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Background: Advance care planning initiatives are becoming more widespread, increasing expectations for providers to engage in goals of care conversations. However, less is known about how providers communicate advance care planning within and throughout a health care system., Aim: To explore perspectives of communication processes in the rollout of an advance care planning initiative., Design: Theoretically informed secondary analysis of 31 semi-structured interviews., Setting/participants: Key partners in a Veterans Health Administration goals of care initiative., Results: Using the constant comparative approach followed by qualitative mapping of themes to the layers of the Socio-Ecological Model, four themes and corresponding Socio-Ecological layers were identified: Goals of Care Communication Training (Policy, Community, and Institutional) requires more resources across sites and better messaging to reduce provider misconceptions and promote an institutional culture invested in advance care planning; Interprofessional Communication (Interpersonal) suggests care team coordination is needed to facilitate continuity in goals of care messaging; Communication in Documentation (Institutional, Interpersonal, and Intrapersonal) highlights the need for capturing the context for goals of care preferences; and Patient/Family Communication (Interpersonal and Intrapersonal) encourages offering materials and informational resources early to facilitate rapport building and readiness to determine goals of care., Conclusions: Findings support the need for initiatives to incorporate an evaluation of how goals of care are discussed beyond the interpersonal exchange between patient and provider and signal opportunities for applying the Socio-Ecological Model to better understand goals of care communication processes, including opportunities to improve initiation and documentation of goals of care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To contribute to a better understanding of the complexities of social support exchanged within couples coping with Parkinson's disease (PD), the present study aimed to identify costs and complications of support between persons with PD (PWPs) and their partners, as well as how to effectively manage such challenges., Methods: In-depth interviews were conducted with 63 participants, including 31 PWPs and 32 partners. Interviews were transcribed and analyzed using constant comparative techniques., Results: Participants reported the following complications and costs of social support: partners' differing approaches to coping can make support difficult, support can be perceived as identity-threatening and controlling, support can lead to dependency, and support can be draining. In addition, participants discussed effectively managing challenges of support by seeking/providing support subtly, taking the other's perspective, and relinquishing control., Discussion: In health care and interventions, it is important for PWPs and partners to be educated about social support so that couples can anticipate these costs and complications of support and consider which management strategies are likely to be effective for them in various circumstances., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Life-sustaining treatments (LST) aim to prolong life without reversing the underlying medical condition. Being associated with a high risk of developing unwanted adverse outcomes, decisions about LST are routinely discussed with patients at hospital admission, particularly when it comes to cardiopulmonary resuscitation. Physicians may encounter many challenges when enforcing shared decision-making in this domain. In this study, we map out how junior physicians in Southern Switzerland refer to their experiences when conducting LST discussions with hospitalized patients and their learning strategies related to this., Methods: In this qualitative exploratory study, we conducted semi-directive interviews with junior physicians working at the regional public hospital in Southern Switzerland and analyzed them with an inductive thematic analysis., Results: Nine physicians participated. We identified 3 themes: emotional burden, learning strategies and practices for conducting discussions. Participants reported feeling unprepared and often distressed when discussing LST with patients. Factors associated with emotional burden were related to the context and to how physicians developed and managed their emotions. Participants signaled having received insufficient education to prepare for discussing LST. They reported learning to discuss LST essentially through trial and error but particularly appreciated the possibility of mentoring and experiential training. Explanations that physicians gave about LST took into account patients' frequent misconceptions. Physicians reported feeling under pressure to ensure that decisions documented were medically indicated and being more at ease when patients decided by themselves to limit treatments. Communication was deemed as an important skill., Conclusions: Junior physicians experienced conducting LST discussions as challenging and felt caught between advocating for medically relevant decisions and respecting patients' autonomy. Participants reported a substantive emotional burden and feeling unprepared for this task, essentially because of a lack of adequate training. Interventions aiming to ameliorate junior physicians' competency in discussing LST can positively affect their personal experiences and decisional outcomes., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background: The main purposes of the nursing profession are to protect and improve health and to prevent and heal diseases. It is crucial to investigate the factors that can influence nurses' ability to enhance their performance in their professional lives and conduct the nursing care process more qualitatively and effectively., Objective: This study aimed to examine the association between emotional intelligence and compassionate communication in nurses., Methods: This cross-sectional and descriptive study was conducted with 140 nurses working in various units of the public hospital in Kilis, Turkey. Data were collected through a demographic information form, Emotional Intelligence Scale, and Compassionate Communication Scale., Results: It was determined that nurses' emotional intelligence and compassionate communication were above average. A significant association was found between nurses' emotional intelligence and compassionate communication ( F  = 16.08, P  < .001) and emotional intelligence explains 10% of the variance in compassionate communication ( R  = 0.323, R 2  = 0.104)., Conclusions: Emotional intelligence and compassionate communication should be taken into consideration so that nurses can recognize and understand patients' emotions, alleviate their hurt, and deliver delicate, kind, and compassionate care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This qualitative study explored the lived experiences of eight Sri Lankan mothers of infants with complex congenital heart disease (CCHD) using semi-structured interviews. Four themes were generated as: illness perception , communication with medical staff , challenges faced , and coping mechanisms . These provided insight into the multi-faceted nature of mothers' experiences, importance of medical-caregiver communications and their need for psychosocial services. The findings enhance the limited knowledge of South-Asian primary CCHD caregiver experiences and will help in improving psychosocial support services in Sri Lanka., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study proposed and tested the cross-sectional effects of patient-centered communication (PCC) on cancer screening behaviors via an affective-cognitive sequential chain of mediation through cancer worry and health self-efficacy. Cross-sectional data were analyzed from four iterations