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Why you should read this article: • To understand that women with mobility impairments have lower rates of uptake of cervical screening and a higher incidence of cervical cancer than those without mobility impairments • To recognise the challenges of accessing cervical screening attendance for women with mobility impairments • To acknowledge the important role of the nurse in improving uptake of cervical screening for women with mobility impairments. Cervical cancer, the fourth most frequently diagnosed malignancy worldwide, is largely preventable through cervical screening and human papillomavirus vaccination programmes. Despite this, there is a higher incidence of cervical cancer in women with lower limb mobility impairments, and lower rates of cervical screening uptake, compared with those without such impairments. This article reports the findings of an integrative literature review that explored the challenges experienced by women with lower limb mobility impairments in accessing cervical screening services and identified strategies used to overcome these challenges. Challenges included environmental barriers, time constraints, inadequate education of healthcare professionals and lack of awareness of the need for cervical screening for this patient population. Nurses, as the healthcare professionals who most often carry out cervical screening, must take the lead in addressing these challenges. The word ‘women’ is used in this article to reflect the cohorts in the studies reviewed and the terminology used in the literature search. [ABSTRACT FROM AUTHOR]

* OBJECTIVE: To ascertain whether manipulating contextual effects (eg, interaction with patients, or beliefs about treatments) boosted the outcomes of nonpharmacological and nonsurgical treatments for chronic primary musculoskeletal pain. * DESIGN: Systematic review of randomized controlled trials * DATA SOURCES: We searched for trials in 6 databases, citation tracking, and clinical trials registers. We included trials that compared treatments with enhanced contextual effects with the same treatments without enhancement in adults with chronic primary musculoskeletal pain. * DATA SYNTHESIS: The outcomes of interest were pain intensity, physical functioning, global ratings of improvement, quality of life, depression, anxiety, and sleep. We evaluated risk of bias and certainty of the evidence using Cochrane Risk of Bias tool 2.0 and the GRADE approach, respectively. * RESULTS: Of 17 637 records, we included 10 trials with 990 participants and identified 5 ongoing trials. The treatments were acupuncture, education, exercise training, and physical therapy. The contextual effects that were improved in the enhanced treatments were patient-practitioner relationship, patient beliefs and characteristics, therapeutic setting/environment, and treatment characteristics. Our analysis showed that improving contextual effects in nonpharmacological and nonsurgical treatments may not make much difference on pain intensity (mean difference [MD], -1.77; 95% confidence interval [CI]: -8.71, 5.16; k = 7 trials; N = 719 participants; Scale: 0-100; GRADE: Low) or physical functioning (MD, -0.27; 95% CI: -1.02, 0.49; 95% prediction interval [PI]: -2.04, 1.51; k = 6; N = 567; Scale: 0-10; GRADE: Low) in the short term and at later followups. Sensitivity analyses revealed similar findings. * CONCLUSION: While evidence gaps exist, per current evidence, it may not be possible to achieve meaningful benefit for patients with chronic musculoskeletal pain by manipulating the context of nonpharmacological and nonsurgical treatments. [ABSTRACT FROM AUTHOR]

To achieve expertise, transplant surgeons in Turkiye undergo rigorous training, including medical school, residency, compulsory service, and extensive training in transplant surgery. Despite their high academic and clinical knowledge level, success in transplant surgery heavily depends on cultural competency. Through semi-structured interviews with 21 transplant surgeons specializing in kidney and liver transplants in Ankara, this study reveals how health illiteracy, culture, and folklore create significant barriers. Surgeons navigate these challenges while enduring harsh working conditions. This research highlights the critical role of cultural competency in transplant surgery, emphasizing the necessity for surgeons to understand and address the diverse cultural needs of their patients. Key findings indicate that surgeons must balance medical expertise with cultural sensitivity to deliver effective care. This study identifies four main cultural barriers: spiritual trust, family politics, health illiteracy, and subcultural incompetency. Effective transplant surgery requires a combination of theoretical proficiency and cultural awareness to meet a patient's needs and improve surgical outcomes. [ABSTRACT FROM AUTHOR]

Background: The unprecedented increase in telehealth use due to COVID-19 has changed general practitioners' (GP) and patients' engagement in healthcare. There is limited specific advice for effective communication when using telehealth. Examining telehealth use in practice in conjunction with perspectives on telehealth as they relate to communication allows opportunities to produce evidence-based guidance for optimal use of telehealth, while also offering practitioners the opportunity to reflect on elements of their communicative practice common to both styles of consultation. The objective of this research was to develop evidence-based resources to support effective, person-centred communication when GPs and patients use telehealth. This included examination of interactional practices of recorded telehealth consultations, exploration of GP and patient perspectives relating to telehealth, and identifying priorities for guidance informed by these analyses as well as participant co-design. Methods: This study involved recording telehealth consultations (n = 42), conducting patient surveys (n = 153), and interviewing patients (n = 9) and GPs (n = 15). These were examined using interaction analytic methods, quantitative analysis, and thematic analyses, to create a robust, integrated picture of telehealth practice and perspectives. The process of research translation involved a co-design approach, engaging with providers, patients, and policy makers to facilitate development of evidence-based principles that focus on supporting effective communication when using telehealth. Results: Three key themes relating to communication in telehealth were identified across the different analyses. These were relationship building, conversational flow, and safety netting. The draft best practice principles drawn from these themes were modified based on co-design feedback into five Best Practice Principles for Communication between GPs and Patients using Telehealth. Conclusions: Effective communication is supported through relationship building and attention to conversational flow in telehealth consultations, which in turn allows for safety netting to occur. In telehealth, GPs and patients recognise that not being co-present changes the consultation and use both intuitive and strategic interactional adjustments to support their exchange. The mixed-method examination of experiences through both a detailed analysis of telehealth consultations in practice and comparative exploration of GP and patient perspectives enabled the identification of principles that can support effective communication when using telehealth. Co-design helped ensure these principles are ready for implementation into practice. [ABSTRACT FROM AUTHOR]

