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Background: Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. Methods: This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. Results: The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Conclusion: Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.

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BACKGROUND: Modern approaches such as patient-centered care ask health care providers (eg, nurses, physicians, and dietitians) to activate and include patients to participate in their health care. Mobile health (mHealth) is integral in this endeavor to be more patient centric. However, structural and regulatory barriers have hindered its adoption. Existing mHealth apps often fail to activate and engage patients sufficiently. Moreover, such systems seldom integrate well with health care providers' workflow. OBJECTIVE: This study investigated how patient-provider communication behaviors change when introducing patient-generated data into patient-provider communication. METHODS: We adopted the design science approach to design PatientHub, an integrated digital health system that engages patients and providers in patient-centered care for weight management. PatientHub was developed in 4 iterations and was evaluated in a 3-week field study with 27 patients and 6 physicians. We analyzed 54 video recordings of PatientHub-supported consultations and interviews with patients and physicians. RESULTS: PatientHub introduces patient-generated data into patient-provider communication. We observed 3 emerging behaviors when introducing patient-generated data into consultations. We named these behaviors emotion labeling, expectation decelerating, and decision ping-pong. Our findings show how these behaviors enhance patient-provider communication and facilitate patient-centered care. Introducing patient-generated data leads to behaviors that make consultations more personal, actionable, trustworthy, and equal. CONCLUSIONS: The results of this study indicate that patient-generated data facilitate patient-centered care by activating and engaging patients and providers. We propose 3 design principles for patient-centered communication. Patient-centered communication informs the design of future mHealth systems and offers insights into the inner workings of mHealth-supported patient-provider communication in chronic care.

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BACKGROUND: Patients with persistent critical illness experience prolonged multi-system morbidity, functional impairments, and chronic conditions. As a result, these patients have prolonged intensive care unit admissions. If discharged, they return home with long-term medical dependencies. Care partners take on a variety of physical, mental health, cognitive, and social roles to support the provision of care for these patients. There is limited evidence, however, of the impact of being a care partner for this patient population during hospitalization. METHODS: A qualitative descriptive study was conducted to explore the impact care provision on care partners for patients experiencing persistent critical illness. Patients who have or have had persistent critical illness and care partners were recruited from two inpatient units in a single community academic hospital in Toronto, Canada to participate in semi-structured interviews. Data was analyzed using a team-based inductive content analysis. RESULTS: Seven (43.8%) participants were patient survivors, and nine (56.3%) were care partners. Patients and care partners reported physical, socio-emotional, and social stress as impacts of care provision during persistent critical illness hospitalization. Care partners identified several protective strategies that they used to mitigate the impacts of care provision on them such as seeking external mental health support and boundary setting. Features of formalized and care partner programs were also identified and suggest that these programs can be protective of care partner values, mitigate feelings of helplessness and stress, and may improve relationships between the family members who are in the care partner role and the healthcare team. CONCLUSIONS: This study identified physical, socio-emotional, and social stress related impacts of care provision on care partners of patients with persistent critical illness during hospitalization. Additionally, this study identified protective factors initiated by care partners to mitigate the reported stresses of the role, as well as protective features of a care partner program. The results provide a better understanding supportive features of care partner programs that are specific to the experiences and needs of persistent critical illness and add to the growing body of evidence about how to provide equitable access to care during and post hospitalization.

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Patient experience is considered a pillar of high-quality care, integral to patient-centered care, but despite significant policy focus on patient-reported experience measures (PREMs), little is published regarding their development, use, or impact on clinical practice. In nephrology, PREMs are increasingly used in research to capture and quantify patients' perceptions of their experiences with health care services. It has been shown that a negative patient experience impacts patients' physical and psychological health, and a small but significant proportion of patients across a selection of settings report their experiences of health care as poor or suboptimal. Evidence of whether PREMs improve quality of care or support person-centered care in the clinical setting remains largely theoretical. Extensive effort has been invested to develop various PREMs for kidney services. Although little evidence linking PREM collection to meaningful change in delivery of care currently exists, work is underway. Early indications are that with the right facilitators, implementing PREMs in routine practice can help providers recognize where change is needed and galvanize transformation. The journey toward understanding the connection between PREM data and modifiable provider characteristics to target and enable change has started, but further evidence is needed. This article outlines the history of PREMs in nephrology and details their current use alongside implementation challenges. The use and benefits of PREMs are discussed before considering the evidence base for their impact on renal health care. Possible next steps for PREMs are suggested and best practices highlighted.