of the Health Information National Trends Survey (2011, 2014, 2017, and 2020). The results found that lowered cancer worry following PCC does not show a cross-sectional positive effect in promoting cancer screening behaviors, while enhanced health self-efficacy as a subsequent state is a facilitator of screening behaviors. The findings further demonstrated increased PCC, a rise in cancer worry, and a sustained level of health self-efficacy. Also, our research has identified an upward trend in cancer screening behaviors from 2011 to 2017, followed by a notable decrease in 2020. These insights underscore the nuanced ways PCC can foster cancer screening behaviors, emphasizing the importance of emotional and cognitive aspects in clinical settings., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In this paper, we explore the ways in which patients invoke third parties to gain decision-making influence in clinical consultations. The patients' role in decision-making processes is often overlooked, and this interactional practice has rarely been systematically studied. Through a contextual narrative exploration of 42 naturally occurring consultations between patients (aged 22-84) and general practitioners (GPs) in England, we seek to fill this gap. By exploring how and why patients invoke third parties during discussions about medical treatments, who they refer to, what kind of knowledge their referents possess, and how GPs respond, our main aim is to capture the functions and implications of this interactional practice in relation to decision-making processes. Patients refer to third parties during decision-making processes in most of the consultations, usually to argue for and against certain treatment options, and the GPs recognise these utterances as pro-and-contra arguments. This enables patients to counter the GPs' professional knowledge through various knowledge-sources and encourage the GPs to target their specific concerns. By attributing arguments to third parties, patients claim decision-making influence without threatening the GPs' authority and expertise, which their disadvantaged epistemic position demands. Thereby, patients become able to negotiate their role and their epistemic position, to influence the agenda-setting, and to take part in the decision-making process, without being directly confrontational. Invoking third parties is a non-confrontational way of proposing and opposing treatment options that might facilitate successful patient participation in decision-making processes, and so limit the risk of patients being wronged in their capacity as knowers., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This systematic review aimed to identify and compare instruments measuring nurses' organizational well-being, summarise the dimensions measured by these instruments, the statistical analysis performed for validity evidence and identify an instrument that comprehensively investigates nurses' organizational well-being. The JBI Manual for Evidence Synthesis and the PRISMA checklist were used as guidelines. The search was conducted on Medline, CINAHL, Cochrane Library and Scopus. Critical appraisal and data extraction were drawn on the COSMIN checklist. Dimensions were conceptually synthesized by the measurement concepts' similarity. Twenty-two articles were retrieved and they included 21 instruments that measured nurses' organizational well-being. The instruments vary by dimension number (range 2-19), items (range 12-118) and concept elicitation. A plurality of methodologies has been used in instrument development and assessments of evidence for validity. Only four instruments reported a concurrent criterion validity or a measurement comparison with an already tested-for-validity instrument. Similar dimensions were leadership and support, relationships and communication, work-family balance, work demands, violence, control and autonomy, satisfaction and motivation, work environment and resources, careers, and organizational policy. This review underlines the core areas of the instruments that measure nursing organizational well-being. It allows administrators and researchers to choose the appropriate instruments for monitoring this multidimensional concept.

Background: In the U.S., assisted living (AL) is increasingly a site of death, and anxiety about dying has been identified in long-term care residents and their caregivers. Communication about death and dying is associated with better quality of life and care at end of life (EOL)., Objective: To understand communication behaviors used by AL residents and their informal caregivers (i.e., family members or friends) related to death and dying, and address communication needs or opportunities applicable to EOL care in AL., Design: A thematic analysis of in-depth interviews and fieldnotes from a subsample of data from a 5-year NIA-funded study., Setting/subjects: Participants included 15 resident-caregiver dyads from three diverse AL communities in Atlanta, Georgia in the U.S., Measurements: Interview transcripts were coded for communication behavior. Concordances and discordances within dyads were examined., Results: We identified a typology of four dyadic communication behaviors: Talking (i.e., both partners were talking with each other about death), Blocking (i.e., one partner wanted to talk about death but the other did not), Avoiding (i.e., each partner perceived that the other did not want to communicate about death), and Unable (i.e., dyads could not communicate about death because of interpersonal barriers)., Conclusions: Older residents in AL often want to talk about death but are blocked from doing so by an informal caregiver. Caregivers and AL residents may benefit from training in death communication. Recommendations for improving advance care planning and promoting better EOL communication includes timing these conversations before the opportunity is lost., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Home health aides (HHAs) care for patients highly vulnerable to COVID-19 and are disproportionately women from minority communities that have been adversely impacted by COVID-19. Yet, direct care workers are less likely to be vaccinated against COVID-19 compared to others. As the pandemic evolves, interest in vaccination may decrease suggesting the need for relevant vaccine messaging to HHAs. Objectives: (1) to describe HHAs and administrators' perspectives related to COVID-19 vaccination messaging, and (2) to co-design a Communication Toolkit to create COVID-19 vaccine messages. Methods: HHAs and administrators from 4 geographically diverse Palliative Care Research Cooperative (PCRC) hospice agencies were recruited for a multi-method process involving qualitative interviews (17 HHAs and 5 administrators), community engagement (CE) studios, and development of a Communication Toolkit. Interviews were guided by the PEN-3 conceptual framework to explore barriers and facilitators to vaccination. Data were analyzed using qualitative content analysis. Results: Despite power differences, HHAs and administrators share a commitment to protecting patients affected by serious illness. HHAs desire vaccine messaging that includes personal narratives, good news about the vaccine, and facts about benefits and risks of the vaccine. Preferred message formats include the agency intranet, daily briefings, or "little seeds" (ie, short, high-impact information). Through the studios, HHAs provided input on a Toolkit prototype with messages tailored to the context of home care. Conclusions: Grounded in the commitment of HHAs and administrators to protecting vulnerable patients, we co-created an adaptable Communication Toolkit to address COVID-19 vaccination misinformation and mistrust among direct care workers., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Optimal care for seriously ill and older patients often involves advance care planning (ACP), goals-of-care (GOC) conversations, and specialty palliative