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• Latino adults are disproportionately impacted by dementia due to high exposure to adverse social determinants of health (SDOH). • "Brain health literacy" in middle adulthood may be a modifiable factor that could help mitigate later life risk of cognitive decline. • The proposed Brain Health Literacy framework can guide health promotion efforts, with the ultimate goal of increasing brain health equity. [ABSTRACT FROM AUTHOR]

Sharing new medical information that is perceived as seriously effecting people's lives, i.e., breaking bad news (BBN) is important in caring for patients and relatives and is challenging for healthcare professionals. Optimal BBN requires incorporation and implementation of multiple professional competencies acquired gradually throughout years of training. The BBN encounter has implications for all participants: the patient, family members, their close social environments, and the deliverer of the news. Due to these implications and the accountability involved, medical schools invest educational resources in helping medical students develop this competency. The current paper summarizes literature, research, and teaching experiences while suggesting practical guidelines for designing and teaching a BBN course to undergraduate students. The following principles lie behind the recommendations: stepwise spiral continuity of exposure to and teaching of communication skills in various contexts while focusing on BBN in the advanced clinical years; relating the developing skills to broader humanistic studies; enhancing awareness of self-perspectives and beliefs regarding BBN; connecting to patients' and family members experiences and needs; providing a BBN protocol and opportunities for structured experiential learning followed by reflection and feedback; using observation and reflection to address gaps between theory and real-life practice; and creating continuity of learning about BBN through undergraduate, graduate, and continuing medical education. Applying this learning process can help enhance the management of these difficult conversations to improve patients' care during these difficult, life-changing encounters, and physicians' well-being. [ABSTRACT FROM AUTHOR]

Objective: Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice.Methods: This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19.Results: Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises.Conclusion: We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare.Practice Implications: This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare. [ABSTRACT FROM AUTHOR]

Although the use of theories and evidence is often stressed in the development of health promotion interventions, this does not guarantee the success of an intervention. Thus, we need to reflect on intervention development processes that use different types of theories and evidence. In this paper, we provide a reflective discussion on how we identified evidence-based behavior change techniques and counseling themes for a health promotion intervention. In addition, we discuss the challenges that we encountered and what we learned during the process: a) a lack of previous research and meta-analyses, b) inconsistencies in evidence, c) integrating evidence and theories that have different starting points, and d) collaborating with researchers who represent different evidence and theories. During the process, we benefitted from having the clear goal of conducting evidence- and theory-based work. We solved the challenges by, for example, utilizing different types of evidence and being reflective about the reasons behind any inconsistencies in the evidence. In retrospect, we would have benefitted from closer collaboration between the teams that worked separately with different evidence. These kinds of reflective descriptions of development processes and the challenges encountered during them may help other researchers and professionals avoid encountering the same challenges. [ABSTRACT FROM AUTHOR]

Objective: In order to deliver good healthcare quality, it should explicitly be taken into account what patients value in healthcare. This study reviews qualitative studies in which patients express what they value. Based on this body of literature a preliminary taxonomy is designed.Methods: A systematic review of qualitative papers on what patients' value.Results: 22 studies out of a total of 3259 met the inclusion criteria. After critical appraisal, data extraction was carried out by two researchers independently and revealed values related to 1) the individual patient; 2) the expected behavior of professionals and 3) the interaction between patients and professionals. Seven key elements were recognized on the bases of content analysis; 1) uniqueness, 2) autonomy, 3) compassion, 4) professionalism, 5) responsiveness, 6) partnership and 7) empowerment.Conclusion: This study gives a rich insight into what patients value in various contexts and provides a promising taxonomy in line with patient centered based theories. The taxonomy needs further empirical research for a deeper insight and clarifaction in its elements.Practice Implications: This review and preliminary taxonomy contribute to the conceptualization of patient values as a bases for guidelines, policy and daily practice. [ABSTRACT FROM AUTHOR]

