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Objective. Oncology and palliative care guidelines for patients with incurable cancer recommend supporting patients at the end of life (EOL) by considering their personal values, wishes, and goals to facilitate decision making in advance care planning and patient‐centered care. It is unclear, though, how to successfully address and integrate personal values in clinical practice. The aim of this study was to explore values, wishes, and goals from the perspective of patients with advanced lung cancer. Methods. Semistructured interviews were conducted with patients with advanced lung cancer and transcribed verbatim. The data were analysed using a structured content analysis. After identification of main categories, values were identified using Schwartz's Theory of Basic Human Values as a theoretical framework. Results. Identified main categories were "the individual in medical care," "living now," and "coming to terms." Values in the dimensions "conservation" and "openness to change" were described concerning patient‐physician interaction, therapy goals, preparedness for EOL, and life goals. "Self‐transcendence" values mainly related to caring for the burden on relatives. In general, patients showed reluctance in expressing information about personal values when communicating with physicians. Conclusion. Patients with advanced lung cancer engage in various ways to determine how they want and can influence their life and medical care. Different values and the associated wishes and goals play a crucial role in this context and should be taken into account by healthcare providers. The reluctance to express personal information in medical encounters underscores the need for a proactive attitude in physicians and improved interprofessional collaboration. The study was registered in the German register for clinical trials (DRKS00026993). [ABSTRACT FROM AUTHOR]

Introduction: To find the adherence rate to periodic dilated eye examinations (DEEs) and its determinants among patients with diagnosed diabetes. Research Design and Methods: In this cross‐sectional study of 165 participants with diagnosed diabetes (Type 1/2) attending a general hospital with a diabetes clinic, we explored perceptions of barriers and facilitators of DEE at the individual level using a framework adapted from the health belief model (HBM). Patients were compared using t tests for continuous data and chi‐square tests for categorical data. Results: The rate of adherence to DEE (as defined by DEE within a year) was 62.4% (95% confidence interval [CI] = 55.0%–69.8%). The mean age of the patients was 56.81 (±13.29) years. We found that the mean benefit score was significantly higher, and the mean barrier score was significantly lower in those adhering to DEE (p < 0.001); but the susceptibility, severity, and self‐efficacy scores were not significantly different. Furthermore, those under treatment for diabetes mellitus (DM), those with diabetic retinopathy (DR) in them or their family member, and those with DM duration of 1 year or less were significantly likely to adhere to DEE (p < 0.005). Additionally, those who had received advice for eye screening from their physicians were about 25 times more likely to adhere to DEE (95% CI =6.80–92.05) than those who were not advised. Conclusion: A larger proportion of people with diabetes did not adhere to periodic DEE. Benefits and barriers were found to be determinants in this population. Further exploration in a larger population and the use of HBM to increase adherence to periodic DEE can be tested by targeting behavioral counseling along with other traditional approaches. [ABSTRACT FROM AUTHOR]

Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as "holding" for individuals with complex needs, who lack informal networks of support or who are waiting to access services. We explore the concept of holding, its meaning and significance in this context, and consider its consequences. As part of a realist evaluation, we observed seven link workers in GP practices in England during focussed ethnographies over a 3‐week period. We took field notes and interviewed 61 patients and 93 healthcare and voluntary sector professionals. Nine to twelve months later, we carried out follow‐up interviews with forty‐one patients, seven link workers, and a link worker manager. We identified four functions of holding: supporting patients waiting for services, sustaining patients as they prepare for change, reducing the emotional burden of primary healthcare professionals, and bearing witness to patients' distress. Holding appears to be a vital but often overlooked aspect of social prescribing. Patients benefit from having a reliable and consistent person to support their emotional needs. However, similar to the impact of holding on other primary care professionals, there are unintended consequences: some link workers exceed their capacity, become overburdened, experience burnout, and leave their job. Recognizing the importance of holding and understanding its role in link workers' primary care responsibilities are critical. If holding work is accepted as a role for link workers, providing training and support to them should be prioritised to ensure successful implementation and positive outcomes for patients, link workers, and primary healthcare staff. [ABSTRACT FROM AUTHOR]

Background. As the second leading cause of death in women in the world, breast cancer has several physical and psychological effects. Nowadays, nonclinical approaches such as patient empowerment have been considered by physicians along with clinical care. Given the increasing number of breast cancer women worldwide, promoting the empowerment of these patients is one of the key factors affecting their survival and quality of life. Therefore, because of no comprehensive research on the empowerment needs and related improvement strategies, this study is aimed at determining the empowerment status of breast cancer patients referred to the Shahid Motahari Breast Cancer Clinic in Iran, Shiraz, and at providing strategies to improve their empowerment in 2021. Methods. This applied study was conducted in two phases. In the quantitative phase, 310 Cancer-Related Patient Empowerment Scale questionnaires (Persian format) were distributed among the studied patients selected through the random sampling method in the clinic, and the items with "unacceptable status" became the basis for determining the empowerment strategies through the scoping review and semistructured interviews with 22 medical staff and patients through the thematic analysis. The collected data were analyzed using the SPSS 20.0 and MAXQDA10 software. Results. The mean score of the participants' empowerment strategies was 3.58. The results showed that trust in the physician, family support, and spiritual beliefs could affect the empowerment of the studied patients. Moreover, the participants needed empowerment strategies in 11 scale items with unacceptable status, for which 46 strategies were determined in the scoping review and interview phase. Conclusion. The results of this study provided useful strategies for empowering breast cancer patients, the most important of which were classified into five categories of financial support, informational support, interaction with the physician, occupational support, and complementary therapies, the use of which by the stakeholders could help to improve the patients' quality of life while improving their empowerment. [ABSTRACT FROM AUTHOR]

Aim. The purpose of this study was to examine the association among doctor-patient communication, trust, and patients' negative stereotypes for healthcare professionals during COVID-19. Background. Patients' negative stereotypes for healthcare professionals have been considered a major cause of violence against healthcare professionals. During COVID-19, since the fear for illness could exacerbate patients' negative stereotypes for healthcare professionals, therefore, how to inhibit patients' negative stereotypes for healthcare professionals has become a top priority. Methods. From January 2020 to April 2020, a cross-sectional survey study was performed in which a total of 2000 patients were convenience-sampled from different regions of China. The survey measured doctor-patient communication, institutional trust, interpersonal trust, and patients' negative stereotypes for healthcare professionals, respectively. After standardizing the total data scores, the association between doctor-patient communication, trust and patients' negative stereotypes for healthcare professionals using the bootstrap method was built. Results. There was a moderate to the high correlation between doctor-patient communication, patients' negative stereotypes for healthcare professionals, interpersonal trust, and institution trust (r = 0.36–0.68, p < 0.01). Mediation analysis showed that patients' interpersonal trust (β = −0.25, 95% CI: −0.312–−0.209) than patients' institution trust (β = −0.02, 95% CI: −0.042–−0.007) played a greater role in suppressing negative stereotypes through doctor-patient communication. Conclusions. Through communication, healthcare professionals and patients increase their familiarity and identification, thereby reducing patients' negative stereotypes. Moreover, because interpersonal trust connotes emotional and cognitive trust, it was more beneficial than institution trust in reducing negative stereotypes. Implications for Nursing Management. The results of this study can tell governments, healthcare organizations, communities, and healthcare professionals that reducing violent behaviors based on negative stereotypes requires attention to institutional trust building, interpersonal trust development, and communication improvement. [ABSTRACT FROM AUTHOR]