care consultation, three sometimes overlapping, yet distinct practices. Insufficient staffing and investment in these areas have limited their availability., Objectives: We explored the facilitators and barriers to successful implementation of the VIDEO-PCE trial. The intervention aimed to increase patient engagement in ACP, GOC, and by establishing Palliative Care Educators, a new clinical role integrated into existing hospital wards., Design: This qualitative interview study employed a semi-structured interview guide tailored to the interviewee's clinical role. The interviews elicited perceptions of the facilitators and barriers to integration of palliative care educators (PCEs) into existing workflows. We developed deductive codes a priori and inductive codes as we coded interview transcripts., Setting/subjects: Medical/surgical floor clinical colleagues, palliative care team members, and PCEs from both participating sites were interviewed., Results: Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role., Conclusion: The creation and implementation of a new role within existing clinical workflows posed some challenges but were felt to relieve staff from some work burden and allow more patients to engage in ACP and GOC conversations., Trial Registration: ClinicalTrials.gov Identifier: NCT04857060., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr Angelo Volandes has a financial interest in ACP Decisions, a non-profit organization developing advance care planning video decision support tools. Dr Volandes’ interests were reviewed and are managed by MGH and Mass General Brigham in accordance with their conflicts of interest policies. Dr Aretha Delight Davis is the CEO of ACP Decisions, a nonprofit organization focused on strengthening shared decisions making through video decision aids, from which she receives a salary. None of the other authors have any conflicts of interest to disclose.

Young adults have long been leaders of social change, yet university student samples are often criticized for limits to generalizability. However, students may be a critical population to gather insight from to understand how they engage in activism and how their wellbeing is impacted by global conflict. We conducted two studies examining college students' perceptions of the Russian invasion of Ukraine and their activism at an urban Northeastern US university. In study one which included two waves of data collection ( n = 44 at T1; n = 30 at T2), students reported increased anxiety related to the invasion which decreased over time, but not significantly. In study two, participants ( n = 123) reported high levels of direct and indirect activism across a variety of social issues. Findings indicate that students were impacted by global conflict and engaged in social activism. University students provide valuable insight into global and social issues and should be considered as more than a convenience sample., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Since 2009, nurses have relocated to Japan from Indonesia, the Philippines, and Vietnam under the auspices of the Economic Partnership Agreement (EPA). We asked why some migrant nurses remain in Japan whereas others leave., Method: We applied the methodology of Constructivist Grounded Theory. All participants were internationally educated nurses (IENs) currently or formerly working in Japan after passing the National Nursing Examination., Results: Difficulty in mastering the Japanese language was established as one of the main themes. Initial coding elicited two explanatory sub-categories: lack of confidence in communication and effects of language difficulty on workplace relationships. One explains how practical experience in the workplace affected nurses' confidence in communication. The other explains how levels of Japanese language attainment shaped relationships with colleagues., Discussion: These findings suggest a need to regulate the working conditions of foreign nurses, and a need for training schemes to optimize IEN retention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: When providing health information in a diverse society and during health crises, it is crucial that nurses can adapt their communication to immigrants, as this may have an impact on their health outcomes. This study seeks to identify how nurses experienced and assessed their communication and information work with immigrants during COVID-19 and to discuss measures to improve practice., Method: The study has an interpretive and explorative qualitative design, analyzing 10 semi-structured interviews with nurses from the municipal health service in Norway., Results: Three themes were created as follows: multilingual infection control teams and cooperation with volunteers, challenges when providing COVID-19 information, and the nurses' suggestions for improvements in the event of a new pandemic or other health crisis., Discussion: Nurses' cultural competence and their knowledge of immigrants' health literacy can help them understand how immigrants think and behave during illness. It is important that nurses use discretion during health crises., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

What is the role of experts and their expertise in the context of trans-science, in which issues that are raised in scientific terms cannot be answered by science alone? This article examines the discourses and practices around safety of low-dose exposure to radiation in the ongoing aftermath of the Fukushima Daiichi Nuclear Power Plant accident in Japan in 2011. Following the nuclear fallout, scientific experts and STS scholars in Japan debated what forms of science communication were adequate to address the situation. Ethnographic research and textual analysis of their debates show a shift in emphasis on the role of experts from cultivating 'public understanding of science' for the sake of science and policy to an 'expert understanding of the public' for the sake of the public and its diverse everyday concerns. Two forms of expertise are emerging: 'co-expertise' and 'intra-mediary expertise'. Both are parts of a transition from a paternalistic form of expertise to one that acknowledges the need to engage the public to address issues of scientific uncertainty. However, co-expertise ultimately upholds the existing political structures that shape risk governance, while intra-mediary expertise engages those often excluded from current structures of accountability. Discussion of the potentials and limitations of emerging forms of expertise in Japan show that epistemic justice is not enough. Civic justice that acknowledges diverse publics and their needs must be upheld in the uncertain sphere between science, politics, and everyday life., Competing Interests: Declaration of conflicting interestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Surrogate Decision-Makers (surrogates) are frequently employed in decision-making for critically ill adults. There are insufficient data considering the surrogate experience, stress, and potential for mitigation., Methods: An anonymous online survey queried (1) medical situation (2) total stress (3) demographics (4) potential factors, including sources of information about patient wishes, external sources of support or competing stressors, and their interactions with the medical team through the experience., Results: 108 respondents were included; 91 completed all items. Most respondents ranked their experience as a surrogate as one of the most stressful experiences of their lives; this was associated with whether it was an end-of-life decision ( P = .003), Respondent Religion ( P = .015), or religious or spiritual beliefs ( P = .024), and having their own health problems (P = .008). On individual Likert responses, surrogates reported significant stress mitigation when they felt they had been helpful ( P < .001), knew the patient's wishes ( P = .0011), specifically discussed patient wishes ( P < .001), or patient's wishes