Medication use is the main therapeutic intervention in people with intellectual disabilities (PWID). The limited evidence available in the literature suggests that pharmacists can make positive interventions in relation to the quality of the medication use process, in collaboration with other healthcare professionals, carers and PWID. The public health role of the pharmacist is yet to be clearly defined, broadly recognized and sufficiently promoted by public health agencies, pharmacy educators or other health care professionals. Baseline audit of medication and public health communications provided by a pharmacist in a residential centre for PWID in Ireland. Collation of pharmacy electronic and paper based information communication records. Survey of carers – electronic and paper based. Pharmacist's communication about health/ medicines is perceived important by carers. Proactive information is communicated without a query in advance for the benefit of staff and residents. "I value pharmacist's interest in making information available to all those who are interested". The pharmacist communicates information using finite resources (one pharmacy staff member) to support maximisation of outcomes and minimisation of medication risks and health risks. Impact of pharmacist's interventions in this setting cannot be accurately measured. With the right communication, health systems can reduce the likelihood of certain conditions or improve the quality of life for PWID who already have these conditions. Specialist pharmacists can engage PWID and their carers with targeted communication. All types of health care provider should consider how to include pharmacy staffing into the overall skill mix for their service. Pharmacists have a role in optimising medication use, promoting health for PWID, preventing and delaying disease, and ensuring continuity of care. The pharmacist's role has expanded beyond the traditional product-oriented functions of dispensing. Pharmacists must learn how to communicate with PWID and their carers. [ABSTRACT FROM AUTHOR]

Objective: To identify decision characteristics for which SDM authors deem SDM appropriate or not, and what arguments are used.Methods: We applied two search strategies: we included SDM models from an earlier review (strategy 1) and conducted a new search in eight databases to include papers other than describing an SDM model, such as original research, opinion papers and reviews (strategy 2).Results: From the 92 included papers, we identified 18 decision characteristics for which authors deemed SDM appropriate, including preference-sensitive, equipoise and decisions where patient commitment is needed in implementing the decision. SDM authors indicated limits to SDM, especially when there are immediate life-saving measures needed. We identified four decision characteristics on which authors of different papers disagreed on whether or not SDM is appropriate.Conclusion: The findings of this review show the broad range of decision characteristics for which authors deem SDM appropriate, the ambiguity of some, and potential limits of SDM.Practice Implications: The findings can stimulate clinicians to (re)consider pursuing SDM in situations in which they did not before. Additionally, it can inform SDM campaigns and educational programs as it shows for which decision situations SDM might be more or less challenging to practice. [ABSTRACT FROM AUTHOR]

Objective: To propose a possible taxonomy for diverse stakeholders outside the healthcare communication field and to promote meaningful patient engagement in healthcare settings. Moreover, to support them in making more coherent policy, strategy, and practice decisions to enhance patient participation in their healthcare systems.Discussion: This paper is part of the pEACH Position Papers Series and provides a critical and experience-based reflection on patient engagement in different healthcare-related settings. We propose a framework that operationalises actionable patient engagement at the micro-meso-macro levels. Finally, the authors will highlight some "points of attention" that need to be addressed to support patient engagement implementation in healthcare organisations.Conclusion and Practice Implications: Understanding and systematising the established meanings of patient engagement through a psychosocial lens is critical to addressing the following questions: "how can various health care organisations ensure that authentic patient engagement informs decision-making and strategies", "how can these organisations build authentic connections with their patients", and importantly, "how can patients gain valuable and reliable insights through patient engagement"? Answering these questions can enable key stakeholders to make informed decisions that ensure the quality and effectiveness of patient engagement initiatives in different healthcare settings. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate health literacy (HL) interventions in chronic conditions by exploring theoretical perspectives, intervention content and effectiveness.Method: We searched MEDLINE, Cochrane, CINAHL, EMBASE, ERIC, Web of Science and PsycINFO. Standardised systematic review methods were used, and sequences informing our research question were extracted and analysed. The study includes a descriptive summary of the included papers.Results: We included 39 unique interventions, with diabetes and heart disease as the most targeted chronic conditions. Fifty-four percent of papers included a definition of HL, but the studies showed significant heterogeneity of theoretical underpinnings, modes, measures and content. We identified 23 HL measures, mostly assessing functional HL. The HL interventions were often more complex than the measures indicated. A significant change in HL was found in 28 studies. Study quality was generally poor.Conclusions: Interventions optimizing HL appear important to improve health outcomes in chronic conditions. To ensure cumulative knowledge development of this field we need theory-based interventions, consistency in methods and more tailored and comprehensive measures to capture the interventions' complexity.Practice Implications: A more valid understanding of HL interventions and measurements is needed to reach an agreed understanding of their components and intentions. [ABSTRACT FROM AUTHOR]