Introduction: Research suggests that general practice can play an important role in managing long COVID. However, studies investigating the perspectives of general practitioners (GPs) and patients are lacking and knowledge regarding optimal long COVID care in general practice is therefore limited. Aim: To investigate GPs' and patients' perspectives on the topic of long COVID and its management in general practice. Methods: Brief questionnaires (GP n = 11, Patient n = 7) and in-depth semi-structured interviews (GP n = 10, Patient n = 7) were conducted with GPs and patients from Irish general practices during July 2022-January 2023. Interviews were conducted via telephone and audio recordings were transcribed. A phenomenological analysis involving reflexive thematic analysis and constant comparison techniques was adopted. Results: Analysis of interviews with GPs (male = 7, female = 3; median age = 50yrs (IQR = 39.5–56)) and patients (males = 2, female = 5; median age = 58yrs (IQR = 45-62yrs) generated four themes. These were (1) Complex presentations (2) the value of standardising care, (3) choosing the right path, and (4) supportive and collaborative doctor-patient relationships. Strong agreement was observed among GPs and patients regarding the need for holistic and integrated multidisciplinary care. Supportive and collaborative doctor-patient relationships were largely well received by GPs and patients also. GPs strongly endorsed standardising long COVID care operations. Conclusion: GPs and patients indicated that structured, integrated, and collaborative care can help optimise long COVID management in general practice. GPs are advised to incorporate these elements into their long COVID care practices going forward. Future research examining stakeholder's perspectives using larger and longitudinal samples is advised to enhance the generalisability of evidence in this area. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP. Methods: Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics. Results: The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, P <.01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered. Conclusions: Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters. [ABSTRACT FROM AUTHOR]

Background: In an effort to improve the quality of medical care, the philosophy of patient-centered care has become integrated into almost every aspect of the medical community. Despite its widespread acceptance, among patients and practitioners, there are concerns that rapid advancements in artificial intelligence may threaten elements of patient-centered care, such as personal relationships with care providers and patient-driven choices. This study explores the extent to which patients are confident in and comfortable with the use of these technologies when it comes to their own individual care and identifies areas that may align with or threaten elements of patient-centered care. Methods: An exploratory, mixed-method approach was used to analyze survey data from 600 US-based adults in the State of Florida. The survey was administered through a leading market research provider (August 10–21, 2023), and responses were collected to be representative of the state's population based on age, gender, race/ethnicity, and political affiliation. Results: Respondents were more comfortable with the use of AI in health-related tasks that were not associated with doctor-patient relationships, such as scheduling patient appointments or follow-ups (84.2%). Fear of losing the 'human touch' associated with doctors was a common theme within qualitative coding, suggesting a potential conflict between the implementation of AI and patient-centered care. In addition, decision self-efficacy was associated with higher levels of comfort with AI, but there were also concerns about losing decision-making control, workforce changes, and cost concerns. A small majority of participants mentioned that AI could be useful for doctors and lead to more equitable care but only when used within limits. Conclusion: The application of AI in medical care is rapidly advancing, but oversight, regulation, and guidance addressing critical aspects of patient-centered care are lacking. While there is no evidence that AI will undermine patient-physician relationships at this time, there is concern on the part of patients regarding the application of AI within medical care and specifically as it relates to their interaction with physicians. Medical guidance on incorporating AI while adhering to the principles of patient-centered care is needed to clarify how AI will augment medical care. [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]

To evaluate the implementation of telephone consultations to assess cancer patients' needs for rehabilitation, with focus on patients' acceptance, health professionals' experience and contextual factors. A mixed methods process evaluation was conducted at a primary healthcare rehabilitation clinic. Cancer survivors above 18 years of age with an unclarified rehabilitation need at discharge from hospital, was offered a telephone consultation provided by health professionals. Data on implementation and acceptability were collected using medical records systems, data collection forms and semi-structured interviews with six patients and two health professionals. Eighty-one cancer survivors were referred to the intervention, and 54% continued to further rehabilitation. The telephone consultations were executed approximately eight days after referral and took on average 44 min to deliver. Overall, the patients found that the telephone consultation addressed what they considered the most important topics, and the health professionals found the intervention to be acceptable. Both patients and health professionals reported challenges regarding the referral process. Patient acceptance of the intervention was high, and the telephone consultation was implemented to a high degree, resulting in more than half of the patients continuing to further rehabilitation. Patients' and health professionals' perspectives provided valuable insights about contextual factors. [ABSTRACT FROM AUTHOR]

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Given the long-standing debate about the nature of the concept of disease, the objective of this study was to understand how doctors categorize a condition as a disease or not, and what the kind of information they use is. A survey with a set of eighteen clinical vignettes was designed, and nineteen physicians and senior students purposefully selected were asked to interpret those situations as diseases or not and to produce an anonymous short written piece of text providing the motivation of their choice. Realist thematic analysis was used to analyse the answers, and four themes emerged: the temporal dimension of a disease, reification of disease, disease as an existential condition, and disease as a motivation to action. The respondents' interpretations were very heterogeneous, supporting the idea that physicians do not share a common prototypical concept of disease. The results suggested that the interpretation of a condition as a disease or not is the final outcome of a process, in which information from objective, subjective, and socially mediated elements is taken into consideration. According to a critical realist and systemic approach, we hypothesize that the context of doctor–patient relationship could influence the interpretation of the same condition as being a disease or not. [ABSTRACT FROM AUTHOR]

(1) Background: Patients who undergo a medical rehabilitation treatment are often facing a physical, emotional and spiritual crisis, mostly due to pain, loss of limb functionality, the memory of the pre-disease days or questions about their role and value in life. Most of the time, the physician does not have the ability to deal with these issues or to provide the expected responses. The aim of this study was to analyze the patient's perception on spirituality and faith while going through a medical rehabilitation program. (2) Methods: The current study included 173 patients treated in the Rehabilitation Department of the Clinical Rehabilitation Hospital in Cluj-Napoca, Romania. Of them, 91 comprised the study group and were assessed in 2023, while 82 comprised the control group and were assessed in 2007. All patients answered a 34-item questionnaire designed by the authors regarding the role of religion, spirituality and prayer in their post-disease life. (3) Results: The results show that 99% of the patients assessed believe in God, 80% pray every day, 50% have less pain after praying and 44% trust their priest the same as they trust their doctor. When comparing groups, results from 2023 show that more patients pray every day, while fewer are afraid of dying, think their disease is serious or wish for the medical team to pray with them, compared to 2007. (4) Conclusions: The physician should not neglect the faith of the patient and should use it to achieve a better rehabilitation outcome. [ABSTRACT FROM AUTHOR]