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BACKGROUND: Patient-centered care for persons with Parkinson's disease (PwPD) is associated with positive outcomes, but is lacking in current healthcare systems. OBJECTIVE: In this qualitative study, we solicited advice from PwPD to medical professionals, family members/friends, and newly-diagnosed PwPD. METHODS: Through an online survey, 275 PwPD answered open-ended questions asking for their advice. Responses were analyzed using content analysis. Interrater reliability was 94.5%. RESULTS: Three qualitative themes were identified. First, participants advised enhancing care and communication, with healthcare professionals balancing clinical constraints with compassion, and family/friends balancing support with appreciating autonomy of PwPD. The second theme was empowering PwPD through increasing their knowledge of the disease and care options. The third reflected the importance of focusing on well-being and connection. CONCLUSION: The results highlight several gaps in meeting the needs of PwPD in healthcare settings and personal relationships, underscoring the importance of integrating their perspectives in shaping approaches to care.

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BACKGROUND: Patient-centered care (PCC) is an essential component of high-quality health, yet patients with non-English language preferences (NELP) experience worse PCC outcomes. Additionally, there are likely unique aspects to PCC for patients with NELP in the emergency department (ED). To inform the development of strategies to improve PCC for NELP in the ED, we sought to understand how Spanish-speaking ED patients experience care and the factors that influenced their perceptions of the patient-centeredness of that care. METHODS: We conducted a single-center qualitative study using semistructured interviews with adult, Spanish-speaking patients who had been discharged home from the ED. Interviews were conducted using an interview guide, recorded, transcribed, and analyzed iteratively in Spanish using inductive and deductive thematic analysis. RESULTS: We conducted 19 interviews with participants from 24 to 72 years old. Participants were born in seven different Spanish-speaking countries. Participants identified three domains of PCC: patient, medical team's skills, and system. Several of the identified themes such as shared decision making, open communication, compassionate care, and coordination of follow-up care are often incorporated into PCC definitions. However, other themes, including uncertainty leading to fear, use of professional interpreters to promote understanding, receiving equitable care, technical proficiency, and efficiency of care expand upon existing domains in PCC definitions. CONCLUSIONS: We now have a more nuanced understanding of how Spanish-speaking patients with NELP experience PCC in the ED and what matters to them. Several of the themes identified in this analysis add details about what matters to patients within the domains of previous PCC definitions. This suggests that the conceptualization of PCC may vary based on the setting where care is provided and the population who is receiving this care. Future work should consider patient population and setting when conceptualizing PCC.

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Excessive and incorrect use of antibiotics contributes to the rise of antimicrobial resistance (AMR). Given that pharmacists act as final checkpoint before antibiotics is handled over to patients, they play a crucial role in promoting proper antibiotic use and ensuring treatment adherence. However, there is often a gap between the patients' needs and perceptions, and what the pharmacists provide. Improving pharmacists' training is essential for enhancing patient-centered care. The aim of this research was to evaluate the suitability of academic detailing (AD) for improving Norwegian pharmacists' knowledge and practice on adherence promoting counseling of antibiotic patients. Key insights from prior qualitative research regarding community pharmacists' position in promoting optimized antibiotic use were incorporated in a tailored AD program. The AD's suitability was evaluated using the validated "Provider Satisfaction with Academic Detailing" (PSAD) and "Detailer Assessment of Visit Effectiveness" (DAVE) instruments. Additionally, participants preferred knowledge updates method were assessed. Eighty-one of 86 visits completed PSAD (94% response rate). Satisfaction summary score for PSAD was 40.03 (of maximum 45) and scale summary score for DAVE 12.45 (of maximum 15). One-sample t-test (P < .001) indicated preference for AD over other knowledge update methods. This study confirmed that AD is a successful knowledge updating tool for improving adherence promoting counseling among Norwegian pharmacists. Future research should align practice change intentions with actions post-AD and evaluate patient impact.

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Objectives: The 2030 Sustainable Development Agenda stresses a feminist approach for healthcare services. Cultural and religious influences impact utilization of healthcare services by Muslim women within the Middle East, posing unique challenges. This paper aimed to investigate the factors influencing Middle Eastern women's utilization of healthcare services within the region. Methods: In the year 2024, a systematic review was conducted. PubMed, Scopus, ProQuest, and the Cochrane Database of Systematic Reviews were searched for this purpose. The quality of the included articles was assessed using the Accuracy, Coverage, Objectivity, Date, Significance (ACODS) checklist. Subsequently, the Joffe method of thematic analysis was employed to analyze the data obtained from the review. Results: A final selection comprising 59 studies was made for inclusion in the research. The studies demonstrated a high level of quality, and the risk of bias within them was deemed acceptable. The thematic analysis revealed seven principal themes, which encompassed Demographic Factors, Level of Education and Awareness, Sources of Information, Risk Factors, Personal Factors, Level of Service Access and Quality, and Organizational Factors. Conclusions: This study highlighted key factors influencing women's utilization of healthcare in the Middle East and potentially the healthcare systems with a large number of Middle Eastern female immigrants around the globe: educational factors such as awareness campaigns and patient education, and personal barriers like fear and cultural norms. Moreover, Telehealth, particularly mHealth, was suggested to enhance women's participation and utilization of healthcare services. Further research is needed to explore this assertion with greater precision.

