables. Cohort study. Level 3. Seven elite-level Brazilian youth artistic gymnasts (age, 11.3 ± 0.4 years; mass, 33.0 ± 7.0 kg; height, 137.7 ± 10.6 cm; experience, 4.0 ± 1.2 years) participated in this study. Five nonconsecutive microcycles were monitored. Both external and internal training loads were quantified by counting the number of elements in video recordings of training sessions and by the session rating of perceived exertion method. A total of 168 individual training sessions were monitored. The microcycle that succeeded the main competition showed a significantly lower training load than ≥3 of the other 4 microcycles for all training load variables, except for vault elements, of which microcycle 4 was inferior only to the microcycle before the competition. Significant correlations were found between weekly internal training load and the total of elements and elements performed on uneven bars. Youth women's artistic gymnasts present fluctuations in external and internal training load variables over the weeks close to a major competition. Training load management in this sport must consider the specificity of each apparatus, as they have different demands and training load behaviors. A better comprehension of external and internal training loads in youth WAG and its apparatuses can benefit coaches and support staff and provide more information to overcome the challenge of training load management in gymnastics.

Tobacco Industry Engagement in the House of Commons Science and Technology Select Committee E-cigarettes Inquiry

Background: A now extensive literature has documented political strategies of healthharming industries (HHIs), but little is known about their engagement with Parliamentary select committees. Recent investments by trans-national tobacco corporations (TTCs) in electronic nicotine delivery systems (ENDS) has raised concerns that industry actors may be using these to re-engage policymakers in ways precluded by the Framework Convention on Tobacco Control (FCTC) Article 5.3. Methods: This article examines tobacco industry engagement with the House of Commons Science and Technology Committee (STC) inquiry into electronic cigarettes. It draws on a qualitative analysis of semi-structured interviews with committee members and support staff (n=4) triangulated against written and oral evidence submissions. Results: TTCs featured prominently in the STC inquiry via written and oral submissions. Opportunities existed for industry engagement, and potential influence, at each stage of the process. There was an absence of oral testimony from those sceptical about the potential health benefits of ENDS. The governance mechanisms in place for select committees appear inadequate for protecting committee work from industry influence. As it relates to TTCs, this has implications for the UK’s commitments under FCTC Article 5.3, yet understanding of the FCTC and the requirements of Article 5.3 compliance within the committee were limited. Conclusion: The governance of select committees requires urgent reform in order to balance norms of openness and participation with the need to protect their work from power of economic actors with conflicts of interest. This is particularly the case in relation to TTCs and adherence to FCTC Article 5.3. These findings are of relevance to other select committees whose work affects the interests of HHIs. Further research is needed on other committees and sectors.

Development of sport policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes

Our objective is to describe the development of evidence-based policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes. A community-based participatory research approach was employed as the...

The All Together Group: Co-Designing a Toolkit of Approaches and Resources for End-of-Life Care Planning With People With Intellectual Disabilities in Social Care Settings.

Support staff within social care settings have expressed a need for resources to facilitate end-of-life care planning with people with intellectual disabilities. This study aimed to co-design a preliminary toolkit of end-of-life care planning approaches and resources that can be implemented in adult social care services for people with intellectual disabilities. An adapted Experience-Based Co-Design process was applied to develop a toolkit for end-of-life care planning with people with intellectual disabilities. A co-design group (the 'All Together Group') met six times from January to October 2023. The group comprised nine people with intellectual disabilities (including four researchers with intellectual disabilities, who also co-facilitated the workshops), five family members, five intellectual disability support staff, two intellectual disability service managers,and five healthcare professionals. The All Together Group tested resources for and approaches to end-of-life care planning with people with intellectual disabilities, based on findings from a scoping review and a focus group study. Easy-read end-of-life care planning forms were deemed overwhelming and complicated, whilst visual and creative approaches were welcomed. Three new visual resources to support illness planning and funeral planning with people with intellectual disabilities were developed: (i) 'When I'm ill' thinking cards; (ii) 'Let's Talk About Funerals' conversation-starter pictures; and (iii) 'My funeral' planning cards. These three resources, alongside three positively evaluated existing resources, were included in a new toolkit for end-of-life care planning with people with intellectual disabilities. Through an iterative, flexible, inclusive,and comprehensive co-design process, a toolkit of three newly developed and three existing resources was created to facilitate support staff in doing end-of-life care planning with people with intellectual disabilities. Following a trialling process with support staff, the final toolkit was made freely available online. The research team included four researchers with intellectual disabilities (A.C., D.J., L.J., and R.K.-B). Researchers with intellectual disability have been part of every step of the research process; from study design to data collection and analysis to dissemination of study findings.Intellectual disability service provider representatives (M.W., N.P., and S.S.) were part of the co-design group as well. Two of these representatives were also co-applicants in the overall project (N.P. and S.S.). The co-design group included people with intellectual disabilities, families, intellectual disability support staffand health and social care professionals. The study was supported by a Research Advisory Group comprising a variety of stakeholders, including people with intellectual disabilities families, intellectual disability researchers, representatives from intellectual disability organisations,and policymakers.

Oncology stewardship practice in the United States: A Hematology/Oncology Pharmacy Association national survey.

The treatment of cancer is associated with high risk for toxicity and high cost. Strategies to enhance the value, quality, and safety of cancer care are often managed independently of one another. Oncology stewardship is a potential framework to unify these efforts and enhance outcomes. This landscape survey establishes baseline information on oncology stewardship in the United States. The Hematology/Oncology Pharmacy Association (HOPA) distributed a 38-item survey composed of demographic, institutional, clinical decision-making, support staff, metrics, and technology sections to 675 HOPA members between 9 September 2022 and 9 October 2022. Most organizations (78%) have adopted general pharmacy stewardship practices; however, only 31% reported having established a formalized oncology stewardship team. More than 70% of respondents reported implementation of biosimilars, formulary management, and dose rounding as oncology stewardship initiatives in both inpatient and outpatient settings. Frequently cited barriers to oncology stewardship included lack of clinical pharmacist availability (74%), lack of oncology stewardship training (62%), lack of physician/provider buy-in (32%), and lack of cost-saving metrics (33%). Only 6.6% of survey respondents reported their organization had defined "value in oncology." Lack of a formalized stewardship program was most often cited (77%) as the rationale for not defining value. Less than one-third of respondents have established oncology stewardship programs; however, most are providing oncology stewardship practices. This manuscript serves as a call to action for stakeholders to work together to formalize oncology stewardship programs that optimize value, quality, and safety for patients with cancer.