Purpose. To explore the value of visual electrophysiology in evaluating the fundus function of mature cataract patients. Methods. 124 mature cataract patients (153 eyes) were examined before cataract surgery; the examinations included best corrected visual acuity (BCVA), pattern visual evoked potential (PVEP), full-field electroretinogram (ffERG), and multifocal electroretinogram (mfERG). According to the postoperative fundus conditions, the subjects were divided into two groups: the no fundus disease group and the fundus disease group. Approximately one month after the operation, BCVA was measured, and visual electrophysiology was performed on subjects who had a stable fundus condition and had not received treatment for fundus disease. Results. One month after cataract surgery, BCVA ≤ 0.3 logMAR was found in 60 eyes (96.8%) without fundus disease and 59 eyes (64.8%) with fundus disease. Compared with the group without fundus disease, the preoperative electrophysiological examination of the group with fundus disease showed that the amplitude of ffERG waves and the amplitude density of the P1 wave in the 2nd to 5th rings of mfERG were decreased (all P < 0.05). ffERG and mfERG can be used for differential diagnosis of fundus disease (all P < 0.05), while PVEP has no significant diagnostic value for fundus disease (all P > 0.05). In the group without fundus disease, the amplitude of the PVEP 15′ P100 wave and the amplitude of dark-adapted (DA) 0.01 b-wave, DA 3.0 a-wave, and DA 10.0 a-wave were negatively correlated with postoperative logMAR BCVA (all P < 0.05). In the group with fundus disease, the amplitude of PVEP and ffERG and the amplitude density of mfERG were negatively correlated with postoperative logMAR BCVA (all P < 0.05). In the eyes of cortical cataracts, some parameters of PVEP, ffERG, and mfERG were significantly different before and after surgery. In the eyes of nuclear cataracts, some parameters of ffERG and mfERG were significantly different before and after surgery. In the eyes of posterior subcapsular cataracts, some parameters of PVEP and ffERG were significantly different before and after surgery. Conclusions. ffERG and mfERG can be used to detect fundus disease in mature cataract patients. The preoperative visual electrophysiological examination has high clinical value in predicting postoperative vision of mature cataract patients with fundus disease. Different types of cataracts have different effects on electrophysiological examination results. When interpreting the electrophysiological report, it is necessary to consider the existence of cataracts. This trial is registered with 2019-K068. [ABSTRACT FROM AUTHOR]

Purpose. In recent years, decision-making between conventional medicine, complementary medicine (CM), and alternative medicine (AM) has been studied. The purpose of this study is to take a closer look at patients' thoughts regarding AM and CM and, if possible, to identify differences. Patients and Methods. Ten cancer patients were recruited to participate in a guided semistructured interview. Recruitment was via verbal request during counseling sessions for complementary healing methods. The main recruiting criterion was their interest in or use of AM or CM. In the following face-to-face interviews, demographic data, previous experience with alternative medicine and conventional medicine, doctor-patient communication, role of the family, and sources of information were determined. The interviews were conducted in a semistructured manner using a guide and were recorded anonymously. The recordings were subsequently transcribed. Results. The number of patients was 10, of which eight were female and seven could show higher educational status. In most of the cases, poor communication was mentioned, both in past situations and at the time of diagnosis. Patients described a lack of emotion in the communication of their diagnosis and paternalistic discussions. They complained that they did not receive an overview of the therapy and that they were hardly involved in the decision-making process. Especially, the demanding content as well as the scarcity of conversation time played an important role for the doctor-patient relationship and the resulting trust toward the doctor. A fundamentally dismissive attitude toward CM, AM, and CAM procedures led to a more fragile trust base. Most frequently used sources were the Internet, support organizations, and books. Conclusion. The first point of contact for cancer patients is usually the conventional physician. Commonly, he is one of the most important sources. If the patient is satisfied with the atmosphere of the conversation and the information regarding CAM received, he will probably follow the doctor's recommendations. Only in the case of dissatisfaction do patients seek advice from alternative medicine. Good training of conventional physicians in communication and complementary therapy options could, therefore, be of great importance. [ABSTRACT FROM AUTHOR]

Health education is one of the most effective and efficient ways to achieve the goal of universal health coverage and the sustainable development goals. The equity of access to health services (especially services from community healthcare centers) for internal migrants is an important issue of global concern. However, due to the registration system, long-term residence plan, education level, and other determinants, it is more difficult for internal migrants to enjoy equitable health education compared with local residents. At present, there is no research on signing up with family doctors mainly from community healthcare centers among internal migrants and their impact on access to health education services. In this nationwide cross-sectional study, we used the migrant population dynamic monitoring survey (MDMS) in 2018 to assess the disparities in signing up with a family doctor and its association with health education among internal migrants in China. Among the 151,892 participants, a total of 11.26% migrants had signed up with a family doctor and 81.37% internal migrants had received health education. There was a significant association between signing up with a family doctor and health education in the univariate model (aOR = 1.113; 95% CI: 1.095, 1.132) and the multivariate model (aOR = 1.107, 95% CI: 1.089, 1.126). Meanwhile, age (aORinteraction = 0.996, 95% CI: 0.994, 0.997), migration time (aORinteraction = 0.927, 95% CI: 0.907, 0.948), and migration range (aORinteraction = 0.994, 95% CI: 0.992, 0.997) also had an impact on the relationship between signing up with family doctors and health education. Due to the health education inequalities among internal migrants in China, we need to improve health education access and utilization of internal migrants. As signed up with family doctors was significantly associated with health education among migrants in China, we recommended that the government and healthcare facilities promote health education through family doctors. The number and professional ability of family doctors should also be improved especially in areas with weak healthcare service resources in the future. [ABSTRACT FROM AUTHOR]

Male hypogonadism (MH) is a clinical and biochemical syndrome caused by inadequate synthesis of testosterone. Untreated MH can result in long-term effects, including metabolic, musculoskeletal, mood-related, and reproductive dysfunction. Among Indian men above 40 years of age, the prevalence of MH is 20%–29%. Among men with type 2 diabetes mellitus, 20.7% are found to have hypogonadism. However, due to suboptimal patient-physician communication, MH remains heavily underdiagnosed. For patients with confirmed hypogonadism (either primary or secondary testicular failure), testosterone replacement therapy (TRT) is recommended. Although various formulations exist, optimal TRT remains a considerable challenge as patients often need individually tailored therapeutic strategies. Other challenges include the absence of standardized guidelines on MH for the Indian population, inadequate physician education on MH diagnosis and referral to endocrinologists, and a lack of patient awareness of the long-term effects of MH in relation to comorbidities. Five nationwide advisory board meetings were convened to garner expert opinions on diagnosis, investigations, and available treatment options for MH, as well as the need for a person-centered approach. Experts' opinions have been formulated into a consensus document with the aim of improving the screening, diagnosis, and therapy of men living with hypogonadism. [ABSTRACT FROM AUTHOR]

Participation by patients with chronic diseases under primary health care requires more attention to achieve effective disease management and better health outcomes. In 2016, China proposed accelerating the establishment of a system of family doctors (FDs) and strengthening doctor-patient communication to better meet residents' health service needs. This study aimed to describe perceived participation in primary health care among patients with chronic diseases in northeastern China and explore the impact of FD contract services and patient's trust on patients' perceived participation. A cross-sectional survey of 847 patients with chronic diseases in 16 primary healthcare institutions was conducted in Jilin Province, China. Among all participants, 453 patients reported signing up for FD contract services (62.93%). The perceived participation of patients with chronic diseases was at a low level (mean = 6.71 and SD = 3.35). After controlling for sociodemographic variables and health-related variables, FD contract services directly and indirectly influenced patients' perceived participation. The patient's trust was a mediator in the relationship between FD contract services and perceived participation. This study confirmed the valuation of family doctor contract services and provided a theoretical basis for the formulation of primary health service policies. Health organizations should continue to enhance the capacity of primary health services and attract more chronic disease patients to contract with FD teams, thereby enhancing doctor-patient trust and increasing patient's participation in primary health care. [ABSTRACT FROM AUTHOR]