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This report analyzes the evolution of cancer nursing research in Italy, focusing on 207 publications from nursing journals indexed in MEDLINE. Using Latent Dirichlet Allocation, we identified four primary research topics from the included abstracts: Patient-Centered Care, Clinical Nursing Practice, Healthcare Institutions and Systems, and Research and Data Analysis. The temporal trends reveal a shift from foundational studies on healthcare systems in the late 1990s to more recent emphases on patient-centered care and clinical practice. This progression underscores the growing importance of personalized healthcare approaches. Our findings highlight the need for continued investment in innovative nursing interventions and advanced technologies, such as telehealth, to enhance patient outcomes. Research priorities need to investigate how to tailor nursing interventions to individual patient characteristics, such as their cultural background, lifestyle, and personal values, in the area of clinical nursing practice, which is less represented in the literature thus far. The limited publications regarding clinical nursing practice in the Italian context might reflect the need to strengthen cancer nursing as a specialization in Italy to trigger research and practice that address unmet patient needs. The current analysis provides a foundation for future comprehensive studies and strategic development of a research agenda for cancer nursing research in Italy, led by the Italian Association of Cancer Nursing.

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BACKGROUND: Patients with advanced heart failure (AHF) desire communication around values and goals prior to treatment decisions. OBJECTIVES: To evaluate the timing and content of the first serious illness communication (SI conversation) for patients with AHF after referral to a specialist palliative care (PC) team (HeartPal). METHODS: In this retrospective cohort study, we used electronic health records to identify patients referred to HeartPal and their first SI conversations at a tertiary care hospital between October 2018 and September 2021. We used natural language processing and predetermined codes to quantify prevalence of prior goals of care conversations by the cardiology team within six months preceding the HeartPal consultation and the prevalence of hopes, fears, and seven conversation content codes. Consecutive SI conversations and patient outcomes were followed until March 2022. RESULTS: Of 468 patients (mean age: 64 years, 72 % male, 66 % referred for goals of care conversation), 25.2 % had prior documented goals of care conversations preceding the HeartPal consultation. During the study period, 206 (44.0 %) patients died (median time from initial SI conversation to death: 65 days, IQR 206) and 43.2 % engaged in multiple SI conversations before death. SI conversation analysis (n = 324) revealed that patients hoped to "be at home" (74.1 %, n = 240), "be independent" (65.7 %, n = 213) and "live as long as possible" (53.4 %, n = 173). Conversation content included goals of care (83.0 %), strengths (83.0 %), decision-making (79.3 %), spirituality (71.0 %), coping (52.2 %), and prognostic communication (43.5 %). CONCLUSION: Specialist PC service provides documentation of goals and values and offers longitudinal follow-up for patients with AHF.

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BACKGROUND: Positive person-centered attributes of inpatient rehabilitation need to be identified from the patient's perspective to be further developed and sustained. PURPOSE: To identify which attributes patients openly evoke as being great care experiences, using an open appreciative inquiry during the inpatient rehabilitation stay. METHODS: Qualitative secondary analysis of appreciative patient comments during a bedside patient experience rounding facilitated by a neutral party was performed. Two independent analysts employed an inductive, summative form of content analysis. RESULTS: Among 150 patients rounded, 122 provided categorizable appreciative accounts. Over two-thirds of the patients (67.2%) focused on "staff attributes" in their great-experience accounts. Those attributes were mostly interpersonal such as being "attentive & caring-beyond clinical duty" and being "encouraging (but not too hard) & reassuring". These interpersonal staff attributes were reported with words showing deep levels of personal significance or patient appreciation. Beyond staff attributes, the perceived quality of "patient care" (31.1%) and opportunities for "leisure and social activities" (9.0%) were also frequently evoked. Amenities like food or customer service were the least evoked, rarely so as an exclusive attribute (0.8% for each). CONCLUSIONS: The human(e) factor, especially the interpersonal qualities of staff, emerged as greatly appreciated from the patient experience perspective during inpatient rehabilitation. These experiences help identify which person-centered attributes of care might be further developed and sustained.

