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Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered. [ABSTRACT FROM AUTHOR]

Background: The goal of advance care planning (ACP) is to improve end-of-life decision-making for patients and their spokespersons, but multiple studies have failed to show substantial or consistent benefit from ACP. Understanding how and why ACP under-performs in the setting of complex medical decision-making is key to optimizing current, or designing new, ACP interventions. Aim: To explore how ACP did or did not contribute to a spokespersons' understanding of patient wishes after engaging in ACP. Design: Thematic analysis of 200 purposively sampled interviews from a randomized control trial of an ACP decision aid. Setting/Participants: 200 dyads consisting of patients 18 years or older with advanced serious illness and their spokesperson at 2 tertiary care centers in Hershey, PA and Boston, MA. Participants were interviewed 1 month after completing ACP. Results: ACP helped participants: 1) express clear end-of-life wishes, 2) clarify values, and 3) recognize challenges associated with applying those wishes in complex situations. Shortcomings of ACP included 1) unknown prognostic information or quality-of-life outcomes to inform decision-making, 2) skepticism about patients' wishes, and 3) complicated emotions impacting end-of-life discussions. Conclusions: Helping patients and their spokespersons better anticipate decision-making in the face of prognostic and informational uncertainty as well as the emotional complexities of making medical decisions may improve the efficacy of ACP interventions. [ABSTRACT FROM AUTHOR]

The use of mixed methods research in intervention trials mostly centers around using quantitative data to assess primary outcomes and qualitative data primarily for exploratory purposes, to supplement, and/or explain quantitative findings. We describe a novel mixed methods procedure that generates an integrated outcome variable used to reexamine unexpected findings that resulted from an advance care planning interventional randomized controlled trial. The integrated outcome variable helped explain apparent anomalies in study data that resulted from analyzing quantitative or qualitative data independently. The methodology outlined in this article provides a useful mixed methodological contribution by illustrating steps that may be taken by researchers seeking a more meaningful way to integrate qualitative and quantitative data to form intervention variables in trials. [ABSTRACT FROM AUTHOR]

Purpose: Sexual assault care provided by sexual assault nurse examiners (SANEs) is associated with improved health and prosecutorial outcomes. Upon completion of SANE training, nurses can demonstrate their experience and expertise by obtaining SANE certification. Availability of nurses with SANE training or certification is often limited in rural areas, and no studies of rural certified SANEs exist. The purpose of this study is to describe rural SANE availability. Methods: We analyze both county‐level and hospital‐level data to comprehensively examine SANE availability. We first describe the geographic distribution of certified SANEs across rural and nonrural (ie, urban or suburban) Pennsylvania counties. We then analyze hospital‐level data from semistructured interviews with rural hospital emergency department administrators using qualitative content analysis. Findings: We identified 49 certified SANEs across Pennsylvania, with 24.5% (n = 12) located in 8 (16.7%) of Pennsylvania's 48 rural counties. The remaining 37 certified SANEs (75.5%) were located in 13 (68.4%) of Pennsylvania's 19 nonrural counties. Interview data were collected from 63.9% of all eligible rural Pennsylvania hospitals (n = 63) and show that 72.5% (n = 29) have SANEs. Of these, 20.7% (n = 6) have any certified SANE availability. A minority of hospitals (42.5%; n = 17) have continuous SANE coverage. Conclusions: Very few SANEs in rural Pennsylvania have certification, suggesting barriers to certification may exist for rural SANEs. Though a majority of hospitals have SANEs, availability of SANEs was limited by inconsistent coverage. A lack of certified SANEs and inconsistent SANE coverage may place rural sexual assault victims at risk of receiving lower quality sexual assault care. [ABSTRACT FROM AUTHOR]

Background: Rural and underserved communities often struggle to provide access to specialized health care, including sexual assault care. Telehealth is an effective solution for providing access to an array of specialized health care services. Prior sexual assault telehealth programs have provided evidence that telehealth is a feasible and acceptable solution. However, there is scant information about program development and considerations in the literature to guide those who may seek to implement a sexual assault telehealth program in their communities. Purpose: The purpose of this paper is to describe the Sexual Assault Forensic Examination Telehealth (SAFE‐T) Center—a nurse‐led model for providing comprehensive, high‐quality sexual assault care in rural and underserved communities recently implemented at 3 hospitals in rural Pennsylvania. Methods: Using the program's logic model, we present our community‐engaged approach to the development and implementation phases of the SAFE‐T Center. Findings: We first describe how academic researchers partnered with multiple stakeholders to form a statewide advisory board and articulated a vision and mission for the SAFE‐T Center that meets the needs of local communities. We then describe the overall design of the model, how it was informed by this academic‐community partnership, and how each element relates to anticipated outcomes. We also present our plans for program evaluation, expansion, and sustainability. Conclusion: This detailed description of collaborative partnership, coalition‐building, program design and implementation can serve as a guide for hospitals and health systems seeking to implement telehealth programs to improve the care provided to survivors of sexual assault. [ABSTRACT FROM AUTHOR]