Objective. To investigate patients' preference and the attitude towards physician attire in an internal medicine clinic in China. Methods. This study was conducted from 1 January 2021 to 30 June 2021 in a tertiary care hospital in China. We surveyed 126 patients in the hospital with 6 sets of pictures of commonly worn physician attires in the hospital setting with a two-part questionnaire. The first part listed respondent demographics to collect basic information. The second part of the questionnaire was administered to adult patients who received care in the internal medicine clinics (outpatients). Survey forms collected demographic data (age, gender, patient age, education, marital status, and employment status), asked questions regarding 6 specific attires (scrubs, scrubs and white coat, casual, casual and white coat, business suit, and formal and white coat), and behavioral items (professional, responsible, reliable, knowledgeable, succession rate, and medical safety), finally, to assess the preference of attire on overall perception. Results. Scrubs and white coat scored the highest through 6 domains about physicians' attire (professional, reliable, responsible, knowledgeable, medical safety, and succession rate, p < 0.05 for all comparisons). A casual suit without a white coat was the least preferred across the surveyed attributes. There was a significant preference gap between wearing a white coat and not wearing a white coat (p < 0.001). Physician attire to white coat was considered as more professional, reliable, responsible, knowledgeable, having greater medical safety, and a higher success rate than attires without white coat. Conclusion. Patients felt that the physician wearing a white coat was better than other attires. Scrubs and white coat was the most popular attire. Hospital or related authorities may promote the standardized wearing of white coats, leading in a greater patient-physician relationship. [ABSTRACT FROM AUTHOR]

Background. Physician review websites (PRWs) are increasing in usage and popularity. Our purpose is to characterize one-star reviews of orthopedic oncology surgeons to understand factors in healthcare that contribute to patient satisfaction. Methods. Orthopedic oncology surgeons were randomly selected from the Musculoskeletal Tumor Society. A search for one-star reviews was performed on Google Reviews, Healthgrades, and Vitals.com. Reviews were classified as clinical or nonclinical. Statistical analyses were performed regarding the frequency of reviews and complaints for each category. Results. Of the 7,733 reviews discovered, 908 (11.7%) were identified as one-star reviews. Of 907 usable complaints, 362 (40.8%) were clinical and 545 (59.2%) were nonclinical. The most common nonclinical complaints included bedside manner (65%) and limited time with providers (19%). The most common clinical complaints included complications (26%) and disagreements with the treatment plan (26%). There were 120 surgical and 221 nonsurgical reviews. Surgical patients had a higher rate of clinical complaints. Nonsurgical patients had a higher rate of total complaints. Conclusion. To the best of our knowledge, this is the first study examining PRWs regarding orthopedic oncology surgeons. Most one-star reviews were due to nonclinical complaints from nonsurgical patients. The most common factors are bedside manner, limited time with provider, phone communication issues, and rude/unprofessional conduct. [ABSTRACT FROM AUTHOR]

Objective: End of life communication (EOLC) is generally regarded as a challenging aspect of the medical profession, with high influences of culture, the physician's experience and awareness. The aim of the current study was to assess the awareness of Austrian oncologists towards EOLC practices in their daily clinical routine and to identify limiting and supporting factors of these conversations. Methods: Overall, 45 oncologists participated in the assessment in this cross‐sectional, mixed‐method design using semi‐structured interviews and questionnaire. Results: Themes that occurred during the interviews included the initiation of EOLC, EOLC in practice, strategies for EOLC, limiting and supporting factors and consequences of EOLC. There were several variations in the EOLC approach, that is, the use of time frames, timing, initiation and the amount of details given to the patient. Conclusion: Oncologists agreed that EOLC is important in their daily clinical routine and for their patients. Nevertheless, there seems to be an underlying variation in approaches chosen by Austrian oncologists. This variation might be reduced by asking patients about their information preferences in advance and by routine implementation of communication guidelines, nomograms and prognostic calculators to reduce uncertainty. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. Methods: A first draft of the questionnaire was compiled based on skills reflecting good physician–patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. Results: After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient‐centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. Conclusion: A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com‐On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. Practice Implications: The questionnaire is suitable for measuring both the strengths and deficits within the physician–patient communication in oncology from the patients' perspective. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to explore whether general practitioners (GPs) communicate with cancer patients on complementary and integrative medicine (CIM) in a patient‐centred and case‐specific manner. Methods: We designed two cases of standardised breast cancer patients and allocated 29 GPs to hold a consultation either with Case 1 or Case 2. Case 1 presented with fears of possible physical side effects of hormone treatment. Case 2 feared a loss in social functioning because of nausea and emesis as possible side effects of chemotherapy. Consultations were audiotaped and analysed using the Roter Interaction Analysis System (RIAS). We analysed whether recommended CIM treatments and GPs' focus on psychosocial or medical and therapy‐related content differed according to whether they were counselling Case 1 or Case 2. Results: In consultations with Case 1, GPs rather focused on medical and therapy‐related content and most often recommended mistletoe, diets and sports. In contrast, GPs focused on psychosocial content and they most often recommended methods of self‐care when counselling Case 2. Conclusion: The GPs in our sample reacted case‐specifically to the patients' interest in CIM. Such responsive and patient‐centred communication is a valuable resource but is often time‐consuming. Adequate training and reimbursement should therefore be considered for GPs. [ABSTRACT FROM AUTHOR]

Federally certified opioid treatment programs (OTPs) provide psychosocial counselling in addition to medications for opioid use disorder (MOUDs) using a patient‐centered approach in providing substance use disorder treatment. This study explored factors associated with patients' adherence to counselling while receiving MOUD at an OTP. A retrospective cohort design using data on adult patients (n = 1151, 61% females, 39% males) admitted to an OTP from July 1, 2014, to June 30, 2016, was employed. The data were for single episodes of care up to 52 weeks. Survival analysis (cox proportional hazards regression) assessed the relationship of personal characteristics, socio‐economic status, payment for services, type of substance use, comprehensive care and social support with counselling for up to a year. Results indicated that age, having services paid for by public means, was associated with counselling adherence. Primary heroin use patients had a higher risk of counselling adherence failure than patients who primarily used non‐medicinal prescription substances. Treatment agencies may benefit from funding and using evidence‐based practices for primary heroin use patients and young adults to better engage and retain these populations in treatment. [ABSTRACT FROM AUTHOR]

This study aimed to provide insight and learnings from Australian general practitioners in facilitating positive interactions with refugee and asylum seeker patients and the role they play in helping those community members engage with healthcare. We conducted semi‐structured individual remote interviews with 12 general practitioners (GPs) who worked in areas with high refugee and migrant populations. Interview transcripts were coded inductively and deductively, based on the research questions, using Thematic Analysis. Extensive debriefing and discussion took place within the research team throughout data collection and analysis. Creating a culturally safe environment was an initial step taken by GPs to minimise the inherent power imbalance, in addition to applying the principles of trauma‐informed care (TIC) to appropriately listen and respond to their patients' needs and individual social circumstances. GPs at times were involved in using their role to advocate on behalf of their patient and played a key role in helping build their patients' health systems literacy. This study highlights the important role that GPs play in advocating and engaging refugee and asylum seeker patients, as well as helping them navigate the healthcare system. Whilst GPs practice can be made more efficient through experience and time; to deliver the care required GPs need to provide care in response to the individual's capacity and social circumstances. Enabling time and the application of the principles of TIC and cultural safety may allow for GPs to provide the quality of care that is needed in supporting patients from refugee and asylum seeker backgrounds. [ABSTRACT FROM AUTHOR]

In Australia, mental illness has been recognised as a National Health Priority area, with the coronavirus pandemic adding a layer of urgency to the need to address the multiple health problems faced by clients with mental illnesses. Whilst much has been done in efforts to support these clients, little is known about their medication knowledge and experience with health professionals. The aim of the study was to explore the knowledge and beliefs of clients on the use of psychotropic medications and study their experiences with healthcare providers. Adult participants at a not‐for‐profit community‐managed specialist mental health service provider in Adelaide, South Australia were recruited. Four focus group sessions were conducted between February 2020 and March 2021. All sessions were co‐facilitated by a peer practitioner with lived experience. Sessions were audio recorded and transcribed verbatim. Participants (n = 27) reported that provision of medication education was inadequate and, in some cases, non‐existent. There was an apparent lack of support for monitoring and managing common side effects, such as weight gain. Participants described not being involved in any decision‐making processes and that establishing and maintaining a therapeutic relationship with their healthcare providers was challenging. Perceived stigma remains a barrier in accessing healthcare. Despite participants regularly interacting with a range of healthcare providers, findings highlight key gaps in care, particularly medication education and establishing a therapeutic relationship with their healthcare providers. Future mental health reforms should consider the provision of additional medication education in community settings, such as at not‐for‐profit organisations. Moreover, healthcare providers should take a proactive approach in establishing therapeutic relationships. [ABSTRACT FROM AUTHOR]