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BACKGROUND: In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. METHODS: Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. RESULTS: Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. CONCLUSIONS: This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

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INTRODUCTION: Professional caregivers' perspectives on dementia and on people living with dementia (PlwD) can influence their feelings, judgements and behaviours in work situations, for example, how they think about symptoms, disease progression and the impact on a person's quality of life. Their individual dementia mindset, which can be investigated with the 12-item Dementia Mindset Scale (DMS), might influence job satisfaction, work-related well-being and person-centred care. The aim of the proposed replication study is to confirm the results of the original study of the DMS and to test whether a malleable mindset is correlated with higher levels of caregiver education, dementia-specific professional experience/competence and dementia knowledge. METHODS AND ANALYSIS: Professional caregivers in residential care facilities for older persons who work directly with PlwD will be asked to answer an anonymous web-based online survey. The survey encompasses five standardised questionnaires: the DMS, the Dementia Knowledge Assessment Scale, the Oldenburg Burnout Inventory, the Job-related Affective Well-being Scale and the Sense of Competence in Dementia Care Staff Scale. In addition, job satisfaction, the educational background, professional experience and work situation are surveyed. For replication, the analyses will re-evaluate the psychometric properties (structural validity, model fit, internal consistency and predictive validity) by applying descriptive statistics, regression analysis, confirmatory factor analysis and correlation analysis. The additional analyses will use descriptive statistics, regression analysis and correlation analysis. Rasch analysis will be used to rank the difficulty of the items. ETHICS AND DISSEMINATION: This study was approved by the ethics committee of the German Society of Nursing Science (ID number 23-004). No personal information will be gathered. The results of the study will be distributed nationally and internationally through peer-reviewed academic journals, conferences, institutional websites and journals for nursing care practice.

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BACKGROUND: This study aimed to test the efficacy of patient-centered self-management intervention (PACE-SMI) to improve HbA1c, self-efficacy, and self-care behaviors in adults with type 2 diabetes mellitus (T2DM). METHODS: In this multicenter, parallel two-arm randomized controlled trial, 612 adults with T2DM and HbA1c ≥ 7% were enrolled and assigned to the control group (n = 310) and the intervention group (n = 302) using stratified permuted block randomization. The control group received usual care, whereas the intervention group received usual care plus nurse-led, theory-driven, culturally tailored PACE-SMI, comprising eight weekly sessions of individualized education, counseling, behavioral training, and home visit. Outcomes were assessed at baseline, postintervention, and 3 months follow-up. RESULTS: Data at 3 months were provided by 583 participants (control: n = 295, intervention: n = 288). Per-protocol analysis showed that the intervention group had a lower mean HbA1c (8.49% [standard deviation (SD), 1.58]) than the control group (8.74% [SD, 1.62]), with small yet statistically significant mean difference of 0.25% (95% confidence interval [CI], -0.01 to 0.51; Cohen's d = 0.16; p = 0.03). Self-efficacy and self-care behaviors significantly improved in the intervention group (116.89 [SD, 25.50] and 70.01 [SD, 17.97]) compared to the control group (75.43 [SD, 18.99] and 51.54 [SD, 12.04]), with mean differences of 41.48 (95% CI, 37.83-45.13; Cohen's d = 1.84; p < 0.0001) and 18.56 (95% CI, 16.08-21.04; Cohen's d = 1.22; p < 0.0001), respectively. Linear regression analysis indicated the effect of PACE-SMI on HbA1c was significantly mediated by improvements in self-efficacy and self-care behaviors (R2 = 0.232, p < 0.001). CONCLUSION: PACE-SMI led to modest but significant improvement in HbA1c and substantial enhancements in self-efficacy and self-care behaviors in adults with T2DM.

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This paper explores transformative strategies in hand therapy aimed at improving the patient experience - a critical factor linked to improved clinical outcomes and increased satisfaction for patients and therapists. The focus is on three key areas: personalized interactions, empathic communication, and sensory engagement. Personalized interactions ensure therapy is uniquely tailored to each patient' needs, fostering a sense of individual attention and care. Empathic communication involves understanding and responding effectively to patients' verbal and nonverbal cues, creating a supportive environment where patients feel genuinely heard. Sensory engagement utilizes the therapeutic environment's visual, olfactory, and auditory elements to create a calming, welcoming space conducive to healing and relaxation. Integrating these strategies aims to increase treatment effectiveness and improve therapist well-being by promoting a fulfilling and less stressful work environment. Through a comprehensive review of existing evidence, current practices and innovative approaches, this paper advocates for a holistic, patient-centered model of hand therapy that significantly improves treatment outcomes and enhances the overall therapeutic experience, ensuring it is both practical and compassionate.