were documented ( P < .001). Items about surrogate-team interaction also met significance, including the physician being communicative and available (P < .001), respectful ( P = .007), honest ( P < .001), and validating ( P = .001)., Conclusions: Surrogate stress is an evolving area for research. Significant factors included relationship with the medical team, making this an important area for HPM to play a key role in mitigating surrogate stress., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: We implemented and studied a novel curriculum that combined role play, didactic education, and the use of a procedure card for asynchronous learning to improve second-year pediatric residents' skills in delivering serious news. Design: Phase 1 established baseline performance with a self-efficacy survey and observed simulation delivering serious news. Phase 2 included directed education of participants with a validated communication skills training framework. During Phase 3, participants were instructed to review the communication procedure card as a just-in-time reference prior to delivering serious news to patients and their families over 6 months. Following this period, participants completed a second self-efficacy survey and engaged in another observed simulation session delivering serious news. Pre and post intervention performance and self-efficacy were compared. Results: A total of 21 out of 26 (81%) participants completed all phases of this study. Participants had a statistically significant increase ( p < .001) in self-efficacy scores post-intervention compared to pre-intervention for each of the skills to effectively deliver serious news: assess understanding, communicate news clearly, allow for silence, respond to emotion, and equip for next steps. Additionally, investigator assessments of participants showed an overall statistically significant improvement ( p < .001) in all five communication skills post intervention compared to pre intervention. Conclusions: This curriculum resulted in significantly improved self-efficacy and observed ratings of communication skills in second-year pediatric residents over a 6-month period., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Advance care planning (ACP), a critical component of quality dementia care, is underutilized due to lack of clinician comfort and the challenging nature of ACP in this context. The Serious Illness Conversation Guide (SICG) is a well-validated clinician-facing tool, developed with patient and clinician input, to facilitate ACP. The aim of this project was to adapt the SICG for dementia for the first time to promote high-quality ACP. Methods: This study uses a mixed-methods approach to adapt the SICG tool for use in dementia care. Experts with relevant clinical, ethical, and topical knowledge were interviewed to develop alterations to the SICG for dementia care. Patients and caregivers were shown a mock interview of the adapted SICG for dementia (SICG-D) to elicit feedback. Results: 8 relevant experts were interviewed. Adaptations included topical alterations to make the conversation more applicable to dementia as well as alterations to the structure of the conversation to accommodate the patient-caregiver dyad. Twenty interviews were conducted with 14 patients and 18 caregivers (either together or separately). A thematic content analysis of interview transcripts demonstrated positive impressions of the tool. In anonymous survey results, 94% reported a positive impression of the conversation and 89% endorsed incorporation of the adapted guide into dementia healthcare. Conclusion: This paper presents the SICG-D, an adapted version of the SICG for use in dementia care. This guide leverages the strengths of the SICG to promote values-based ACP conversations and has been adapted to better facilitate patient-caregiver-clinician triadic communication., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Family involvement is widely considered an important part of patient care in the intensive care unit. From professional health care organizations, government, and hospital associations, there has been a cultural shift toward family presence as part of a wider commitment to patient-centered care. At the same time, the meaning and impact of family involvement in the intensive care unit setting remain opaque and under-studied. This study employed an ethnographic approach to better understand family involvement in practice and from the perspective of health care professionals and family members by studying an implementation trial of a family involvement tool in two intensive care units over 2 years. The findings revealed that an expanded and self-defined role for family members as carers in the intensive care unit challenged the current configuration of the nurse patient/family relationship and that family members were aware of these dynamics. While the intensive care unit implementation teams were both motivated to implement a novel way of facilitating family involvement, the processual, organizational, and contextual factors in the intensive care units largely determined the possibilities of its application. This suggests that interventions should address the specific context in which they are employed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The number of school-aged students with diverse linguistic and cultural backgrounds is increasing across the United States. This survey identifies strategies school nurses use for communicating to families with limited English proficiency and describes recommendations to improve language needs. The online survey was completed by K-12 school nurses and data were analyzed using descriptive statistics. Among the 52 participants, only 23% (n = 12) indicated that resources they were currently using to interpret health information always met their language needs, with the most common resource described as school personnel who can speak the language needed for interpretation. To improve communication, most (73%; n = 38) participants described preferences for in-person resources and estimated that if on-demand interpreter resources were readily available, they would use on-demand resources for approximately 3.6 hours per week. By improving linguistic and cultural competencies among students and families with limited English proficiency, school nurses can improve student health outcomes., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Despite decades of research on risk-communication approaches, questions remain about the optimal methods for conveying risks for different outcomes across multiple time points, which can be necessary in applications such as discrete choice experiments (DCEs). We sought to compare the effects of 3 design factors: 1) separated versus integrated presentations of the risks for different outcomes, 2) use or omission of icon arrays, and 3) vertical versus horizontal orientation of the time dimension., Methods: We conducted a randomized study among a demographically diverse sample of 2,242 US adults recruited from an online panel (mean age 59.8 y, s  = 10.4 y; 21.9% African American) that compared risk-communication approaches that varied in the 3 factors noted above. The primary outcome was the number of correct responses to 12 multiple-choice questions asking survey respondents to identify specific numbers, contrast options to recognize dominance (larger v. smaller risks), and compute differences. We used linear regression to test the effects of the 3 design factors, controlling for health literacy, graph literacy, and numeracy. We also measured choice consistency in a subsequent DCE choice module., Results: Mean comprehension varied significantly across versions ( P  < 0.001), with higher comprehension in the 3 versions that provided separated risk information for each risk. In the multivariable regression, separated risk presentation was associated with 0.58 more correct responses ( P  < 0.001; 95% confidence interval: 0.39, 0.77) compared