Previous research on general practitioners' (GPs') involvement in end‐of‐life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual‐level care provided for patients in their last year of life. The findings of the study were drawn from a nation‐wide survey of GPs' experiences in end‐of‐life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end‐of‐life care reported by GPs were categorised into four groups: patient‐related factors, carer‐related factors, interactions between GPs and patients/carer‐related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end‐of‐life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end‐of‐life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital‐based services reaching into community settings and broader community‐based resources for families beyond simply the healthcare system. [ABSTRACT FROM AUTHOR]

This rapid realist review aims to explain how and why person‐centred care (PCC) in primary care works (or not) among others for people with low health literacy skills and for people with a diverse ethnic and socioeconomic background, and to construct a middle‐range programme theory (PT). Peered reviewed‐ and non‐peer‐reviewed literature (Jan 2013–Feb 2021) reporting on PCC in primary care was included. Selection and appraisal of documents were based on relevance and rigour according to the Realist And Meta‐narrative Evidence Syntheses: Evolving Standards (RAMESES) criteria. Data on context, mechanisms and outcomes (CMO) were extracted. Based on the extracted data, CMO configurations were identified per source publication. Configurations containing all three constructs (CMO) were included in the PT. The middle‐range PT demonstrates that healthcare professionals (HCPs) should be trained and equipped with the knowledge and skills to communicate effectively (i.e. in easy‐to‐understand words, emphatically, checking whether the patient understands everything, listening attentively) tailored to the wishes, needs and possibilities of the patient, which may lead to higher satisfaction. This way the patient will be more involved in the care process and in the shared decision‐making process, which may result in improved concordance, and an improved treatment approach. A respectful and empathic attitude of the HCP plays an important role in establishing a strong therapeutic relationship and improved health (system) outcomes. Together with a good accessibility of care for patients, setting up a personalised care plan with all involved parties may positively affect the self‐management skills of patients. Good collaboration within the team and between different domains is desirable to ensure good care coordination. The coherence of items related to PCC in primary care should be considered to better understand its effectiveness. [ABSTRACT FROM AUTHOR]

Online healthcare platforms serve not just as a medical knowledge-sharing community but also bring about effective interactions between professional physicians and patients. However, it is unclear whether online technology adoption affects such interactions in the same way between traditional Chinese medicine and modern medical departments. By utilizing a large sample of online doctor-patient interaction information from 168,870 doctor-specific interactive webpages recorded in a famous Chinese online healthcare community, this paper studies the differences between 17,513 traditional medicine doctor homepages and 151,357 others from more than 100 different specialty areas. Our chosen platform is representative since it covers about 800,000 physicians working at over 10,000 hospitals across all major provincial regions in China. We document that online medical service users tend to accept and use online health care services. However, patients seeing Chinese medicine doctors exhibit the following unique characteristics. They still prefer choosing doctors according to third-party information and may be reluctant to pay for the current online service price level. This problem is hard to overcome by the platform in the short run. Patients need a long-term process to adapt to the upgraded medical environment gradually. Therefore, establishing a personalized doctor recommendation system has become the most urgent demand presently. [ABSTRACT FROM AUTHOR]

Objective: In Switzerland, palliative sedation consists of using sedatives to relieve terminally ill patients. It is divided into several steps, with one of them consisting of informing patients and relatives about the procedure. In the current recommendations, there is a lack of orientation about how and when this discussion should take place. Hence, we aim to explore perceptions and experiences of palliative care professionals regarding these questions. Methods: Qualitative semi‐structured interviews with five physicians and five nurses working in specialised palliative care were conducted. They were then analysed with thematic analysis. Results: Results showed a uniformity around definition, goals and indications of palliative sedation. However, there was a lack of consistency regarding the process of delivering this information to patients and relatives. Finally, some participants strongly opposed the idea of systematically informing patients in specialised palliative care, while others were more divided on this question. Conclusion: Despite a common understanding of the concept of palliative sedation, there is no standard practice when informing patients on palliative sedation among palliative care professionals. Therefore, this study demonstrates the need for further guidelines on this question and calls for a better understanding and knowledge of palliative sedation among health professionals outside palliative care. [ABSTRACT FROM AUTHOR]

Aims: This study aims to investigate the impact of occupational exposure on job satisfaction and overall happiness and to identify related factors of job satisfaction and overall happiness among physicians and nurses. Background: Occupational exposure against physicians and nurses has become one of the most serious public health issues worldwide. Methods: A cross‐sectional study was conducted among physicians and nurses from 14 public tertiary hospitals using purposive sampling. Propensity score matching was used to compare job satisfaction and overall happiness among physicians and nurses with and without occupational exposure. Furthermore, binary logistic regression analysis was used to identify and analyse the influencing factors of job satisfaction and overall happiness. Results: A total of 2139 physicians and nurses (55.59%) from 3791 participants had experienced occupational exposure hazards. Before matching, the job satisfaction and overall happiness among the physicians and nurses were 38.54% and 42.14%, respectively. Participants who experienced occupational exposure were more likely to develop job dissatisfaction (OR = 1.08, 95% confidence interval [CI]: 0.90–1.28) and overall unhappiness (OR = 1.24, 95% CI: 1.05–1.46) than those who did not. Participants' work experience, self‐evaluated health status, satisfaction with the work environment, evaluation of doctor–patient relationship and stress were common factors affecting job satisfaction and overall happiness. Conclusions: Our findings suggest that physicians and nurses who experience occupational exposure are more likely to develop job dissatisfaction and overall unhappiness, especially if they have shorter work experience and a tense or neutral relationship with patients. Implications for Nursing Management: It is necessary to pay attention to the occupational exposure. When physicians and nurses experience occupational exposure, managers could provide support to prevent job dissatisfaction and unhappiness. [ABSTRACT FROM AUTHOR]

Despite providing 20 percent of primary healthcare and a larger proportion of care for patients with chronic conditions, little is documented about working in public primary healthcare clinics in Singapore. While previous studies of primary care physicians' occupational stress focused on burnout, this study explores broader personal, professional and organisational factors affecting their experiences. It examines factors influencing doctors working in such clinics to leave or remain in this setting, and the initiatives that would retain and encourage re‐entry in the public sector. The study employs a qualitative approach involving semi‐structured interviews with 22 doctors conducted between November 2018 and May 2019. These doctors had at least 1 year of experience working in a public primary healthcare clinic. Sixteen of them had left the public sector and six others remaining. Qualitative content analysis was used to interpret the data. The respondents shared three key less favourable themes of working in these clinics; heavy workload and long working hours, short consultation times, and a perceived lack of management's concern about doctors' welfare, and two key valuable experiences of working in this setting; continuity of care and opportunities for academic scholarly activity, including teaching and research. The findings suggest that to retain doctors in these clinics, change is needed at an organisational and structural level. Overall, this study bears important implications for health policy and planning, especially with regard to how the public healthcare system can strike a balance between meeting the demand for high‐quality healthcare, and the professional needs of healthcare providers. [ABSTRACT FROM AUTHOR]