Objective: To investigate the barriers and facilitators to and support needed for e-cigarette cessation.Methods: We systematically searched the subject-specific databases MEDLINE, CINAHL complete and psycINFO and the Cochrane database using synonyms relating to the terms e-cigarettes and cessation including English language, empirical, peer reviewed research papers, published from 2010 to 2021. We included papers that addressed the research question in its broadest sense, including papers reporting reasons for and interventions to support e-cigarette cessation. Data extraction was completed two authors independently using a bespoke spreadsheet. We conducted a narrative synthesis of all data and we were able to extract and combine descriptive quantitative data from included survey papers.Results: After reviewing 2593 titles 10 papers fit our criteria. Barriers to e-cigarette cessation were: a fear of returning to tobacco, dependency and stress reduction. Barriers or facilitators were: health and hazard beliefs, degree of enjoyment, social influences and environmental factors. A number of e-cigarette smoking support measures were suggested by participants.Practice Implications: E-cigarette cessation poses similar and additional challenges to that of tobacco cessation. E-cigarettes are not the final step on a journey to smoking cessation. Addressing barriers specific to e-cigarettes need to be considered in intervention design. [ABSTRACT FROM AUTHOR]

The paper focuses on cases in which children disconfirm a symptom previously reported by their parents and analyzes how doctors and parents continue asking questions to elicit symptom confirmation from children. The study employs Conversation Analysis (CA) to examine 50 video recordings of Russian-language pediatric consultations with 4 pediatricians and approximately 50 children. The findings indicate two strategies used by participants to pursue symptom confirmation. First, calibrating question design via changing the questions' format and narrowing the questions' topical agenda to specify what kind of information is expected from the child. Second, changing the questions' format (from content to polar) without adjusting the topical agenda. The paper argues that engaging children in medical consultations might be challenging because they do not orient to, and so do not perform a responsibility that is institutionally expected from patients, in particular, reporting medically-relevant information. Practice implications: The analysis shows that using polar questions about everyday activities and experiences relevant to the child and pursuing symptom reports by gradually narrowing down the questions' topical agenda can be an effective way to secure medically-relevant information. • Conversation analysis of 50 videotaped Russian-language pediatric consultations. • Children often do not orient to the task of presenting the visit as doctorable or as worthy of medical attention. • Involving children is challenging because they do not perform the institutional responsibilities of patients. • Using polar questions about everyday experiences relevant to children can be an effective way of securing symptom reports. [ABSTRACT FROM AUTHOR]

This paper examines question-response sequences, in which clinicians asked questions to child patients who appear to interact using means other than the verbal mode of communication. Conversation Analysis methods were used to study questions in 46 paediatric palliative care consultations. These questions were directed towards children who observably used vocalisations and embodied modes of communication (e.g., gaze, gesture and facial expressions) but did not appear to use the verbal mode. Most questions asked children either about their willingness and preferences for a proposed next activity, or their current feelings, experiences or intentions. Questions involved children by foregrounding their preferences and feelings. These questions occasioned contexts where the child's vocal or embodied conduct could be treated as a relevant response. This paper demonstrates how questions are used to involve children in consultations about their own healthcare, and how their views come to be understood by clinicians and family members, even when children interact using means other than the verbal mode of communication. Questions can be asked of both children who do and do not verbally communicate. When asking questions, clinicians should be mindful of the modes of communication an individual child uses to consider how the child might meaningfully respond. • Questions can be asked of both children who do and do not verbally communicate. • Questions involve children by foregrounding their preferences and feelings. • Children who use different modes of communication respond meaningfully to questions. [ABSTRACT FROM AUTHOR]

Objectives: To determine which training methods positively influenced healthcare professionals' communication skills and families' deceased organ donation decision-making.Methods: An integrative review using systematic methods and narrative synthesis for data analysis. Electronic databases of PubMed, Cumulative Index to Nursing and Allied Health Literature (EBSCO), Embase (OVID) and ProQuest Dissertations & Theses Global, were searched between August 1997 and March 2020, retrieving 1019 papers. Included papers (n = 14) were appraised using the Medical Education Research Study Quality Instrument.Results: Training programmes offered theory, experiential learning, feedback and debriefing including self-reflection, the opportunity to role-play and interact with simulated participants within realistic case scenarios. Programmes reported observed and self-rated improvements in communication learning and confidence. The methodological quality score averaged 13, (72% of maximum); few studies used an experimental design, examined behavioural change or families' perspectives. Weak evidence suggested training could increase organ donation authorisation/consent rates.Conclusions: Multiple training strategies are effective in improving interprofessional healthcare professionals' confidence and learning of specialised communication. Methodological limitations restricted the ability to present definitive recommendations and further research is warranted, inclusive of family decision-making experiences.Practice Implications: Learning of specialised communication skills is enhanced by using multiple training strategies, including role-play and debriefing. [ABSTRACT FROM AUTHOR]