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INTRODUCTION: Persons after stroke experience limitations in activities of daily living even in the chronic phase. Many patients who had a stroke report mobility limitations with loss of social roles such as reduced gait-related participation. International best-practice recommendations for patients who had a stroke include interprofessional diagnostics as a core element for goal setting and intervention planning to improve social participation. Interprofessional diagnostics has not yet been implemented in Germany. METHODS AND ANALYSIS: The aim is to develop an interprofessional diagnostic toolkit. This will be done in a multi-step process: first, an integrative review is conducted to synthesise the literature. Second, the experiences regarding diagnostics and walking outside is captured in focus groups with persons after stroke, relatives and health professionals. Third, a toolkit for the interprofessional diagnostic process of gait-related-participation will be developed based on the results of the previous steps in a future workshop. Fourth, the results of each work package will be integrated into the iterative development process for evaluation and implementation. All steps will be performed in accordance with the respective reporting guidelines. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee at the Ludwig Maximilians University (LMU), Germany and is overseen by LMU-Medical Institutional Review Board. Written informed consent will be obtained from all participants. Results will be disseminated through knowledge exchange with stakeholders and in peer-reviewed journal publications, scientific conferences, formal and informal reports. Stakeholders, patients and providers will be involved in most steps of the development from the beginning, which will facilitate later implementation at a larger scale. TRIAL REGISTRATION NUMBER: German Register Clinical Trials/Deutsches Register Klinischer Studien DRKS00032389.

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INTRODUCTION: Care aides are health workers who deliver hands-on care to patients across the healthcare continuum. The use of technology in healthcare delivery is increasing, and evidence regarding how care aides' attitudes may either facilitate or hinder the adoption of healthcare technologies is lacking.The aim of the proposed scoping review is to examine available evidence regarding care aides' attitudes towards the adoption of innovation and factors that may influence the sustainable use of technology in healthcare delivery. Published studies, grey literature and review articles that identify a method for the review, conference abstracts and website publications regarding the attitude, uptake and sustainable use of technology in care delivery by care aides will be included. For abstracts that have resulted in publications, the full publications will be included. The search for evidence commenced in June 2023 and will end in March 2024. METHODS AND ANALYSIS: The Joanna Briggs Institute (JBI) method will be used to conduct the review. The CINAHL, Cochrane Library, EMBASE, MEDLINE, ProQuest, PubMed, SCOPUS, PROSPERO, Web of Science and JBI Evidence Synthesis databases will be searched using keywords for publications within the last 20 years to examine trends in health technology and attitudes of care aides towards innovation over the last two decades. A search of grey literature and websites will be conducted. The reference list of the retrieved articles will be used to identify additional literature. The search results will be exported into a literature management tool for screening and analysis. Article screening will be performed by two authors and if a third is needed to resolve any differences. Data analysis will be guided by two theoretical frameworks. ETHICS AND DISSEMINATION: No ethics approval is required. The findings will be disseminated in a peer-reviewed journal and presented in conferences. REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/CZQUP.

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BACKGROUND: Adolescence and young adulthood are critical life stages with varied healthcare needs. Adolescents and young adults (AYAs) are often confronted with challenges in their sexual and reproductive health (SRH) and rights. Uptake of SRH services among AYAs groups remains limited, especially in resource-limited settings. This could be partly attributed to the existing services not catering for the preferences of AYAs. However, there is no systematic evaluation of research to explore the preferences of AYAs for SRH services in Africa. Therefore, the objective of this systematic review is to assess AYAs's preferences for SRH in Africa. METHODS AND ANALYSIS: The systematic review will follow the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. Stated preference studies in the area of SRH services conducted among AYAs will be included. We will search MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, Global Health and Google Scholar databases. Two independent researchers will screen the articles, and any disagreement will be handled through discussion with the broader research team. The quality of the included papers will be assessed and reported. The preferences for attributes, the most important and least important attributes and preference heterogeneity will be reported. In addition, the preference research gap across African regions and SRH services among AYAs will be reported. ETHICS AND DISSEMINATION: Ethical approval is not required for this protocol. The systematic review findings will be published in a peer-reviewed journal and presented at conferences. PROSPERO REGISTRATION NUMBER: CRD42023386944.

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