Background. Acne is the most common inflammatory skin disease in adolescence. It is also prevalent in adults, especially females. The disease has a considerable impact on health-related quality of life. Many studies have reported the negative impact of acne on patients due to skin disfigurement, ineffective treatment, and adverse effects of the treatment. Numerous factors contribute towards nonadherence to therapy. Summary. This review discusses the various factors that are related to treatment nonadherence such as ineffective therapy, adverse effects with topical pharmacotherapy such as skin irritation and erythema as well as patient-related factors such as lack of knowledge of disease and a poor patient-physician relationship. Various methods are being adopted to increase adherence to treatments. Increased adherence to acne therapy has been associated with the use of dermocosmetics, such as moisturizers and cleansers. Encouraging the use of dermocosmetics in synergy with pharmacological regimens could support improved treatment adherence resulting in better clinical outcomes for acne patients. Conclusion. Dermocosmetics as an adjunct to pharmacological regimens has the potential to improve clinical outcomes by increasing treatment adherence in patients with acne. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory skin disease showing a high burden due to its aesthetic, social, psychological, and quality of life (QoL) implications which also affect patient‐physician relationship and, consequently, the adherence to treatments. Limited data on the natural history of psoriasis and factors predicting its prognosis are available. The aim of this study was to investigate patients' global characteristics, including treatments, associated with QoL impairment in psoriasis. Questionnaires evaluating sociodemographic features and Dermatology Life Quality Index (DLQI) were administered to patients. Multiple regression analysis was performed to evaluate factors associated with a large effect on patient's life (DLQI > 10), moderate effect on patient's life (DLQI ≥ 6 ≤ 10), small effect on patient's life (DLQI ≥ 2 < 6), and no effect on patient's life (DLQI < 2). Overall, 1052 consecutive patients affected by mild‐to‐severe psoriasis were recruited. Our logistic regression analysis showed that the influencing factors for a large effect on QoL were living in Southern Italy, depression, psoriatic arthritis, and psoriasis localization on facial, intertriginous, palmoplantar, trunk and scalp regions. For a moderate effect on patient's life, phototherapy and non‐biological systemic therapies resulted to be the predictive factors. Mild psoriasis, living in social housing and the isolated involvement of scalp psoriasis had a small effect on QoL. Lastly, mild psoriasis and current biological therapies including anti‐IL‐12/23, anti‐IL‐17, and anti‐TNF‐α were positively associated with no life quality impairment. Perceived quality of life impairment in psoriasis not only depends on the skin disease but rather on patients' global characteristics. Therefore, the individual background of these patients should be respected in the selection of treatment options. [ABSTRACT FROM AUTHOR]

It is important to identify means of improving and maintaining a sustainable doctor-patient relationship to address current healthcare issues. Although many studies have made outstanding contributions to the healthcare doctor-patient relationship literature, little work has been done to explore the influencing elements of the doctor-patient relationship in relation to expectation confirmation theory. To fill this gap, this study produced a theoretical framework model of the influencing factors of the doctor-patient relationship according to the expectation confirmation theory. Data from 335 Chinese patients were analyzed using a structural equation modeling method, and the results showed that patient satisfaction and patient trust are the most important factors in building a good relationship between doctor and patient. Furthermore, three components of postdiagnosis patient's perception, namely, perceived service quality, perceived communication quality, and perceived service attitude, are examined. These have a significant impact on patient confirmation. These three components ultimately affect the doctor-patient relationship. This study will be helpful for doctors to understand patients' service demands and their future diagnosis behavior. The proposals of this study may lead to optimization of the process of diagnosis and improvements in the quality of clinic services. [ABSTRACT FROM AUTHOR]

Background: Poor perception of informed consent compromises patients' autonomy and self-determination; as a result, they feel powerless and unaccountable for their treatment. This study aimed to assess patients' perception of informed consent and its associated factors among surgical patients attending public hospitals in Dessie City Administration, Northeast Ethiopia.Methods: Facility-based cross-sectional study was conducted on 422 surgical patients. A systematic sampling technique was used to select the study participants. Data were collected using a pretested structured interviewer-administered questionnaire. EpiData version 3.1 was used for data entry, and then data were exported to SPSS version 25 for analysis. Multivariable logistic regression analysis was done to identify factors associated with the outcome variable among the participants. Variables with p value less than 0.05 were considered statistically significant factors.Results: The prevalence of poor perception of informed consent for surgical procedures was found to be 33.2% (95% CI: 28.8-37.8). In multivariable analysis, educational status with inability to read and write (AOR = 5.71; 95% CI: 2.76-11.80) and basic ability to read and write (AOR = 6.03; 95% CI: 2.57-14.16), rural residence (AOR = 3.71; 95% CI: 1.94-7.07), marital status being widowed and divorced (AOR = 3.85; 95% CI: 1.83-8.08), language of written informed consent different from mother tongue (AOR = 4.196; 95% CI: 1.12-15.78), poor patient-physician relationship (AOR = 2.35; 95% CI: 1.31-4.24), and poor knowledge of surgical informed consent (AOR = 3.05; 95% CI: 1.56-5.97) were significantly associated with poor perception of surgical informed consent.Conclusion: In this study, one-third of surgical patients appear to have poor perceptions of informed consent for surgical procedures. Educational status, being rural residents, being widowed/divorced, language of written informed consent, poor patient-physician relationship, and poor knowledge of surgical informed consent were variables that are independent predictors of poor perception of informed consent for surgical procedures. The ministry of health and healthcare providers should develop a plan to raise patients' awareness about the informed consent process for surgical procedures. [ABSTRACT FROM AUTHOR]

Healthcare provider attitudes and perceptions of disability may influence the delivery of comprehensive quality care to patients with disabilities. The study was conducted to ascertain healthcare providers' perspectives on access to healthcare by disabled people in a peri‐urban district of Ghana. We employed a qualitative approach and selected participants using the purposive sampling technique. Qualitative data were collected from 28 healthcare providers through face‐to‐face interviews using an interview guide. Data let thematic an alysis was employed to tease out the findings through categorisation and the main themes have been presented as findings with specific quotations to support them. We found that people with disabilities who visited healthcare facilities were perceived as individuals who are stressed up, selfish and inconsiderate, violent, having low self‐esteem and also difficult to communicate with. This could affect the interactions between healthcare providers and people with disabilities who visit the facility and subsequently the quality of service provided. It is recommended that the Ministry of Education, Ministry of Health and the Ghana Health Service work closely with the various educational institutions to train healthcare professionals to improve their knowledge on disability issues to improve service delivery. [ABSTRACT FROM AUTHOR]

Effective narrative turn of doctor-patient communication can strengthen the trust between doctors and patients, close the doctor-patient relationship, and reduce the contradiction between doctors and patients. Health humanities, as a more inclusive, open, and application-oriented discipline, has been gradually recognized by academic circles. Narrative medicine, as an interdisciplinary subject of humanities education and medicine, plays an important role in cultivating medical students' narrative ability. 30 medical staff in a general hospital were selected as the research object by questionnaire survey. General information questionnaire and medical narrative ability scale were used to investigate and multiple linear regression was used to analyze the influencing factors of medical students' medical narrative ability. The results show that the standardized regression coefficients of communication content, empathy, and communication results are 0.439, 0.367, and 0.138, respectively. The total score of medical narrative ability of medical students is 133, and the average score of items is 4.87, which is at a low level. In conclusion, the medical narrative ability of medical students is at a low level, and nursing managers should take targeted intervention measures to improve the medical narrative ability of medical students. [ABSTRACT FROM AUTHOR]

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption. [ABSTRACT FROM AUTHOR]

This paper introduces the background and experience of the development of a digital operating room and designs the main functions of the digital operating room based on the Internet of Things, the impact on medical data in hospitals, and how to build the digital operating room to cope with the huge amount of data in the "data era." The infrastructure of the digital operating room is described, as well as how to collect and transmit medical data, how to store large amounts of medical data, and how to analyze medical data and explore its hidden data value are also described. One hundred and four surgical patients from June 2020 to June 2021 were randomly selected for the study, and they were randomly and equally divided into 52 cases each in the control group and the observation group, with the control group implementing the management of conventional care methods and the observation group implementing information technology for care management, comparing the management effects of patients in both groups. The satisfaction of patients in the observation group was significantly higher than that of the control group (P < 0.05). The use of information technology to ensure the quality of care in the operating room not only can help patients recover early but also can help patients relieve the psychological pressure after surgery, thus improving the doctor-patient relationship, and has a significant application effect. [ABSTRACT FROM AUTHOR]

