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Objectives Glucocorticoids (GCs) ('steroids') are used to treat rheumatic diseases but adverse effects are common. We aimed to explore the impact of GC therapy on health-related quality of life (HRQoL), to inform the development of a treatment-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. Methods Semi-structured qualitative interviews were conducted with patients from the UK, USA and Australia, treated for a rheumatic condition with GCs in the last 2 years. Purposive sampling was used to select participants with a range of demographic and disease features. An initial conceptual framework informed interview prompts and cues. Interviews elicited GC-related physical and psychological symptoms and salient aspects of HRQoL in relation to GC therapy. Interview data were analysed inductively to develop initial individual themes and domains. Candidate questionnaire items were developed and refined. Results Sixty semi-structured qualitative interviews were conducted (UK n  = 34, USA n  = 10, Australia n  = 16). The mean age was 58 years; 39/60 were female; and 18 rheumatic diseases were represented. Some 126 individual themes were identified and organized into six domains: physical symptoms; psychological symptoms; psychological impact of steroids; impact of steroids on participation; impact of steroids on relationships; and benefits of steroids. Candidate questionnaire items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews and linguistic translatability assessment, informing a draft questionnaire. Conclusion We describe an international qualitative study to develop candidate items for a treatment-specific PROM for patients with rheumatic diseases. A future survey will enable the validation of a final version of the PROM. [ABSTRACT FROM AUTHOR]

Background Due to the climate crisis, it is increasingly evident that countries will have to decarbonize. Healthcare, which has a large carbon footprint and uses vast quantities of resources, will have to undergo significant transformation. In this research, we sought the ideas of leading thinkers in the field, to address the question of how health systems can provide high-quality care in a carbon-constrained world. Methods Semi-structured, qualitative in-depth interviews with 15 healthcare thought leaders from Australia, the UK, the USA and New Zealand. The interviews were transcribed and analysed by matrix display and thematic analysis. Results 'Green' initiatives such as improving energy efficiency and implementing travel plans will be insufficient to achieve the scale of decarbonization required. According to the thought leaders in our study, it is likely that greater carbon and resource savings will come from thinking much more broadly about innovative models of care and using 'new' sources of 'value' such as 'people' and 'relationships'. Conclusions Using human resources and human interactions as low-carbon sources of value in healthcare are promising models. [ABSTRACT FROM AUTHOR]