Digital pathology (DP) has become a part of the cancer healthcare system, creating additional value for cancer patients. DP implementation in clinical practice provides plenty of benefits but also harbors hidden ethical challenges affecting physician-patient relationships. This paper addresses the ethical obligation to transform the physician-patient relationship for informed and responsible decision-making when using artificial intelligence (AI)-based tools for cancer diagnostics. DP application allows to improve the performance of the Human-AI Team shifting focus from AI challenges towards the Augmented Human Intelligence (AHI) benefits. AHI enhances analytical sensitivity and empowers pathologists to deliver accurate diagnoses and assess predictive biomarkers for further personalized treatment of cancer patients. At the same time, patients' right to know about using AI tools, their accuracy, strengths and limitations, measures for privacy protection, acceptance of privacy concerns and legal protection defines the duty of physicians to provide the relevant information about AHI-based solutions to patients and the community for building transparency, understanding and trust, respecting patients' autonomy and empowering informed decision-making in oncology. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a major cause of morbidity and mortality, contributing to approximately 20 000 deaths in 2021 in Australia. Importantly, progression of CKD can be substantially reduced if it is detected and treated early. Here we present the perspectives of a general practitioner (primary care physician), a nephrologist and a patient advocate on how the diagnosis and management of CKD in primary care could be improved. Early detection and treatment of CKD are impeded by limited patient awareness and knowledge, communication challenges between patients and doctors, and psychosocial issues, with these factors also interacting with, and exacerbating, each other. We make the following recommendations to help improve outcomes in patients with CKD: (1) identifying people at increased risk of CKD and ensuring they have a complete kidney health check (including estimated glomerular filtration rate, urine albumin-creatinine ratio and a blood pressure check) every 1−2 years; (2) using simple, nonconfrontational language and supportive resources to communicate with patients about kidney health; (3) implementing early treatment to slow the progression of CKD and avoid adverse cardiovascular disease outcomes; and (4) asking patient-orientated questions to support shared decision-making and empower patients to be active partners in their healthcare. We acknowledge that limited time is a major barrier to implementing these recommendations in primary care. Utilizing the expertise of the whole practice team, and adopting supportive technology to introduce efficiencies, are likely to be of benefit. By adopting these recommendations, we believe general practitioners have the opportunity to drive improved outcomes and quality of life for people living with CKD in Australia. [ABSTRACT FROM AUTHOR]

Objective: To explore the symptom experiences and influencing factors of gastrointestinal (GI) cancer patients on chemotherapy (CTX) in China. Methods: Semi-structured interviews were conducted with 13 GI cancer patients undergoing CTX. Following the Colaizzi 7-step analysis method, the interview data were read carefully, meaningful statements related to the research questions were extracted, coded, collected, and described in detail, and the authenticity of the theme was verified. Results: Nine themes were grouped into two main areas including the characteristics of symptom experiences and influences on symptom experiences. Conclusion: The symptom experiences of patients undergoing CTX for GI cancer is poor and influenced by multiple factors. Nurses need to pay attention to the assessment and monitoring of CTX-related symptoms, improve symptom recognition, enhance doctor-patient communication and social support, explore intelligent management methods, and increase the efficiency of healthcare services to improve patients' symptom experience. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the surgical process information sharing system could alleviate the parental anxiety during a pediatric selective operation. Design: Randomized controlled trial. Methods: A questionnaire survey was conducted one day before surgery for the enrolled participants. Family members assigned to the intervention group received real-time process information sharing through service reminders during the surgical period, while the control group received standard perioperative education. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality during the perioperative period, and the State of Cohesion-13 Scale (SOC-13) and Self-rating Anxiety Scale (SAS) were used to assess anxiety levels. Satisfaction levels during the perioperative period were assessed through a follow-up survey conducted one day after surgery. Results: The intervention group showed better scores in terms of PSQI, SOC-13, SAS, and postoperative satisfaction levels at various time points compared to the control group, with statistically significant differences observed (P < 0.05). Conclusion: Real-time process information sharing is effective in reducing perioperative sleep disorders and anxiety among family members of pediatric patients, as well as improving satisfaction levels. This approach not only establishes a process and mechanism for effective doctor-patient communication but also helps implement continuous perioperative care, thereby optimizing internet healthcare services. [ABSTRACT FROM AUTHOR]

The article focuses on the essential role of interprofessional communication in successful shared decision-making (SDM). Topics include the definition and characteristics of SDM, the impact of the SACCIA (Safe Communication and Collaboration in Interprofessional Activities) framework on communication practices, and a case study illustrating the challenges of conflicting provider perspectives.

Introduction: An overarching principle for the management of psoriatic arthritis (PsA) is a shared decision-making process between physicians and patients. The aim of this study is to assess the patient–physician relationship in a group of patients with PsA, by using the Perceived Efficacy in Patient–Physician Interactions (PEPPI) and CollaboRATE instruments. Methods: This is a cross-sectional multicenter study where consecutive patients with PsA were enrolled. For each patient, the main demographic, comorbid conditions, and clinical data were collected, including the assessment of disease activity, function, quality of life, and impact of disease. PEPPI and CollaboRATE questionnaires were used, respectively, to evaluate the patient's perception of the patient–physician relationship and the shared decision-making process. Results: A total of 81 patients with PsA were enrolled at four centers in Italy. Overall, our patients showed a high level of confidence in obtaining needed health care, with relatively high median (IQR) values of PEPPI (20; 16–23), and a good shared decision-making process, with high median (IQR) values of CollaboRATE questionnaire (7; 6–9). PEPPI and CollaboRATE scores showed a statistically significant inverse correlation with different clinical variables such as disease duration, Leeds Enthesitis Index, PsA impact of Disease, Health Assessment Questionnaire, pain, patient's global assessment of disease activity and clinical disease activity for PsA. The presence of comorbidities did not appear to be associated with lower values of PEPPI and CollaboRATE. Conclusions: In this study, few patients with PsA were at risk of suboptimal communication with their physician. This phenomenon appeared to be primarily related to higher disease activity and burden. [ABSTRACT FROM AUTHOR]

This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner–patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond. [ABSTRACT FROM AUTHOR]

This essay analyses and historicises a contemporary dominant narrative among India's biomedical doctors, that the early post‐independence period (1940s–1970s) was characterised by immense public trust and confidence in the biomedical profession, with the patient‐doctor relationship experiencing a 'golden era'. By exploring people's experiences with and perceptions of doctors during these decades, I show that contrary to contemporary understanding, public dissatisfaction with doctors was substantial even in the early post‐independence period. I argue that the dominance of privileged‐caste and ‐class Indians in the medical profession nurtured a caste privilege‐based elitist outlook within the mainstream profession and its leadership and created an insurmountable socioeconomic distance between doctors and the large majority of the public. What doctors deemed as people's 'trust' in them and their profession was often simply a manifestation of people's general deference towards the elites of the society. This incorrect interpretation of patient‐doctor dynamics in the past has been a constant feature of mainstream narratives around the doctor‐society relationship in post‐independence India and has remained largely under‐explored and under‐historicised in the medical, scholarly and public discourses. [ABSTRACT FROM AUTHOR]