We explore, from the perspective of primary care health professionals, the motivations that lead patients to not initiate prescribed treatments, by developing a qualitative study in Spanish primary care. Six focus groups (N = 46) were conducted with general practitioners, nurse practitioners, social workers and community pharmacists and carried out in primary care (PC) of Barcelona Province, from April to July of 2018. The 46 participants were identified by three general practitioners and two pharmacists. In the interviews, the reasons for non‐initiation of PC patients' medication were explored. Triangulated content analysis was performed. Patients' perspective, analysed in a previous study, and professionals' perspective agree on most of the factors that affect non‐initiation. New factors were categorized into existent categories, confirming, and supplementing the model developed with patients. Health professionals identified some new factors which were not present in the patients' discourse, such as stigma related to the drug, hidden reasons for consultation, the role of nurses in prescription and support, the role of the pharmacy technician, illiteracy and lack of social support. The professionals confirm and expand on the Theoretical Model of Medication Non‐Initiation. Primary care professionals should consider the factors described when prescribing a new medication. Knowledge contributed by the model should guide the design of interventions to improve initiation. [ABSTRACT FROM AUTHOR]

Many patients with terminal cancer wish to die at home and general practitioners in the United Kingdom have a critical role in providing this care. However, it has been suggested general practitioners lack confidence in end‐of‐life care. It is important to explore with general practitioners their experience and perspectives including feelings of confidence delivering end‐of‐life care to people with cancer. The aim of this study was to explore general practitioners experiences of providing end‐of‐life care for people with cancer in the home setting and their perceptions of confidence in this role as well as understanding implications this has on policy design. A qualitative study design was employed using semi‐structured interviews and analysed using thematic analysis. Nineteen general practitioners from London were purposively sampled from eight general practices and a primary care university department in 2018–2019, supplemented with snowballing methods. Five main themes were constructed: (a) the subjective nature of defining palliative and end‐of‐life care; (b) importance of communication and managing expectations; (c) complexity in prescribing; (d) challenging nature of delivering end‐of‐life care; (e) the unclear role of primary care in palliative care. General practitioners viewed end‐of‐life care as challenging; specific difficulties surrounded communication and prescribing. These challenges coupled with a poorly defined role created a spread in perceived confidence. Experience and exposure were seen as enabling confidence. Specialist palliative care service expansion had important implications on deskilling of essential competencies and reducing confidence levels in general practitioners. This feeds into a complex cycle of causation, leading to further delegation of care. [ABSTRACT FROM AUTHOR]

Background. Patient Perceived Value (PPV) provides a valuable perspective to explain why the government reforms on health system in terms of functional medical treatment performance improvement did not decrease the crowded waiting line or increased patient satisfaction in China. Methods. Questionnaires comprising seven constructs were sent to patients from seven highly recognized hospitals in Zhejiang Province of China. It was collected via face-by-face in a twelve-month period (2019), and 2586 valid data were collected for SPSS statistic accordingly. Results. Besides the significance of the functional medical treatment values (such as the treatment effectiveness, accurate price, standardization, and normalization), the emotional values (reasonable waiting time, convenient accessibility, communication with doctors/nurses) were significant in patients' consciousness. Patient medical treatment seeking preferences were affected by patients' background characteristics and perceived value, which consequently produced differentiated patients' satisfaction. Patients' characteristics, which related to the age, gender, illness conditions, educational, and income level, would have different demanding in medical treatment seeking. These young female patients in outpatient or in mild illness conditions with higher educational and income levels tend to be relatively high in timing and convenience demanding. Conclusion. This result would change the policy maker and hospitals to considerate the patients' emotional value as well as functional value in providing medical treatment. Classified patients' time arrangement tactics consistent with distinguished characteristics, equipped up with convenient accessibility and interconnected medical treatment environment design, can create valuable patients' satisfaction in China. [ABSTRACT FROM AUTHOR]

This research explores how e-health systems' features (information quality, quality of the system, usability perceived, and perceived usefulness) contribute to improving medical personnel performance in medical centers, patient care, and physician-patient interactions in Jordan. The objective is to evaluate a single integrated model consisting of the technology acceptance model. This study used the logical research method and approach. A collection of data from 212 medical personnel working in 19 healthcare facilities throughout Jordan were gathered. To analyze the data collected and test the hypotheses of the research, a partially square/structural equation modeling method has been employed. The study found that the health information system (HIS) information quality has a direct and indirect beneficial effect on the performance of the staff, beneficial effects on patient care alone, and only favorable, indirect effects on the doctor-patient relationship. On the contrary, system quality was shown to influence directly and indirectly and to have a direct and indirect beneficial effect both on the connection between doctors and patients. Remember that the HIS has accessibility, speed, and mistake detection and avoids error issues. These shortcomings are suggested to be rectified in conjunction with improved user perception towards easy usage and utilization of the system. [ABSTRACT FROM AUTHOR]

Background. Patient records' relevance is associated with a variety of needs and objectives. Substantiating the health of patients perpetually and allowing professionals in the medical field to assess both signs and symptoms that fall in a relatively wider temporal point of view and contributions that lead to enhanced diagnoses and treatment are all quintessential of patient records. The advancement of information technology systems has led to the anticipation that development will be put into digitization and electronic means of storing patient records in order to grease their handling. Cape Coast Teaching Hospital (CCTH) is piloting implementation of patient's electronic health record system. The introduction of the electronic health record system known as Lightwave Hospital Information Management System (LHIMS) was to provide a permanent solution to patients' continuity of care. User's acceptance of new information technology is seen to be one of the most challenging issues in information system. This study assesses healthcare providers' (HP') behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital and other factors influencing it. Methods. A nonexperimental cross-sectional study was used to obtain information from 84 HP recruited from the various departments and units in CCTH who use LHIMS to attend to clients. The sample size of 90, representing 8% of HP in CCTH, was randomly selected from the various departments and units. However, 84 (indicating 93.3% response rate) of the selected HP were available during the period of the research. Results. Perceived ease of use (PEOU) of LHIMS had the strongest direct effect on perceived usefulness (PU), with a highly significant path coefficient of 0.75. PU had the greatest impact on attitude about HP' behavioural intention to use (BIU) LHIMS to attend to patients' healthcare delivery in CCTH (0.91). This relationship was highly significant at p < 0.001. PEOU did not have a significant direct effect on attitude about LHIMS use, as hypothesized in the original technology acceptance model. However, attitude towards use had a strong significant effect on HP' BIU of LHIMS, with a strong statistically significant path coefficient of 0.98 at p < 0.001. Conclusions. We conclude that attitude towards use have a significant influence on HP' behavioural intention to use LHIMS to attend to clients in Cape Coast Teaching Hospital. [ABSTRACT FROM AUTHOR]

Objective: Generic distress screening tools may not recognise the unique concerns reported in some cancer populations. The face and content validity of a screening tool derived from the National Cancer Comprehensive Network distress thermometer and problem list and adapted specifically for women with gynaecological cancer is presented. Methods: Building on existing work, panels of clinicians and researchers, and focus groups with women treated for gynaecological cancer, developed a nuanced distress screening tool. Results: The clinical reference group used an iterative process to reduce 54 items to 22 across four domains (practical/family/psychological/physical). These items were included in the draft tool, which was reviewed by two focus groups of long‐term cancer survivors. Participants unanimously thought the tool was necessary though several changes were recommended. The final draft tool contained a global distress score and 25 items across the four domains. Conclusions: This measure provides a structured screening tool tailored to the concerns of women with gynaecological cancer, enhancing communication between clinicians and their patients about potentially identified and unrecognised sources of distress. Future research will focus on establishing sensitivity and specificity of this tool and further assessing its utility in clinical settings for all gynaecological cancers (including rare cancers like vulvar cancer). [ABSTRACT FROM AUTHOR]