with integrated risk information. Neither providing icon arrays nor using vertical versus horizontal time formats affected comprehension rates, although participant understanding did correlate with DCE choice consistency., Conclusions: In presentations of multiple risks over multiple time points, presenting risk information separately for each health outcome appears to increase understanding., Highlights: When conveying information about risks of different outcomes at multiple time points, separate presentations of single-outcome risks resulted in higher comprehension than presentations that combined risk information for different outcomes.We also observed benefits of presenting single-outcome risks separately among respondents with lower numeracy and graph literacy.Study participants who scored higher on risk understanding were more internally consistent in their responses to a discrete choice experiment., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Icon arrays have been shown to be an effective method for communicating medical risk information. However, in practice, icon arrays used to visualize personal risks often differ in the type and color of the icons. The aim of this study was to examine the influence of icon type and color on the perception and recall of cardiovascular risk, as little is known about how color affects the perception of icon arrays., Methods: A total of 866 participants aged 40 to 90 years representative of the German population in terms of gender and age completed an online experiment. Using a 2 × 2 between-subjects design, participants were randomly assigned to 1 of 4 experimental groups. They received their hypothetical 10-year cardiovascular risk using an icon array that varied by icon type (smiley v. person) and color (black/white v. red/yellow). We measured risk perception, emotional response, intentions of taking action to reduce the risk (e.g., increasing one's physical activity), risk recall, and graph evaluation/trustworthiness, as well as numeracy and graphical literacy., Results: Icon arrays using person icons were evaluated more positively. There was no effect of icons or color on risk perception, emotional response, intentions of taking action to reduce the risk, or trustworthiness of the graph. While more numerate/graphical literate participants were more likely to correctly recall the presented risk estimate, icon type and color did not influence the probability of correct recall., Conclusions: Differences in the perception of the tested icon arrays were rather small, suggesting that they may be equally suitable for communicating medical risks. Further research on the robustness of these results across other colors, icons, and risk domains could add to guidelines on the design of visual aids., Highlights: The use of different icons and colors did not influence the perception and the probability of recalling the 10-year cardiovascular risk, the emotional response, or the intentions to reduce the presented risk.Icon arrays with person icons were evaluated more positively.There was no evidence to suggest that the effectiveness of the studied icon arrays varied based on individuals' levels of numerical or graphical literacy, nor did it differ between people with or without a history of CVD or on medication for an increased CVD risk., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors received no financial support for the research, authorship, and/or publication of this article.

Discussing serious news is a fundamental communication skill, and many clinicians have been taught to ask their patients how much detail they want to hear before sharing difficult information. Over the past decade, we have taught hundreds of medical students how to discuss serious news and reviewed hundreds of their recorded conversations. We've found that asking how much detail a patient wants to hear often results in confusion and is not an effective way to understand their communication preferences. Instead of asking how much detail your patient wants to hear, we propose an alternative way to tailor information to their needs when discussing serious news. By asking permission to share, presenting the news in a succinct, jargon-free headline, and providing emotional support and expert guidance at the right times, you can give the correct amount of detail while avoiding unnecessary confusion resulting in high-quality, patient centered communication every time you discuss serious news., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The work of VitalTalk, a 501c3 nonprofit communication skills training organization, informed this manuscript. Dr Wood is a strategic partner and faculty with VitalTalk and has received honoraria for teaching in VitalTalk courses unrelated to this manuscript.

Objective: This study's purpose is to better understand pediatric intensive care nursing perspectives on sedative management as a precursor to improving aspects of sedation assessment, titration, and communication. Methods/Design: We queried nurses in the pediatric intensive care unit at a 40+ bed quaternary care using an electronic survey about their experiences with sedation management. Data was collected using REDCap and statistical analyses were performed to assess for differences between experience levels in areas. Results: Seventy nurses responded with 42% response rate. More than 95% were comfortable calculating sedation and delirium scores. Those with less than 5 years' experience were significantly more likely to consider sedation scores helpful ( P  = .04) and also significant more likely to agree that delirium scores are used effectively ( P  = .01). Eighty-eight percent of respondents were comfortable raising concerns about sedation to the multidisciplinary team, but those with less than 5 years' experience were significantly less likely to express concerns to attending ( P  = .001). Conclusion: Newer nurses are more inclined to support use of standardized scoring systems for sedation and delirium, but less comfortable approaching attending clinicians with their concerns. Intensive care teams should pay careful attention to team dynamics, particularly as they apply to sedative management and work to improve communication, collaboration, and educational interventions to improve patient care. Further work understanding nursing perspectives and further attempts to improve interprofessional communication seems a wise investment and could obviate barriers that may exist., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Physicians-in-training feel uncomfortable coping with the grief they experience while delivering end-of-life care, and medical schools offer minimal formal curricular offerings on end of life care. Few studies have identified what experiences medical students have with death while training or what lessons they are being taught by more senior physicians at bedside. This qualitative study conducted semi-structured interviews prior to and six months into the medical school clinical year. Our goal was to identify when students were encountering seriously ill/dying patients and what informal education students received about caring for dying patients. Descriptive statistics showed the majority of the encounters the students had with seriously ill or dying patients were in the hospital-based medicine setting. A minority of students participated in debriefs about end-of-life care with their care teams after the events. Thematic analysis showed significant heterogeneity in students' exposure and responses to patient deaths., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Effective healthcare clinician communication is a key component of quality palliative and end-of-life (PEOL) care. However, communication may be hampered when clinicians are not comfortable initiating these conversations with patients and their families. Clinicians working in rural areas report several barriers to providing palliative care. This study examined the relationship