Introduction: Because medication adherence is essential to the management of rheumatoid arthritis (RA), identifying (1) subgroups at high risk for low medication adherence and (2) modifiable factors potentially contributing to low adherence can impact patient outcomes. This study aims to describe the relationships between anxiety, trust in the provider, quality patient‐provider communication, fatigue, RA knowledge, adverse medication effects, disease activity, RA medications, disease duration, patient satisfaction, and medication intolerance and cluster factors to differentiate RA‐patient subgroups. Methods: This observational study used correlation analysis, linear regression, and cluster analysis with determination decisions based on Schwarz's Bayesian Criterion. Results: Medication adherence was higher in non‐Hispanic, White participants, inversely correlated with disease activity and pain intensity, and positively correlated with trust in the provider. Patient satisfaction was higher among those with a shorter time since diagnosis, and was negatively associated with disease activity, pain intensity and interference, fatigue, and anxiety. It was positively associated with RA knowledge, trust in provider and quality of patient‐provider communication. Medication intolerance differed by disease duration and was positively correlated with disease activity, pain interference, and fatigue. Of the two clusters, Cluster 1 participants had greater medication adherence and patient satisfaction, and lower medication intolerance. They were of higher income, employed, and non‐Hispanic, White persons with a shorter disease duration and lower perceived pain intensity/interference, fatigue, and anxiety. They were more knowledgeable about RA with higher trust in their provider and perceived quality of patient‐provider communication. Discussion/conclusion: A low medication adherence RA‐patient subgroup‐highly affected by social determinants of health and with unique relational and clinical characteristics was identified. [ABSTRACT FROM AUTHOR]

Background: The lack of trust between patients and physicians has a variety of negative consequences. There are several theories concerning how interpersonal trust is built, and different studies have investigated trust between patients and physicians that have identified single factors as contributors to trust. However, all possible contributors to a trusting patient-physician relationship remain unclear. This review synthesizes current knowledge regarding patient-physician trust and integrates contributors to trust into a model. Methods: A systematic search was conducted using the databases MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), and Eric (Ovid). We ran simultaneous searches for a combination of the phrases: patient-physician relationship (or synonyms) and trust or psychological safety. Six-hundred and twenty-five abstracts were identified and screened using pre-defined criteria and later underwent full-text article screening. We identified contributors to trust in the eligible articles and critically assessed whether they were modifiable. Results: Forty-five articles were included in the review. Patient-centered factors that contributed modifiable promoters of trust included psychological factors, levels of health education and literacy, and the social environment. Physician-centered factors that added to a trusting patient-physician relationship included competence, communication, interest in the patient, caring, the provisioning of health education, and professionalism. The patient-physician alliance, time spent together, and shared decision-making also contributed to trusting relationships between patients and physicians. External contributors included institutional factors, how payments are made, and additional healthcare services. Discussion: Our model summarized modifiable contributors to a trusting patient-physician relationship. We found that providing sufficient time during patient-physician encounters, ensuring continuity of care, and fostering health education are promising starting points for improving trust between patients and physicians. Future research should evaluate the effectiveness of interventions that address multiple modifiable contributors to a trusting patient-physician relationship. [ABSTRACT FROM AUTHOR]

Background:Little is known about the implication of launching virtual-first primary care (VPC) in a health system. Our experience and survey can guide others to establish their virtual-first programs. This study examines implementation, patient perspectives, and satisfaction with VPC at University of Pittsburgh Medical Center (UPMC). Methods:We conducted a Web-based survey to examine factors associated with the likelihood of early adoption and continued use of VPC. We used bivariate comparisons and cluster analysis to evaluate the results. The survey was sent to 1,420 patients seen between August 2022 and January 2023. Responses related to demographics, doctor-patient relations, savings, experience, and future preferences of use were aggregated. To evaluate the relationship between demographics and survey responses, we conducted univariate analysis. Results:Females and patients between 40 and 50 years of age were the primary users and indicated the most interest in continued use. Health insurance status seems not to be a significant predictor in the selection and use of VPC. Most (78%) felt that the physician-patient relationship was unimpaired. The survey showed that 90% of patients saved time by using VPC, and 66% reported saving money on tolls, childcare, or gasoline. Only 13% reported not wanting to continue VPC. Discussion:A majority of surveyed patients felt the doctor-patient relationship was not negatively affected in VPC. VPC programs can be implemented with high patient satisfaction in an integrated health system. VPC is acceptable to most patients, and further expansion of the model is warranted. [ABSTRACT FROM AUTHOR]

The article examines the integration of palliative care principles in dementia diagnosis to enhance communication and care planning for patients and caregivers. It highlights challenges such as stigma, communication gaps, and the psychological complexities of dementia, emphasizing the need for empathetic and structured communication strategies from the onset of diagnosis.

The patient-physician relationship, especially in the case of severely ill patients, is often fraught with anxiety, grief, and guilt in the physician who may come to feel that he or she has failed the patient and thereby becomes a "second victim." This notion was first explored in a 1973 publication (Artiss and Levine N Engl J Med 288(23):1210-4, 1973) that described a novel interactive seminar series for oncology fellows that had been designed to address and possibly remedy the frequent disquiet experienced by young physicians in this setting. Fifty years later, the medical student co-authors of this Perspective enrolled in an elective course that comprised a similar series of interactive seminars, now addressing the contemporary patient-physician relationship. The earlier paper was employed as a historical background, and the framework of the course then broadened such that the students considered the current environmental changes in medical practice (social, cultural, financial, legal, policy) that may be linked to the character of individual patient-physician relationships. This essay reports on the students' perception of such relationships, and on the environmental elements that may be helpful or harmful to the well-being of both patients and physicians. [ABSTRACT FROM AUTHOR]