Despite the benefits of utilising community‐based care services (CBS) for people with dementia and their caregiver being well established, people with dementia and caregivers use fewer services in comparison to other people in need of care. While societal, cultural and logistical factors effecting caregiver use of CBS are frequently studied, research of internal emotional barriers, mental limitations created by one's own self that prevents open communication of thoughts and feelings, and their effect on CBS use is limited. This paper explores internal emotional barriers on caregivers' use of CBS within the Irish Healthcare System. Professional Healthcare Providers were also interviewed as a preliminary indicator of their awareness of these internal emotional barriers and their impact on caregivers' use of CBS. Using interpretive description methodology, interviews with 20 caregivers and fourteen dementia professional healthcare providers were transcribed and a thematic analysis methodology applied to illuminate themes/patterns within participants' subjective perceptions of caregivers emotional barriers to using CBS. Four themes emerge: reluctance to question general practitioner (GP) authority; embarrassment during level of care requirement reviews; sense of obligation to provide all care; and fear of stigma. Caregivers interviewed were reluctant to communicate concerns with professional healthcare providers (PHPs), thereby reducing the PHP's awareness of these barriers and delaying/preventing use of CBS. As key gatekeepers within the care pathway, GPs should address the uneven power dynamic with the caregiver through user‐centred models of care, which actively encourage open dialogue, and receive training to identify the indicative behaviours of internal emotional barriers and empower the caregiver to communicate their feelings/concerns directly. [ABSTRACT FROM AUTHOR]

Adults with intellectual disabilities experience significant physical and mental health needs when compared to their typically developing peers. Previous research evidences that many people with intellectual disabilities have negative encounters within acute hospitals. The aim of this systematic review was to identify the specific views and experiences of adults with intellectual disabilities when accessing acute hospital services arising from the available literature. The review commenced in June 2019 and was updated in May 2020. A systematic search of five electronic databases including CINAHL Plus, MEDLINE, Web of Science, SCOPUS and PsycINFO was undertaken. Studies published from 2014, peer‐reviewed, written in English and referred to adults with intellectual disabilities aged 18 plus and acute hospital settings were included. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and the Critical Appraisal Skills Programme quality assurance checklist were used to review all selected papers. Five studies from a total of 421 were deemed suitable for inclusion in the review as the voices of adults with intellectual disabilities were present. Poor communication from healthcare staff towards adults with intellectual disabilities emerged in four studies while the use of the hospital passport and the intellectual disability liaison nurse to significantly improve the hospital experience for adults with intellectual disabilities was identified in two of the studies. Following a systematic and thematic analysis of the studies, three main overarching themes emerged: communication; information sharing; and compassion and respect. Despite the national and international focus on improving healthcare for people with intellectual disabilities, this review highlights lack of communication, inadequate information sharing and issues related to compassionate care and respect. The review identifies the possibility that an increased use of hospital passports and an extension of the intellectual disability liaison nursing roles may enhance the hospital experience for people with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Although sexuality is an important part of health and emotional well‐being throughout the entire life cycle, including during old age, little is known about how physicians discuss or approach the topic of sexuality during later life. The present study examined the perspectives of two groups of physicians toward discussing sexuality with older patients: 17 physicians who did not have any training in human sexuality and 21 physicians who were certified as sex therapists. The interviews underwent thematic content analysis to identify and code major themes and patterns. Qualitative analysis of the interviews yielded three main themes: (a) discourse between physicians and older adults regarding sexuality, (b) diagnosing sexual dysfunction among older adults, and (c) treating sexual dysfunction among older adults. Physicians who were not trained in sex therapy did not regularly ask their older patients about sexual functioning and/or problems with sex, tended to diagnose sexual problems from a medical perspective, and offered medication as the main treatment for sexual problems. Physicians trained as sex therapists felt more comfortable discussing sex‐related issues with their older patients and diagnosed sexual problems from a medical, social, dyadic and psychological perspective. Although they offered their older patients a greater variety of medication‐oriented interventions than those without training in sexuality, they did not rush into such interventions and instead emphasised the importance of the psychological and relational aspects of sex. The present study highlights the importance of human sexuality training for physicians and points out the effects of such training on the discourse, diagnosis and treatment of sexual concerns in later life. [ABSTRACT FROM AUTHOR]

Background. Patients can access medical services such as disease diagnosis online, medical treatment guidance, and medication guidance that are provided by doctors from all over the country at home. Due to the complexity of scenarios applying medical services online and the necessity of professionalism of knowledge, the traditional recommendation methods in the medical field are confronting with problems such as low computational efficiency and poor effectiveness. At the same time, patients consulting online come from all sides, and most of them suffer from nonacute or malignant diseases, and hence, there may be offline medical treatment. Therefore, this paper proposes an online prediagnosis doctor recommendation model by integrating ontology characteristics and disease text. Particularly, this recommendation model takes full consideration of geographical location of patients. Objective. The recommendation model takes the real consultation data from online as the research object, fully testifying its effectiveness. Specifically, this model would make recommendation to patients on department and doctors based on patients' information of symptoms, diagnosis, and geographical location, as well as doctor's specialty and their department. Methods. Utilizing crawler technique, five hospital departments were selected from the online medical service platform. The names of the departments were in accordance with the standardized department names used in real hospitals (e.g., endocrinology, dermatology, gynemetrics, pediatrics, and neurology). As a result, a dataset consisting of 20000 consultation questions by patients was built. Through the application of Python and MySQL algorithms, replacing semantic dictionary retrieval or word frequency statistics, word vectors were utilized to measure similarity between patients' prediagnosis and doctors' specialty, forming a recommendation framework on medical departments or doctors based on the above-obtained sentence similarity measurement and providing recommendation advices on intentional departments and doctors. Results. In the online medical field, compared with the traditional recommendation method, the model proposed in the paper is of higher recommendation accuracy and feasibility in terms of department and doctor recommendation effectiveness. Conclusions. The proposed online prediagnosis doctor recommendation model integrates ontology characteristics and disease text mining. The model gives a relatively more accurate recommendation advice based on ontology characteristics such as patients' description texts and doctors' specialties. Furthermore, the model also gives full consideration on patients' location factors. As a result, the proposed online prediagnosis doctor recommendation model would improve patients' online consultation experience and offline treatment convenience, enriching the value of online prediagnosis data. [ABSTRACT FROM AUTHOR]

Background. Workplace violence is a common issue worldwide that strikes all professions, and healthcare is one of the most susceptible ones. Verbal and nonverbal miscommunications between healthcare workers and patients are major inducers for violent attacks. Aim. To study the potential impact of verbal and nonverbal miscommunications between the patients and healthcare workers upon workplace violence from the patients' perspectives. Methods. A descriptive cross-sectional study was performed from November to December 2020. Patients and previously hospitalized patients were asked to complete a self-reported questionnaire that involved items of verbal and nonverbal miscommunication. With the use of a suitable available sample composed of 550 participants, 505 had completed the questionnaire and were included in the study. The data were analyzed by using SPSS version 22 software. Results. 7.2% of the study population reported participating in nonverbal violence and 19.6% participated in verbal violence against healthcare workers. The nonverbal and verbal violence was characteristically displayed by the patients who are male, younger than 30 years old, and bachelor's degree holders. The results of the study demonstrated that the verbal and nonverbal miscommunications between the patients and healthcare workers were the major factors in provoking violent responses from patients. Factors, such as age, gender, and level of education, were significant indicators of the type of patients who were more likely to respond with violence. Conclusion. Workplace violence, either verbal or nonverbal, in the health sector is a public health concern in Palestine. The verbal and nonverbal communication skills of healthcare workers should be developed well enough to overcome the effect of miscommunication provoking violent acts from patients and their relatives as well. [ABSTRACT FROM AUTHOR]