Research in health literacy is fundamentally impacted by our ability to adequately assess the construct. Although various measures of health literacy have been developed, there are few reflective discussions of the challenges and learnings from the instrument development process. This is somewhat surprising given that health literacy is a multi-dimensional and contested concept (with inherent measurement challenges), and that there are important practical considerations owing to the fact that people completing health literacy assessments may have lower general literacy (i.e. ability to read and write) and English-language skills. This paper discusses our learnings from developing a performance-based measure of parenting health literacy skills (the Parenting Plus Skills Index). The performance-based instrument is characterised by its grounding in health literacy as asset, with items spanning Nutbeam's functional, communicative and critical health literacy skills, and was designed chiefly to capture improvements resulting from health literacy skills training. This paper elucidates critical junctures in the development process, particularly regarding the conceptualisation and operationalisation of the construct. We also outline our approach to addressing practical measurement issues (e.g. administration time; item difficulty). In summarising these, we offer a 13-item checklist to inform the development of health literacy instruments for other health contexts or health conditions. [ABSTRACT FROM AUTHOR]

Objective: To understand how pharmacists develop patient-pharmacist communication skills.Methods: A realist synthesis approach was used to understand how educational interventions work to improve patient-pharmacist communication. Initial programme theories were developed through a scoping search and stakeholder focus groups (faculty, students, patients and public). A systematic search was then conducted for evidence to test initial theories. Included papers were assessed for relevance and rigour. Extracted data was synthesised to refine the initial programme theories and develop modified programme theories.Results: Forty-seven papers were included in the final synthesis. Role-play with simulated patients and peers, video recording and lectures were the most widely reported interventions. Repeated practice, feedback, reflection and confidence were among the mechanisms by which interventions work. Modified programme theories relating to interactions of role-play, experiential learning, video recording, self-assessment and workshops were developed.Conclusions: Outcomes of communication education interventions are influenced by the level of learner. Educational interventions that promote reflection are particularly useful.Practical Implications: There are a wide range of theory-informed interventions, which should be used in a programmatic approach to communications education. A longitudinal programme of communication skills training, with intervention choice based on level of learning, is important. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to examine the effects of an educational peer-group intervention on knowledge about dementia, perceived ability to talk about it, received support and self-perceived pressure from informal care among family caregivers with a Turkish or Moroccan immigrant background who cared for a person with dementia.Methods: This paper is based on a cluster randomised controlled trial with three measures, including participants who knew or cared for a person with dementia. For the purpose of this study, a selection was made of participants who cared for a person with dementia. Knowledge about dementia, perceived ability to talk about dementia, support received and self-perceived pressure from informal care were assessed inthe intervention and the control condition. Multi-level analyses were conducted to examine the effects.Results: Data for 386 participants was analysed. Improvement in knowledge about dementia over time was significantly greater in the intervention condition than in the control condition. In the intervention condition, there was also a significant increase over time in the support received from home-care staff, which was not found in the control condition. No effects were found on other types of support received, the ability to talk about dementia or the self-perceived pressure from informal care.Conclusion: Offering a culturally sensitive educational peer-group education intervention enhances knowledge about dementia and has a small but positive effect on the support received from home-care staff in these groups.Practice Implications: Offering peer-group-based education about dementia to family caregivers with Turkish or Moroccan immigrant backgrounds is important for multicultural dementia care. [ABSTRACT FROM AUTHOR]

This systematic review aims to identify what is known about patient and healthcare professional experiences of managing recurrent vulvovaginal thrush by synthesising published findings. Five databases were searched for studies on patient and healthcare professional experiences managing recurrent thrush. Two reviewers independently screened and quality assessed qualitative, quantitative, and mixed-methods studies. Findings from eligible studies were thematically synthesised. 720 papers were identified, and 29 were included. Four descriptive themes were developed to depict the repeated management of recurrent thrush. These themes were: (re)experiencing impacts, (re)identifying recurrent thrush, (re)considering consultations, and (re)trying treatments. An analytic high-order frame of 'interwoven and reoccurring uncertainties' was used to understand these themes. Patients and healthcare providers face uncertainties when managing recurrent thrush. The inconsistencies raised across papers suggests an unaddressed gap in knowledge about patient experiences and their informational and support needs; this includes insights about this condition's diagnosis, management, treatment, impacts, and meaning. This review has implications for patient education, health promotion, and communication between patients and providers. Our interpretations suggest the need for more research and resources to help support patients and clinicians in managing this condition to promote more understanding, communication, and collaborative care. • Recurrent thrush differs from acute or episodic experiences. • Managing recurrent thrush is neither straightforward nor inconsequential. • Patients and healthcare professionals face interwoven and recurring uncertainties. • Improvements in communication and patient education on recurrent thrush are needed. [ABSTRACT FROM AUTHOR]