Aims: The Raising Awareness Tool for Endometriosis (RATE) was developed to facilitate discussions with health providers regarding endometriosis‐associated symptoms. We aim to evaluate the acceptability of the RATE by general practitioners (GP), including determining the prevalence of symptoms of women presenting to general practice and immediate management of symptoms. Methods: A mixed‐methods study was undertaken using a combination of quantitative and qualitative data in Western Australian General Practices from 2021 to 2022. A purposive sample of 12 GPs were included, who recruited women (18–50 years) on attendance for consultation over a one‐ to two‐week period, followed by qualitative interviews exploring GPs' experiences with the tool. The quantitative and qualitative components were integrated during analysis of results. Results: A total of 111 women completed the RATE (mean: 33, standard deviation: 8.6 years) prior to routine consultation. The tool was considered to be acceptable for use in general practice and aided discussions on symptoms and management. Overall, 68.5% of patients experienced pelvic pain or discomfort, with 22.4% rating that this interfered with quality of life. Of those with pelvic pain, 75% had associated chronic pain conditions, and 42.1% reported allodynia. The chronic pain questions provoked GP uncertainty. After symptoms were identified, GPs arranged individualised investigations and follow‐up. Conclusions: The RATE was considered to be acceptable for use in the general practice setting. It identified symptoms and initiated discussions on possible diagnosis as well as management of endometriosis. Further GP education on identifying those women at most risk of developing chronic pain syndromes is needed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To identify the most important attributes related to the process of achieving, and outcomes associated with, successful care for differences of sex development (DSD). METHODS: We developed a best--worst scaling survey administered to 520 DSD stakeholders, including individuals or family members of those with DSD, health care specialists, and patient support and advocacy representatives. Fourteen process-related attributes and 16 outcomerelated attributes were identified through qualitative research. We estimated relative importance scores and coefficients from regression analysis to understand the relative importance of attributes and conducted latent class analysis to explore heterogeneity in preferences. RESULTS: The 3 most important process attributes were (1) good communication between care team and patient/family, (2) care team educated patient/family about condition, and (3) care team incorporates the values of patient/family. The 3 most important outcome attributes were (1) patient satisfaction, (2) patient mental health, and (3) treatment maintains physical health. Latent class analyses showed that respondents had heterogeneous preferences. For processrelated attributes, we identified 3 respondent groups: "Patient autonomy and support" (46% of respondents), "Education and care transitions" (18%), and "Shared decision-making" (36%). For outcome-related attributes, we identified 2 respondent groups: "Preserving function and appearance" (59% of respondents) and "Patient health and satisfaction" (41%). CONCLUSIONS: Outcomes such as patient satisfaction and health were the most important outcome attributes, and good communication and education from the care team were the most important process attributes. Respondents expressed heterogeneous preferences for selected DSD care attributes that providers should consider to improve satisfaction with and quality of DSD care. [ABSTRACT FROM AUTHOR]

The growth of wearable technology has enabled the collection of even more personalized information on individuals. New health-related devices marketed to consumers collect health information that might not fall under the traditional category of Protected Health Information, and thus, HIPAA protections do not fully apply. Meaning, commercial wearable health devices do not fall under FDA oversight, and data not paired with a doctor–patient relationship do not fall under HIPAA privacy protection; thus, much of the gathered health-related metrics are left without regulation and open to be sold to data brokers. As such, these data can be leveraged by health insurance, law enforcement, and employers, to name a few. This manuscript explores the loopholes in current regulations and suggests a framework that categorizes wearable data and addresses challenges in data transfer. Furthermore, taking a user perspective, the suggested framework offers solutions that aim to guide users and policymakers in navigating privacy issues in wearable technology. [ABSTRACT FROM AUTHOR]

Background: In the United States (U.S.), adolescents and young adults are increasingly using contraception, including long‐acting reversible contraception (LARC) [e.g., subdermal implants (e.g., Nexplanon®) and intrauterine devices (IUDs)]; however, access to LARC device removal may be difficult for adolescents and young adults. Reproductive justice is the right to bodily autonomy, have children, not have children, and safely parent the children we have. Methods: In this commentary, we discuss that while the specialties of family medicine and obstetrics and gynecology have incorporated the principles of reproductive justice into their contraceptive care, further work is needed to ingrain this philosophy into pediatrics training. Since LARC devices are historically only removable by health care providers, pediatricians may act as gatekeepers to removing LARC, obstructing the reproductive justice of adolescents and young adults. Results: We describe that adolescents and young adults in the U.S. face unique barriers to LARC removal including limited access to the health care system, potential breaches in confidentiality, and provider bias. These barriers may lead adolescents and young adults to remove their own LARC device when experiencing unwanted side effects or desiring pregnancy. While IUD self‐removal is a safe and accessible option, safety and efficacy data on subdermal implant self‐removal is currently limited. Conclusion: In order to promote reproductive justice in adolescents and young adults, we recommend that (1) pediatricians should address potential barriers to LARC removal prior to insertion, (2) pediatricians must offer unbiased LARC removal, (3) pediatricians who place LARC must be knowledgeable about complicated LARC removal, and (4) pediatricians should discuss LARC self‐removal options with adolescents and young adults. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the experiences of women with kidney disease, residing in the United Kingdom (UK), living through the first 18 months of the COVID‐19 pandemic with specific focus on preconception decision‐making, family planning, and parenting. Methods: We conducted a mixed‐methods study, comprising an online survey and follow‐up interviews, with UK‐resident women aged 18–50. Results: We received 431 surveys and conducted 30 interviews. Half (n = 221, 51%) of the survey respondents considered that COVID‐19 influenced the quality of communication with healthcare professionals and 68% (n = 295) felt that the pandemic disrupted their support networks. Interview participants indicated that delayed and canceled appointments caused anxiety, grief, and loss of pregnancy options. Women's perception of themselves as (good) mothers as well as their capacity to have and raise a child, meet partners, and sustain healthy relationships was negatively affected by the "clinically extremely vulnerable" label. Women's trust in their healthcare was dismantled by miscommunication and variation in lockdown rules that caused confusion and increased worry. Women reported that COVID‐19 contributed to postnatal depression, excessive concern over infant mortality, preoccupation over others following rules, and catastrophising. Conclusion: Some women in the UK with chronic kidney disease lost or missed their opportunity to have children during the pandemic. Future pandemic planners need to look more holistically and longer term at what is and is not classed as an emergency, both in how services are reconfigured and how people with chronic conditions are identified, communicated with, and treated. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel disease (IBD) is an incurable illness of the gastrointestinal tract. Its relapsing–remitting nature negatively impacts physical health and quality of life. Food and eating are key concerns for people with this illness. To provide holistic person‐centred care, healthcare providers (HCPs) need to meet patients' dietary information needs. However, there is a paucity of literature describing these in any meaningful detail. The present study aimed to explore the perceived dietary information needs of individuals with IBD, the perceptions of HCPs and enablers and barriers to communication. Methods: Online and face‐to‐face semi‐structured interviews with 13 HCPs and 29 people with IBD were conducted. The framework method aided thematic analysis of de‐identified interview recordings. Results: The cyclical nature of IBD contextualised the five themes. Both individuals with IBD and HCPs articulated similar ideas viewed from different perspectives: (1) living with IBD is exasperating and unique to the individual; (2) individuals with IBD desire dietary information; (3) diet manipulation is used to exert control on a disease with unpredictable nature; (4) people with IBD and HCPs have different views on the role of diet; and (5) doctors are perceived as gatekeepers to accessing dietetics care. Conclusions: A lack of dietary guidance at diagnosis negatively impacts the patient's journey with food and eating. The present study supports a paradigm shift towards holistic person‐centred care for consistent access to dietetics services to meet the needs of people with IBD. Key points: Dietary information needs appear to be influenced by the stage of Inflammatory Bowel Disease (IBD).The journey of IBD is lonely and fraught with uncertainty.Lack of dietary guidance from diagnosis may partly influence information seeking and adoption of dietary restrictions.Dietary manipulation provides a perceived sense of control. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome (IBS) is a common functional gastrointestinal condition. A respectful patient-doctor relationship with good communication is crucial for optimal treatment. Q-methodology is a combination of qualitative and quantitative methods used to study subjectivity. The aim of this study was to compare viewpoints on IBS between patients with IBS and general practitioners (GPs). We conducted a Q-methodology study by including 30 patients and 30 GPs. All participants were asked to complete Q- sorting of 66 statements on IBS using an online software program. Data were processed using factor analysis. In addition, 3 patients and 3 GPs were interviewed. Three factors were extracted from both groups: Patient Factor 1 'Question the diagnosis of IBS', Patient Factor 2 'Lifestyle changes for a physical disorder', Patient Factor 3 'Importance of a diagnosis', GP Factor 1 'Unknown causes of great suffering', GP Factor 2 'Lifestyle changes are important, stress makes IBS worse', GP Factor 3 'Recognized the way IBS affects patients'. There was a strong and statistically significant correlation between patient Factor 1 and GP Factor 1, with a Pearson's r of 0.81 (p < 0.001). Correlations between other factors varied. There was consensus between patients and GPs that IBS is a physical and not a psychiatric disorder of unknown etiology. They also seemed to agree that IBS has a great negative impact on patients' lives and that lifestyle changes are beneficial. There were conflicting opinions regarding gender, cultural factors and the use of antidepressants. [ABSTRACT FROM AUTHOR]