between rural and urban clinicians' reported familiarity with their patients and families end-of-life, their reported comfort in initiating PEOL conversations, and their PEOL care knowledge. Method: This study used a cross-sectional design to examine the relationships between rural and urban clinicians' familiarity, their comfort in PEOL communication, and their PEOL care knowledge. Results: N = 548 rural and urban clinicians participated. Rural clinicians reported greater familiarity, more PEOL knowledge, and more comfort with PEOL communication. Multiple regression analyses of PEOL knowledge showed significant associations in knowledge with older clinicians ( P < 0.01) and additional palliative care training ( P < 0.01); comfort in PEOL communication had significant associations with more palliative care training ( P < 0.01) and opportunities to provide palliative care ( P < 0.01). Conclusion: The concept of familiarity is highly complex and poorly understood in relation to PEOL care in both rural and urban settings. Future research is needed to explore how additional training in PEOL care and clinician reported familiarity positively impact patient outcomes by increasing the number of advance directives completed and followed and improved documentation of advance care planning., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Spiritual care is a core component of high-quality palliative care, yet gaps exist in spiritual care provision. Understanding clinicians' levels of confidence around spiritual care and their perceptions of necessary knowledge/skills to enhance their ability to provide spiritual care is foundational for improving delivery of spiritual care in practice., Objectives: To understand confidence levels with providing spiritual care and perceived needs in relation to the provision of spiritual care among palliative clinicians (nurses, social workers, chaplains)., Design: N = 260 clinicians participating in interprofessional communication and end-of-life care training programs completed a structured survey., Measurements: Clinicians responded to 42 closed-ended questions assessing their confidence in engaging in spiritual care across 6 dimensions, and one open-ended question: "What areas of knowledge or skill would best help to improve your ability to provide spiritual care across diverse populations?", Results: Findings reveal varied levels of confidence with spiritual care across dimensions. Chaplains reported the highest levels of confidence compared with nurses and social workers. Key areas of knowledge/skills to improve spiritual care provision were: (1) Training and support for clinicians in spiritual care; (2) Strategies for providing spiritual care to patients from diverse cultural and/or religious backgrounds; (3) Better understanding of specific populations and contexts that may affect spiritual care provision; and (4) Clinicians' personal growth & practices to improve spiritual care., Conclusions: Additional support with spiritual care provision is needed, especially among spiritual care generalists. A focus on culturally attuned care is needed, honoring unique patient contexts and centering patient and family priorities., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This study explored the learning experiences of intensive care residents in an intensive care unit (ICU) during night shifts and the development of communication skills in this community of practice. This action research qualitative study used the photovoice method in four workshops. A group of nine residents shared their learning experiences and collectively analyzed, built, and presented proposals to improve residents' communication skills in the community of practice in which they become intensivists. Participatory thematic analysis was conducted. Students concluded that night shifts in the ICU offered a perfect situational learning environment for communication with one-on-one resident-teacher relationships, less administrative work, and more resident responsibility, improving intensivist identity. Role models, reflective thinking, and teamwork are essential for fostering communication skills among intensivist community members and are all trainable. The results and student suggestions were presented to teachers and decision-makers in the clinic. These photovoice strategies developed students' abilities to share their critical views and suggestions with decision-makers for subsequent implementation, enhancing their confidence in their learning process, strengthening trust-based relationships with teachers, and improving future intensivists' practice communities., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The use of Information and Communication Technologies is clearly widespread among adolescents from a young age. Although it poses a significant contribution at the academic, social, and emotional levels, it can also involve a set of important risks, including cyberbullying and, therefore, cybervictimization. Previous studies have pointed out the importance of family context since parental control and family communication emerge as contributors to this phenomenon. Therefore, the aim of the present study was to analyze the influence of family communication on cybervictims and the moderating role of different sociodemographic variables (age, gender, nationality, and culture), as well as social, emotional, and personality variables. In this context, a meta-analysis was performed with a random effects model, using a total meta-sample of 29,093 adolescents (mean age: 14.50 years) distributed in k  = 20 samples belonging to nine studies on cybervictimization published in English in Q1 journals between 2015 and 2020. The results showed that family offensive communication is related to cybervictimization. This could be because the affected individuals often use social media to compensate for the deficiencies they perceive within their families, as well as to obtain support, which increases their time spent on the Internet and their exposure to this phenomenon. These findings highlight the need for family and community interventions, not only school-based or individual interventions., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The outbreak of COVID-19 created a global health crisis that has impacted our everyday lives. Risk communication and community engagement (RCCE) is one of the strategic pillars the World Health Organization (WHO) recommends when dealing with public health emergencies like COVID-19. In Malawi, the COVID-19 RCCE response was coordinated by the country's Ministry of Health and involved various organizations that distributed COVID-19 risk communication materials and engaged communities on important infection preventive practices. Furthermore, the Ministry of Information was involved in ensuring the messages were put across at national and subnational levels. Despite the efforts, most Malawians were reluctant to embrace set public health measures for COVID-19. Guided by a phenomenological approach, we used in-depth interviews with senior officials from 10 organizations, including the Ministry of Health, who were involved in RCCE response in Malawi, to understand the challenges that were faced in the implementation of RCCE activities in Malawi. We also reviewed project reports from three organizations, taken from the same implementing local organizations, to understand the experiences of implementing RCCE strategies in Malawi. We established that misconceptions, poor coordination, lack of political will, low-risk perceptions, and social norms undermined the response in Malawi. The results underscore the need for the authorities in Malawi to invest more in RCCE and strengthen the capacity to handle future epidemics. There is also a need to develop a national RCCE strategy with guidelines and protocols on methods of coordination, flow of communication, responsible ministry, tools for handling dis/misinformation and myths, and community engagement.