Objective: Although patient decision aids (PtDAs) have been shown to improve shared decision‐making, integration into clinical care pathways remains limited. This study investigated, among other outcomes, the uptake of the PtDA by professionals and the uptake as perceived by patients. Methods: We performed a process evaluation among four breast cancer care teams that had been exposed to a multifaceted implementation strategy. Data were gathered by auditing patient files using a standardised data extraction sheet and conducting telephone interviews with patients using a structured interview guide. We analysed the data by using descriptive statistics. Results: We found that the implementation strategies, including advice on how and when to present the PtDA to the patient, were followed for 14% of the included patients (N = 84); 92% of the patients reported to have received a login code for the web‐based PtDA, while 67% logged in and used the PtDA at home. An important factor influencing the use was the clinician promoting it when delivering the PtDA (OR 9.95 95% CI 3.03–37.72). Discussion: The implementation strategies were followed in 14% of the patients, and a high delivery of the PtDA was achieved. Redesigning the care pathway and providing personal instruction on using PtDAs seem crucial. [ABSTRACT FROM AUTHOR]

We surveyed breast providers from a national oncology cooperative group to evaluate axillary management recommendations for patients with 1–2 positive sentinel lymph nodes (+SLNs) with scenarios not explicitly included in the Z0011 trial. These scenarios included patients underrepresented (premenopausal, HER2+/triple‐negative tumors, and invasive lobular carcinoma) or excluded (treated with mastectomy or neo‐adjuvant chemotherapy [NAC]) from the ACOSOG Z0011 trial. Survey response rate was 94/149 (64%). For patients in underrepresented groups, 45–63% of providers recommended no further axillary treatment. For mastectomy patients, 45–55% recommended multi‐disciplinary discussion. 83% felt more data are needed to change practice, but 41% believed there would be significant accrual challenges to a clinical trial. For patients treated with NAC, recommendations varied widely. 85% felt more data are needed to change practice, but 26% felt there would be significant accrual challenges. For all scenarios, 86–100% of radiation oncologists recommended axillary radiation, while surgeons more often recommended no further axillary treatment. Traditional randomized trials are likely not feasible to provide answers to these critical management questions, so more pragmatic or big data studies may be needed. [ABSTRACT FROM AUTHOR]

How to improve the doctor-patient relationship has been a continuing topic in academia and management and there have been several attempts to utilize online communications to facilitate healthcare. The application of information technology to create an "Internet + medical care" platform has upended the traditional medical service model in China. As an example of the application of the Internet by the healthcare system, this paper investigates a mobile online appointment system used by hospitals. Data on system use came from questionnaires submitted by 225 patients and analyzed by the structural equation model method. The results showed that patients perceived the hospital's online appointment system as an attempt at transparency to which they reacted positively. The patients' perception of transparency promoted trust in the hospital and the doctors and positively affected their feelings of satisfaction, which, of course, improved the doctor-patient relationship. Patients' perceptions of transparency, trust in the hospitals and doctors, and feelings of satisfaction played a partial mediator role between the availability of an online appointment system and better doctor-patient relationships. There were significant gender differences among patients in terms of their feelings of trust and satisfaction with the new appointment method and whether it really improved the doctor-patient relationship. [ABSTRACT FROM AUTHOR]

Patient satisfaction is an important health care quality indicator. This is particularly relevant in chronic diseases, such as, many dermatological diseases. The purpose of the current systematic review was to assess the validated tools measuring patient satisfaction with physician interaction. We performed a systematic review search in Pubmed, Cochrane Library, and EMBASE. The psychometric properties of the instruments and the domains explored were assessed. Overall, 2229 articles were extracted from the literature search. Of these, 146 articles were eligible for inclusion, 55 were included, and 22 scores were selected. A total of 13 instruments reported cross‐cultural validation and the EUROPEP score highlighted the most diverse cross‐cultural validation involving 11 different countries. All scores were assessed for content validity, construct validity, factor analysis, reliability, and responsiveness to change. The extent of the validation varied between scores with a few assessing practicability. The following domains were explored: listening skills, empathy, caring/compassion, confidentiality, honesty, behavior, competency/technical skills, satisfaction with the information provided, time given, availability, the environment, trust in the physician, ability to comply with the recommendations, and readiness to recommend the physician to other patients. We identified a total of 22 validated instruments. The major gaps in the validation process appear to be the practicability of the scores and the cross‐cultural validation. Major domains evaluated by the scores are communication skills that can be improved by specific training. There is a need to improve evaluation of the quality of the patient‐physician relationship in dermatology using validated instruments. [ABSTRACT FROM AUTHOR]

Objective: The objective of this research was to document the barriers to early presentation and diagnosis of lung cancer within primary healthcare, identified by Māori whānau (families) and primary healthcare providers in the Midland region of Aotearoa New Zealand. Methods: This project used a kaupapa Māori approach. Nine community hui (focus groups) and nine primary healthcare provider hui were carried out in five rural localities in the Midland region. Each community hui included cancer patients, whānau, and other community members. Each healthcare provider hui comprised staff members at the local primary healthcare centre, including General Practitioners and nurses. Hui data were thematically analysed. Results: Barriers and enablers to early diagnosis of lung cancer were categorised into three key themes: GP relationship and position in the community, health literacy and pathways to diagnosis. Conclusion: This study demonstrates that culturally responsive, patient‐centred healthcare, and positive GP–patient relationships are significant factors for Māori patients and whānau serving as barriers and enablers to early diagnosis of lung cancer. [ABSTRACT FROM AUTHOR]

Extensive research has dealt with violence directed at healthcare workers in hospital settings; however, few studies have examined community‐based settings. Furthermore, there is also scant literature regarding the perceptions of healthcare providers who were exposed to violence, compared to those who were not. This study aims to narrow these gaps in the literature by examining community‐based family physicians' (CBFPs) perceptions in a large national Health Maintenance Organisation (HMO) regarding patient‐initiated violence. Using a voluntary online survey, directed at all CBFPs working at the HMO, 412 CBFPs were surveyed on the following issues: exposure to violence initiated by patients or their family members; perceptions of violent occurrences and possible safety measures. The differences between CBFPs who had been exposed to violence and those who had not were compared. The majority of CBFPs reported experiencing verbal attacks (64%), and a small percentage experienced property‐related violence (11.7%) or physical violence (3.4%). Comparing CBFPs who were exposed to violence with those who were not, regarding their perceptions of the 'causes of violence', revealed three differentiating factors: 'waiting time', 'failure to meet the patient's expectations' and 'the nature of the physician‐patient encounter'. Regarding the desired preventive actions, the four differentiating factors were as follows: 'reduction in the number of patients per physician', 'improved queue management processes', 'longer meetings' and 'violence prevention training'. Conducting separate analyses, according to violence type (verbal abuse, vandalism or physical violence), indicated finer differentiations. In terms of Attribution Theory, one might argue that CBFPs who were directly exposed to patients' aggression attributed internal locus to the attacker, and tended to blame the attacker's personal characteristics and cultural values. Conversely, family CBFPs who were not attacked attributed external locus to situational factors such as waiting time, not receiving service, and the nature of the interaction between the attacker and the CBFP. [ABSTRACT FROM AUTHOR]

The traditional patient‐physician relationship is being changed by the patients' searches for medical information on the Internet and in social media (SM). Freely available medical information online bears enormous potential but also holds dangers. In this cross‐sectional, questionnaire‐based study, the patients' motivation, preferences and unmet needs when searching for medical information online and the impact on the patient‐physician relationship were assessed using Spearman's correlation coefficients, χ2‐tests and paired t‐tests. Among 460 participants, 82.4% had already used the Internet/SM to gain medical information, but in only 9.4% their dermatologists had raised this topic. Online search for medical information was associated with female gender (P =.048), a higher skin‐related burden (P =.020), higher level of education (P =.072), higher income (P =.019), anxiety (P =.004), and adnexal skin diseases (P =.043). For 16.1% of patients, "the Internet/SM" was their most important source of medical information; 81.4% deemed the impact of their online searches on their patient‐physician relationship as neutral, 16.0% as positive, 2.6% as negative. The patients' top three unmet needs were "Online consultations", "Professional content on YouTube" and "Chat opportunities". Online search for medical information is a very important topic for most dermatology patients but it may not be adequately addressed by dermatologists. Our results indicate that from the patients'perspective such online searches do not have a significant impact on patient‐physician relationship. [ABSTRACT FROM AUTHOR]