To better understand what makes cost-of-care communication between oncologists and cancer patients more or less successful, we conducted in-depth interviews with 32 oncologists (22 male, 10 female) who were board-certified in medical, surgical, or radiation oncology. Through qualitative descriptive analysis by four coders, we found that oncologists used six broad strategies to discuss cost with patients: open discussion, avoidance, reassurance, warning, outsourcing, and educating. We also found that oncologists invoked certain meanings of cost conversations: cost conversations as holistic care, coercion, a matter of timing, risking patient suspicions, advocacy, unwanted distraction, transparency, bad news delivery, problem-solving, pointless, informed decision making, or irrelevant. These meanings appeared to be linked to oncologists enacting certain strategies (e.g., oncologists who invoked cost conversations as holistic care tended to enact open discussion, those who saw cost conversations as risky tended to use avoidance). Theoretically, our results suggest that the invoked meaning of a difficult conversation may be a key explanatory mechanism for differentiating high-quality from low-quality communication in cost conversations. Practically, our findings suggest that oncologists should consider how well the invoked meaning of the cost conversation is serving their own and their patients' goals. [ABSTRACT FROM AUTHOR]

This brief report concerns a patient interaction in a busy South London Home Treatment Team (HTT) service, where a psychodynamically informed approach was applied to a presentation of psychosis in a crisis setting. We discuss the case in light of the psychodynamic theories on psychosis of Carl Jung and Richard Lucas. Our patient, a young man, had been under the HTT for an extended period of time due to an episode of psychosis that was not resolving. After initially struggling to build rapport, we adapted Lucas' and Jung's models of interacting with acutely psychotic patients to re-establish psychic rapport, which led to our patient agreeing to take the medication that finally pulled him out of this long-standing episode. We believe this case highlights the power of psychodynamic thinking even in acute, short-term settings where extensive psychodynamic intervention may not be appropriate or feasible. [ABSTRACT FROM AUTHOR]

Psychodynamic therapy is commonly used to treat patients with eating disorders. Patients with a diagnosed eating disorder have varying and complex treatment needs. Psychodynamic therapists transitioning their practices to telehealth during COVID-19 experienced the novelty of developing and sustaining a therapeutic connection with their patients without inhabiting a shared physical space. The aim of this qualitative phenomenological study was to gain insight into how psychodynamic therapists treating patients with eating disorders via telehealth during COVID-19 perceived their patients' experiences and personally experienced the therapeutic relationship and therapeutic processes. Twelve respondents met inclusion criteria, consented to participate, provided demographic data, and participated in a 30–45 minute semi-structured interview. Results from the data analysis included four emergent themes: (1) depth of content; (2) manifestations of patient distress; (3) therapist-patient relationship; and (4) implementation of techniques. Participants spoke about the challenges and resilience experienced by themselves and their patients. They highlighted having to rapidly transition their therapy practice to serve patients with exacerbated symptoms. They shared the complexities of navigating a global pandemic and considered the delivery of relational and dynamic therapy via telehealth. Practical implications and considerations for future research are offered with an emphasis on the treatment of patients with eating disorders. [ABSTRACT FROM AUTHOR]

This study aimed to assess the level of public trust in general practitioners (GPs) and its association with primary care contract services (PCCS) in China. Cross-sectional study. Between September and December 2021, 4158 residents across eastern, central, and western China completed a structured self-administered questionnaire. Trust was assessed using the Chinese version of Wake Forest Physician Trust Scale. Multivariable linear regression models were established to identify predictors of trust. The effect size of PCCS on trust was estimated by the average treatment effect for the treated (ATT) through propensity score matching. The study participants had a mean Wake Forest Physician Trust Scale score of 36.82 (standard deviation = 5.45). Enrollment with PCCS (β = 0.14, P < 0.01), Han ethnicity (β = 0.03, P < 0.05), lower educational attainment (β = −0.06, P < 0.01), higher individual monthly income (β = 0.03, P < 0.05), better self-rated health (β = 0.04, P < 0.05), chronic conditions (β = 0.07, P < 0.01), and higher familiarity with primary care services (β = 0.12, P < 0.01) and PCCS (β = 0.21, P < 0.01) were associated with higher trust in GPs. The ATT of PCCS exceeded 1 (P < 0.05). PCCS are associated with higher levels of trust in GPs. PCCS may become an effective tool to attract public trust in GPs, although the relationship between the two may be bi-directional. [ABSTRACT FROM AUTHOR]

The article focuses on summarizing evidence from a systematic review about older persons perceptions and experiences of community palliative care. It highlights the significant challenges and needs of this population, such as the importance of person-centered care, managing symptoms and care costs, dealing with isolation and loneliness, and the desire to receive care and die at home.