Objective: Health behaviors shape more than 30% of one's physical and mental health, as well as overall well-being. Yet, changing behavior is difficult. This paper aims first at operationalizing the concept of health behavior by focusing on its main components and determinants. Second, it gives insights into how to influence health behavior by providing an overview of some of the most commonly used approaches to the design of behavioral interventions.Methods: This is a position paper that presents a selection of evidence-based theories, models and approaches to understand and address behavior.Results: A health behavior broadly refers to every individual action affecting health, disease, disability, or mortality. Behavior is shaped by factors within the skin (biological, psychological) and outside the skin (interpersonal, environmental, policy). Behavior change has therefore to be addressed from an ecological perspective. Specifically, behavior change can be influenced by changing capability, opportunity and motivation. Depending on the specific determinants of the behavior at stake, there are numerous approaches that can be taken. The main steps to design interventions are: defining the problem, selecting and analyzing the target audience, setting objectives, designing the intervention, planning and implementing an evaluation.Conclusion: Behaviors should not be targeted in isolation but within a socio-ecological approach that accounts for both their individual and environmental determinants.Practice Implications: This paper provides practitioners with the bases of behavior change. It offers a road-map of the main factors to consider and shows how to address behavior by planning an intervention in all its main steps. [ABSTRACT FROM AUTHOR]

Moving towards person-centered care, with equal partnership between healthcare professionals and patients, requires a solid role for the patient in the education of students and professionals. Patients can be involved as teachers, assessors, curriculum developers, and policy-makers. Yet, many of the initiatives with patients are isolated, small events for targeted groups and there is a lack of patient involvement at the institutional level. To support educators in involving patients, both at the institutional level and at single educational encounters, we offer twelve practical tips. This paper came about through an innovative collaboration between healthcare professionals, educators, teachers, and patients. These tips can be used as a tool to start or reinforce patient involvement in health professions education and provide guidance on how to make it a sustainable part of the curriculum. The article involves organizational conditions for success, tips for sustainable partnerships, ideas for curriculum design and proposes concrete teaching strategies. Finally, besides practical tips, we stress that involving patients in education is not business as usual, and paradoxically this needs to be acknowledged before it can become business as usual. [ABSTRACT FROM AUTHOR]

Objectives: Communication about deactivation of implantable cardioverter-defibrillator (ICD) therapy at end-of-life (EoL) is a recognised issue within clinical practice. The aim of this scoping review was to explore and map the current literature in this field, with a focus on papers which implemented interventional studies.Methods: Systematic searches of six major databases were conducted. Citations were included by four researchers according to selection criteria. Key demographic data and prespecified themes in relation to communication of ICD deactivation at EoL were extracted.Results: The search found 6197 texts of which 63 were included: 39 quantitative, 14 qualitative and 10 mixed-methods. Surveys were predominantly used to gather data (n = 34), followed by interviews (n = 18) and retrospective reviews of patient records (n = 18).Conclusions: Several key gaps in the literature warrant further research. These include who is responsible for initiating ICD deactivation discussions, how clinicians should initiate and conduct these discussions, when ICD deactivations should be occurring, and family perspectives. Adequately explored themes include patient and clinician knowledge and attitudes regarding ICD deactivation at EoL.Practical Implications: Facilities treating patients with ICDs at EoL should consider ongoing quality improvement projects aimed at clinician education and protocol changes to improve communication surrounding EoL ICD deactivation. [ABSTRACT FROM AUTHOR]

Despite the evidence that person-centred communication underpins all that we do in our interactions with patients, caregivers and team members, the knowledge about the implementation of systematic communication skills training is still in its infancy. This position paper describes some of the main contextual facilitators for translating knowledge about communication skills training for health care professionals (HCP) and recommends ways to guide practical implementation. Based on the literature that has been published over the last two decades, it seems evident that communication skills training programs should be underpinned by clinician self-reflection, be experiential, and focused on behaviour change and implementation of new skills into practice. The programs should be delivered by trainers possessing an understanding of communication micro skills, the skills and confidence to observe interactions, and coach learners through the rehearsal of alternative approaches. Communication skills programs should be flexible to adapt to individual learners, local needs, and circumstances. Interventions should not be limited to the empowerment of individual HCP but should be a part of the organisational quality assurance framework, e.g., by including communication skills in clinical audits. Implementation science frameworks may provide tools to align programs to the context and to address the determinants important for a sustained implementation process. Programs need to be embedded as 'core business', otherwise the culture change will be elusive and sustainability under threat if they are only dependent on provisional funding. [ABSTRACT FROM AUTHOR]