The study explores the role of the Eye to I© intervention model in facilitating advancement through social stages of play in which skills contribute to the quality of social interaction and communication in children with autism. Data were collected on 11 participants, ages of 2-6 years, formally diagnosed with autism, receiving Eye to I© Social Communication therapy at Potentials Therapy Center, New Delhi, India. Eye to I© is developed in-house at Potentials and is further discussed in the paper. All participants attended a form of group intervention. A mixed-method design included quantitative measures administered pre and post intervention (Communication DEALL Developmental Checklist, Communication Matrix) and video coding of Social Communication sessions. Qualitative measures were semi-structured parent interviews conducted at the end of intervention. Thematic analysis and quantitative statistical analysis results show that by the end of the Eye to I© intervention period children engaged in social stages of play of greater developmental complexity and showed increased scores in assessments of social skills as well as generalization of skills. This suggests that skill acquisition necessary to directly support two diagnostic criteria areas of autism as per DSM-V; i.e., communication and social interaction occurred during the period of intervention., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Guidelines on effective provider-led communication are available but may be underused in dentistry, even if such guidelines could help dentists manage complex clinical scenarios like topical fluoride hesitancy. The purpose of this study was to investigate current chairside communication approaches used by dentists with fluoride-hesitant caregivers., Methods: A 27-item semistructured interview script was developed and pretested with 3 dentists, revised, and finalized. One-on-one interviews were conducted with a purposive sample of pediatric dentists and general dentists from April to June 2020. Interviews were digitally recorded, transcribed, and analyzed to identify dentists' communication approaches used during clinical interactions with fluoride-hesitant caregivers. Thematic analyses identified themes and subthemes, and exemplary quotes were provided to illustrate each theme., Results: Twenty-seven dentists participated (21 pediatric dentists and 6 general dentists). The mean age of participants was 43.0 ± 8.2 y (range, 30-73). Most participants were women (88.9%), white (51.9%), and non-Hispanic (85.2%). Participants had been practicing dentistry for a mean of 13.2 ± 10.5 y (range, 2-40). There were 4 themes: leaving topical fluoride decisions completely up to the caregiver, educating the caregiver about fluoride, insisting that the caregiver accept fluoride, and engaging the caregiver and child., Conclusion: Most communications approaches used by interviewed dentists to manage fluoride hesitancy in clinical settings are not evidence based. Future dental education efforts should ensure that trainees are exposed to and can demonstrate competency in appropriate, evidence-based patient-provider communication strategies., Knowledge Transfer Statement: The study highlights the need for dentists to apply evidence-based communication strategies when managing difficult clinical scenarios like fluoride hesitancy, which is important in optimizing dentist-patient trust., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Approaches to HIV/AIDS prevention and treatment have made significant advances since the beginning of the epidemic. However, HIV myths and misinformation continue to persist, stymieing efforts to end the epidemic in the United States, particularly in rural areas. The present study's purpose was to identify prevalent myths and misinformation about HIV/AIDS in the rural United States. Rural HIV/AIDS health care providers (n = 69) were asked via an audience response system (ARS) to provide responses to questions about HIV/AIDS myths and misinformation in their respective communities. Responses were analyzed qualitatively using thematic coding. Responses were grouped into four thematic categories: risk beliefs, consequences of infection, populations affected, and service delivery. Many responses were consistent with myths and misinformation from the start of the HIV epidemic. Study findings support the need for sustained fundamental HIV/AIDS education and stigma reduction efforts in rural areas.