This study investigated whether perceived HIV stigma and HIV infection concerns among healthcare providers (HCPs) mediate the association between stigmatizing clinical setting and their interaction quality with sexual minority men (SMM) patients in Zambia. In 2021, a cross-sectional survey was conducted with 91 HCPs offering HIV-related services to SMM in Zambia. Path analysis was conducted to examine the potential mediation effect of "perceived HIV stigma" and "HIV infection concern" among HCPs in the association between "stigmatizing clinical setting" and their "interaction quality with SMM". Mediators i.e., "perceived HIV stigma" and "HIV infection concern" among HCPs, were associated positively with the stigmatizing clinical setting (β = 0.329, p <.01, β = 0.917, p < 0.01), and negatively with physician-patient interaction quality (β = −0.167, p = 0.051; β = −0.126, p < 0.05). Stigmatizing clinical setting had a significant and negative indirect effect on HCPs interaction quality with SMM through increased perceived HIV stigma (z = −1.966, p < 0.05) and increased HIV infection concern (z = −1.958, p = 0.050). To improve physician-patient interaction quality, stigma reduction interventions among HCPs, who serve SMM in Zambia, should target development of development of inclusive policies and the cultivation of cultural norms that are supportive and respectful to SMM, and protection of HCPs from enacted stigma due to offering care to SMM. [ABSTRACT FROM AUTHOR]

A large proportion of hospital inpatients are affected by cognitive impairment, posing challenges in the provision of their care in busy, fast-paced acute wards. Signs and symbols, known as visual identifiers, are employed in many U.K. hospitals with the intention of helping healthcare professionals identify and respond to the needs of these patients. Although widely considered useful, these tools are used inconsistently, have not been subject to full evaluation, and attract criticism for acting as a shorthand for a routinized response. In order for visual identifiers to be used effectively in acute care settings, thorough consideration must be given to the ethical and legal issues that are engaged in this context, and their potential benefits and harms must be weighed and balanced. This paper proposes a set of legal and ethical principles that can be used to guide the implementation of visual identifiers. Together, these principles provide a framework applicable in the design and implementation phases to systematically identify relevant considerations arising from the use of these tools. We outline some tensions that arise between principles and conclude that selecting a preferred moral framework could help to guide decision-making, as does clarity around the purpose and objectives of the identifier. [ABSTRACT FROM AUTHOR]

We expand on Della Croce's ambition to interpret "epistemic injustice" as a specification of non-maleficence in the use of the influential four-principle framework. This is an alluring line of thought for conceptual, moral, and heuristic reasons. Although it is commendable, Della Croce's attempt remains tentative. So does our critique of it. Yet, we take on the challenge to critically address two interrelated points. First, we broaden the analysis to include deliberations about hermeneutical injustice. We argue that, if due consideration of epistemic injustice is to require more than negative ethical obligations in medicine, dimensions of hermeneutical injustice should be explored as an avenue to arrive at such positive duties. Second, and relatedly, we argue that this may encompass moral responsibilities beyond the individual level, that is: positive obligations to take action on a structural level. Building on Dotson's concept of "contributory injustice" and Scheman's concept of "perceptual autonomy," we suggest that the virtues of testimonial and hermeneutical justice may provide additional content not only to negative prohibitions of action (i.e. non-maleficence) but also to positive requirements of action, like respecting patient autonomy. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

The study reported in this paper explores the experiences of 95 people with intersex variations constituting an international English-speaking sample who completed a mixed methods survey comprises questions designed by the authors to explore 1) genital variations and medical interventions (and pressures to undertake them), 2) experiences with sex education, and 3) experience of physical intimacy, including use of safer sex devices and sexually transmitted infections. Surgeries on minors were common and typically not consensual, often resulting in the need for revisions. Pressures for surgeries most commonly were made by doctors. Experiences of sex education often failed to be inclusive of intersex bodies, with information about menstruation and hygiene rarely provided, and many participants having to learn on their own. Participants had a diversity of experiences of physical intimacy beyond penetration. For those who had experienced penetration, vaginal intercourse was enjoyable for some, but many found it painful. Conversely, anal intercourse was enjoyed by many and rarely found to be painful. The paper concludes by highlighting the importance of an intersex-specific approach to sexual health for this population. [ABSTRACT FROM AUTHOR]

Introduction: Medical students are expected to provide compassionate and empathic care to their patients. Empathy is a crucial component of the doctor-patient relationship. The Triguna theory is a fundamental concept in Hindu philosophy that describes three inherent qualities of nature: Sattva, Rajas, and Tamas. Each individual has a unique combination of these qualities, which shapes their personality and behaviour. However, the relationship between Triguna personality and empathy in medical students has not been explored in depth. Aim: To examine the association between Triguna personality and empathy in medical students. Materials and Methods: The present study was a crosssectional questionnaire-based survey conducted among firstphase medical undergraduates in the Department of Physiology, Rama Medical College Hospital and Research Centre, Kanpur, Uttar Pradesh, India from July 2024 to August 2024. A total of 122 medical students participated in the study. The Vedic Personality Inventory (VPI) was used for assessing personality, and the Brief form of Interpersonal Reactivity Index (B-IRI) was used for assessing empathy. Correlational analysis and an unpaired student's t-test were performed. Results: There were 122 subjects; the proportion of male and female students was 52 (42.6%) and 70 (57.4%), respectively. The mean± Standard Deviation (SD) age was 20.43±1.23 years. Sattva score was positively correlated with Perspective-taking (PT) (r=0.193, p<0.05) and negatively correlated with Personal Distress (PD) scores (r=-0.322, p<0.01). Tamas scores were positively correlated with Fantasy (FT) (r=0.251, p<0.01) and PD scores (r=0.401, p<0.01). Female participants demonstrated significantly higher mean scores as compared to males in Empathic Concern (EC) (16.9±2.681 vs. 14.730±2.951), PT (15.442±2.618 vs. 14.038±2.779), and PD (13.552±2.776 vs. 12.288±3.291) in the present study. There was no significant difference in Sattva, Rajas, and Tamas scores between males and females. Conclusion: The study explores the association between the VPI traits, such as Sattva, Rajas, and Tamas, and empathy measures. Sattva shows a positive correlation with Perspective Taking (PT) and a negative correlation with PD, indicating that individuals with higher Sattva scores are likely to exhibit better social competence and emotional stability. Additionally, gender differences were observed in empathy scores, with females scoring higher than males in PT, EC, and PD, emphasising the relevance of considering personality traits in medical education to foster empathic skills among healthcare professionals. [ABSTRACT FROM AUTHOR]

The article discusses a 2024 study of the enhanced recovery after surgery (ERAS) approach to improve patients' surgical pathways via multimodal interventions. Topics covered include nurse managers' contribution to ERAS implementation, and results which show the themes of resource, innovation and change management, interprofessional collaboration, developing professional practice, and proximity team management. Also noted are the challenges of unclear roles and practice scope among stakeholders.