Social support plays an important role in children's well-being after experiencing a potentially traumatic event (PTE). One such source of support is the parent-child relationship, specifically by discussing the event. However, current literature provides no consensus on whether parents and children communicate about PTEs, in what way they might communicate and how this affects the child. Hence the goal of the current study is threefold, to explore: (a) whether parents and children communicate about PTEs, (b) what this communication looks like, and (c) how this affects children's well-being. These questions are answered by means of a systematic literature review. Articles were eligible for inclusion if it was an empirical study on communication between parents and children about a PTE that the child (under 18 years) had experienced. Initial searches in electronic databases provided 31,233 articles, of which 26 were deemed eligible for inclusion. Results show that most parents and children have discussed PTEs, but that this may depend on cultural background. What the parent-child communication looks like depends on various factors such as, age of the child, tone, and child's initiation of discussion. Parental post-traumatic stress symptoms seem to negatively impact communication. The results of the impact of communication are less clear-cut, but it seems to have a predominantly positive effect on the child's well-being, depending on parental sensitivity. Clinicians should be watchful for parental symptoms of post-traumatic stress disorder and can focus on promoting parental sensitivity and responsiveness when discussing PTEs with their child or on creating a joint narrative within families., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Context: In kidney therapy (KT) decisions, goal-concordant decision-making is recognized to be important, yet alignment with patients' goals during dialysis initiation is not always achieved., Objectives: To explore older patients' and caregivers' hopes, goals, and fears related to KT and communication of these elements with members of their health care team., Methods: The study included patients aged ≥75 years with an estimated glomerular filtration rate ≤25 mL/min/1.73 m2 and their caregivers enrolled in a palliative care intervention for KT decision-making. Patients and caregivers were asked open-ended questions about their hopes, goals, and fears related to KT decisions. A survey assessed if patients shared their goals with members of their health care team. Qualitative data underwent content analysis, supplemented by demographic descriptive statistics., Results: The mean age of patients (n = 26) was 82.7 (±5.7) years, and caregivers (n = 15) had a mean age of 66.4 (±13.7) years. Among the participants, 13 patients and 11 caregivers were women, and 20 patients and 12 caregivers were White. Four themes emerged: (1) Maintaining things as good as they are by avoiding dialysis-related burdens; (2) seeking longevity while avoiding dialysis; (3) avoiding pain, symptoms, and body disfigurement; and (4) deferring decision-making. Patients rarely had shared their goals with the key members of their health care team., Conclusion: Patients and caregivers prioritize maintaining quality of life, deferring decision-making regarding dialysis, and avoiding dialysis-related burdens. These goals are often unshared with their family and health care teams. Given our aging population, urgent action is needed to educate clinicians to actively explore and engage with patient goals in KT decision-making., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Goals of care conversations are essential to delivery of goal concordant care. Infrequent and inconsistent goals of care documentation potentially limit delivery of goal concordant care., Methods: At Kaiser Permanente San Francisco Cancer Center, a standardized documentation template was designed and implemented to increase goals of care documentation by oncologists. The centralized, prompt-based template included value clarification of the goals and values of advanced cancer patients beyond treatment preferences. Documented conversations using the template during the initial pilot period were reviewed to characterization the clinical context in which conversations were recorded. Common goals and motivators were also identified., Results: A total of 178 advanced cancer patients had at least 1 documented conversation by a medical oncologist using the goals of care template. Oncologists consistently documented within the template goals of therapy and motivating factors in decision making. The most frequently documented goals of care were "Avoiding Pain and Suffering," "Physical Independence," and "Living as Long as Possible." The least recorded goal was "Comfort Focused Treatment Only.", Conclusions: Review of oncologist documented goals of care conversations using a prompt-based template allowed for characterization of the clinical context, therapy goals and motivators of advanced cancer patients. Communication of goals of care conversations by oncologists using a standardized prompt-based template within a centralized location has the potential to improve delivery of goal concordant care., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: There are missed opportunities to discuss goals and preferences for care with seriously ill patients in the acute care setting. It is unknown which factors most influence clinician decision-making about communication at the point of care., Objective: This study utilized a cognitive-interviewing technique to better understand what leads clinicians to decide to have a goals of care (GOC) discussion in the acute care setting., Methods: A convenience sample of 15 oncologists, intensivists and hospitalists were recruited from a single academic medical center in a large urban area. Participants completed a cognitive interview describing their thought process when deciding whether to engage in GOC discussions in clinical vignettes., Results: 6 interconnected factors emerged as important in determining how likely the physician was to consider engaging in GOC at that time; (1) the participants' mental model of GOC, (2) timing of GOC related to stability, acuity and reversibility of the patient's condition, (3) clinical factors such as uncertainty, prognosis and recency of diagnosis, (4) patient factors including age and emotional state, (5) participants' role on the care team, and (6) clinician factors such as emotion and communication skill level., Conclusion: Participants were hesitant to commit to the present moment as the right time for GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Context: Prolonged management of critical illnesses in long-term acute care hospitals (LTACH) makes serious illness communication (SIC), a clinical imperative. SIC in LTACH is challenging as clinicians often lack training and patients are typically unable to participate-making caregivers central., Objectives: This qualitative descriptive study characterized caregiver engagement in SIC encounters, while considering influencing factors, following the implementation of Ariadne Labs' SIC training at a LTACH in the Northeastern United States., Methods: Clinicians' documented SIC notes (2019-2020) were analyzed using directed content analysis. Codes were grouped into four categories generated from two factors that influence SIC-evidence of prognostic understanding (yes/no) and documented preferences (yes/no)-and caregiver engagement themes identified within each category., Results: Across 125 patient cases, 251 SIC notes were analyzed. In the presence of prognostic understanding and documented preferences, caregivers acted as upholders of patients' wishes (29%). With prognostic understanding but undocumented preferences, caregivers were postponers of healthcare decision-making (34%). When lacking prognostic understanding but having documented preferences, caregivers tended to be searchers, intent on identifying continued treatment options (13%). With poor prognostic understanding and undocumented preferences, caregivers were strugglers, having difficulty with the clinicians or family unit over healthcare decision-making (21%)., Conclusion: The findings suggest that two factors-prognostic understanding and documented preferences-are critical factors clinicians can leverage in tailoring SIC to meet caregivers' SIC needs in the LTACH setting. Such strategies shift attention away from SIC content alone toward factors that influence caregivers' ability to meaningfully engage in SIC to advance healthcare decision-making., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: To provide an in-depth examination of whether pragmatic, expressive, receptive, and narrative language are associated with the social and academic functioning of children with ADHD., Method: Children with ADHD ( n  = 46) and neurotypical comparison (NC) children ( n  = 40) aged 7 to 11 years completed tasks measuring expressive, receptive, and narrative language, while parents rated pragmatic language and social- and academic functioning., Results: Children with ADHD differed significantly from NC children on pragmatic language, expressive language, receptive language, and narrative coherence. An examination of indirect effects revealed that a significant proportion of the association between ADHD and social functioning was shared with pragmatic language, while a significant proportion of the association between ADHD and academic difficulties was shared with pragmatic language as well as with expressive language., Conclusion: This preliminary study supports the clinical relevance of language in relation to the academic- and social functioning of children with ADHD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.