Accessible Summary: What is already known?: SDM improves clinical outcomes by increasing attendance and treatment adherence in adolescents diagnosed with depression.SDM could reduce treatment disagreements and enhance consumers' and their families' satisfaction with mental healthcare services.Healthcare professionals are a critical part of SDM. However, MHPs' practices of SDM in the daily management of adolescents diagnosed with depression need to be clarified. What the paper adds to existing knowledge?: From the viewpoints of MHPs, SDM was not extensively applied in the daily management of adolescents diagnosed with depression.MHPs who trust their consumers and have received training related to SDM are more likely to practice SDM in the daily management of adolescents diagnosed with depression.The positive preferences for providing information and family involvement in treatment decision‐making are facilitators; working in closed inpatient mental health wards and open inpatient mental health wards are hindering factors for MHPs' practices of SDM. What are the implications for practice?: MHPs should encourage information sharing with consumers and their family members to help them participate in treatment decision‐making actively.A trusting and friendly therapeutic relationship with consumers should be maintained in the daily management of adolescents diagnosed with depression.SDM‐related training should be encouraged for MHPs to promote widespread SDM. Introduction: Shared decision‐making (SDM) is an ideal model for a therapeutic relationship that can improve health outcomes. Healthcare professionals are a critical part of SDM, and they play an important role in the practices of SDM in the clinical setting. Evidence suggests that adolescents diagnosed with depression can benefit substantially from SDM. However, mental health professionals' (MHPs) practices of SDM for adolescents diagnosed with depression in China are not well‐documented. Aim: This study aimed to investigate the practices of SDM for adolescents diagnosed with depression from the viewpoints of MHPs in China. Method: In this cross‐sectional study, we recruited a total of 581 MHPs by convenience sampling. The Shared Decision‐Making Questionnaire—Physician Version (SDM‐Q‐Doc) was used to evaluate the MHPs' practices of SDM for adolescents diagnosed with depression. Results: The mean SDM‐Q‐Doc was 80.47 (±16.31). Within the six specific decision‐making situations, most MHPs selected non‐SDM (52.7%–71.6%). Substantial numbers of respondents believed that MHPs made the final decision, especially with regard to the development (37%) and adjustment of medication regimens (42%). The practice of SDM was predicted by MHPs' preference for providing information, their trust in consumers, preference for family involvement in treatment decision‐making, working in an outpatient clinic and receiving SDM training (F = 23.582; p =.000; R2 =.198; adjusted R2 =.189). Discussion: Although the MHPs' self‐rated score of SDM‐Q‐Doc was high, SDM was not extensively applied in the daily management of adolescents diagnosed with depression. Thus, SDM needs to be further promoted by enhancing SDM‐related training for MHPs, thereby actively promoting the involvement of families, facilitating the information sharing for consumers and families, and building an active, trusting consumer‐practitioner relationship. Implications for Practice: MHPs should prioritise information sharing with consumers and families, as well as build trusting and friendly therapeutic relationships. Family involvement in treatment decisions should be encouraged when adolescents diagnosed with depression are in need. Actively participating in training related to SDM is also important. Future high‐quality evidence is still needed to explore the facilitators and barriers to SDM practices from a tripartite perspective of MHPs, adolescents diagnosed with depression and their families. [ABSTRACT FROM AUTHOR]

Doctors (and sociologists) have a long history of struggling to understand why patients seek medical help yet resist treatment recommendations. Explanations for resistance have pointed to macrostructural changes, such as the rise of the engaged patient or decline of physician authority. Rather than assuming that concepts such as resistance, authority, or engagement are exogenous phenomena transmitted via conversational conduits, we examine how they are dynamically co-constituted interactionally. Using conversation analysis to analyze a videotaped interaction of an oncology patient resisting the treatment recommendation even though she might die without treatment, we show how sustained resistance manifests in and through her doctor's actions. This paradox, in which the doctor can both recommend life-prolonging care and condition resistance to it, has broad relevance beyond cancer treatment; it also can help us to understand other doctor–patient decisional conflicts, for instance, medication nonadherence, delaying emergent care, and vaccine refusal. [ABSTRACT FROM AUTHOR]

KEY CLINICAL MESSAGE: Even in the era of technology‐guided medicine, the clinician must integrate into his daily practice a careful anamnesis and physical examination to be conducted within a close doctor–patient relationship. All these elements, together with tools such as teleconsultation and digitalized medical records, are able to significantly increase the effectiveness of health care action. [ABSTRACT FROM AUTHOR]

Introduction: The global increase in female genital cosmetic surgery (FGCS), including procedures like vaginoplasty and perineoplasty, has raised concerns regarding their safety and effectiveness. Therefore, this study aimed to address this gap by assessing the knowledge and attitudes of Jordanian females towards vaginoplasty and perineoplasty. Study design: A cross-sectional online survey was conducted among 522 Jordanian females aged 18 or older. Methods: Quantile regression models were employed to identify variables associated with females’ knowledge and attitudes towards vaginoplasty and perineoplasty. Results: The study revealed a low level of knowledge regarding vaginoplasty and perineoplasty, despite positive attitudes towards these surgeries. Significant associations were found between knowledge levels and both age and occupation. Similarly, attitudes were significantly associated with age and socioeconomic status. Discussion: These findings underscore the need for targeted educational campaigns to enhance awareness about these procedures and their associated risks. Moreover, there should be a focus on evaluating physician-patient communication to ensure informed decision-making. [ABSTRACT FROM AUTHOR]

Loneliness in medicine is a serious problem not just for patients, for whom illness is intrinsically isolating, but also for physicians in the contemporary condition of medicine. We explore this problem by investigating the ideal physician-patient relationship, whose analogy with friendship has held enduring normative appeal. Drawing from Talbot Brewer and Nir Ben-Moshe, we argue that this appeal lies in a dynamic form of companionship incompatible with static models of friendship-like physician-patient relationships: a mutual refinement of embodied virtue that draws both persons together. The ideal physician-patient relationship has a dialectical character that fosters each member's improvement of phenomenologically recognizing and embodying moral virtues. A key component of this dynamic is a commitment to the common goal of the patient's health, realized through joint interactivities and conversations over time. The physician's presence to the patient's suffering—understood best as an alienating phenomenological condition for the patient—orients and discloses possibilities for virtuous caregiving by structuring the meanings of the goals, conversations, and joint narrative constitutive of their relationship. Presence to suffering, paradoxically, is perhaps an important prerequisite for this dynamic partnership. These activities dialectically build an interpretive horizon of understanding through which moral goods and character refinement—in and for the other—may become revealed for both persons in their shared being-in-the-world. This analysis of suffering, mood, and revealing of (possible) moral goods has implications for addressing the modern problem of loneliness for patients and physicians, who are increasingly inhibited from building flourishing relationships with each other. [ABSTRACT FROM AUTHOR]