<p dir="ltr"><b>Background</b></p><p dir="ltr">Recent developments in cancer therapeutics have allowed increased use of Oral Anticancer Medications (OAMs), including in the treatment of breast cancer. Breast cancer is the most common cancer among women in the United States. Patients with breast cancer may face key barriers in managing their OAMs at home. These challenges can lead to sub-optimal adherence and lower the overall quality of life. Designing interventions that enhance the patient experience with use of OAMs requires a deeper understanding of barriers faced by patients as they navigate their cancer care journey. The objective of this study was to identify the unmet medication management needs of patients with breast cancer who are receiving OAMs and co-design an early prototype intervention with patients to support medication management needs of patients with breast cancer.</p><p dir="ltr"><b>Methods</b></p><p dir="ltr">Two phases comprise this study. Phase 1 involved patient-journey mapping to characterize the longitudinal experience of OAMs use among patients diagnosed with breast cancer. In phase 2, we conducted participatory design (PD) workshops to develop a prototype tool to address OAM needs identified in phase 1. All participants were recruited from an outpatient breast cancer clinic in Indianapolis. Eligible participants were: 18 years of age or older, diagnosed with breast cancer, and currently receiving an OAM. All participants completed a brief sociodemographic and health information questionnaire. In phase 1, enrolled persons participated in a journey mapping exercise through semi-structured interviews. Interviews were conducted either in-person or remotely via Zoom, based on participant preference. For each interview, two researchers and the participant collaborated to create individual patient journey maps to generate a concise visual storyboard focused on medication use experiences related to OAMs. The journey maps helped capture treatment timelines, key markers of medication use, and specific barriers faced by patients. Individual journey maps were consolidated to generate personas representing groups of patients with related characteristics, treatment types, goals, and unmet needs. In phase 2, three rounds of PD workshops were conducted using the focus group format to develop an early prototype intervention. In round one (inspiration stage), participants defined the problem space and prioritized a list of challenges amenable to solutions; in round two (ideation stage), participants generated multiple possible solutions and design ideas; and in round three (convergence stage), two design concepts were selected and evaluated by participants.</p><p dir="ltr"><b>Results</b></p><p dir="ltr">In phase 1, 12 interviews (11 females and 1 male) were completed. The median age of participants was 65.5 years (range, 37-75). Participants were divided into two groups based on their prescribed medication types: (1) specialty medication (palbociclib or ribociclib; n=4 patients) and (2) traditional medication (tamoxifen, anastrozole, or exemestane; n=8 patients). We defined ‘Specialty’ medications as those that require specialty pharmacies and ‘traditional’ medications as those obtainable in local community pharmacies. To represent participants across these two broad categories of medications, two personas were created. Participants who had been prescribed specialty medication reported difficulty navigating the insurance process during medication fills, while participants who prescribed traditional medication did not. Notably, the word “prior authorization” was not used by participants to explain the issues they experienced. While all participants reported having side effects from their medications, sub-optimal adherence (n=2) was reported among the traditional medication group only. Other participants taking traditional medications either found their own ways to manage side effects or simply reported: “dealing with side effects as I don’t want cancer.” Participants expressed coping with side effects by enduring them. Participants had few strategies to manage their side effects, often stating that “they didn’t think of reaching out to the doctor,” when asked. Additionally, participants mentioned needing more financial and emotional support during their treatment journey. In phase 2, each PD session was conducted with 4-5 participants and 2 researchers (the design panel). Participants identified key challenges including difficulties navigating resources and information as well as managing medication side effects. The design panel prioritized two design concepts, which were subsequently developed into two prototypes: 1) a physical breast cancer handbook; and 2) an interactive treatment navigation app for use on tablet and smartphone devices. Our team plans to consolidate, further develop, and evaluate these prototypes in subsequent work as a follow up to this pilot study.</p><p dir="ltr"><b>Conclusion</b></p><p dir="ltr">This study provides insight into the patient experience with OAMs. The personas created can be applied in designing interventions tailored to breast cancer patients’ needs and goals, while the consolidated journey maps identify potential areas for improvement. Adequate patient education and enhanced tools and processes are necessary to manage medication side effects effectively, ultimately leading to improved medication outcomes and assisting patients in navigating their treatment. The two design concepts require further revision prior to implementation and pilot testing.</p>

No description available.

Sepsis är ett potentiellt livshotande tillstånd som kräver tidig identifiering och behandling för att inte resultera i dödsfall eller långsiktiga konsekvenser. I nuläget finns det inget standardiserat förlopp på sjukhus i Sverige för hur vården ska agera för att upptäcka patienter som potentiellt utvecklar sepsis vilket tyder på ett behov av det för att förbättra vårdkvaliteten och patientresultaten. För att säkerhetsställa vårdförloppets syfte med att bidra med en jämlik vård för alla och bättre vård för patienterna är det viktigt att implementeringen lyckas och tillämpas av vårdpersonalen. För att det ska ske behöver vårdpersonalen acceptera vårdförloppet. Med grund i teorin om planerat beteende undersöktes vårdpersonalens uppfattning och upplevelser utifrån deras attityder till vårdförloppet, de sociala normer som råder samt deras upplevda kontroll. Dessa faktorer kommer enligt teorin om planerat beteende att påverka deras intention till att använda vårdförloppet. För att undersöka vårdpersonalens uppfattningar och upplevelser utfördes intervjuer på tre sjukhus i Region Östergötland; Universitetssjukhuset Linköping, Vrinnevisjukhuset Norrköping och Lasarettet Motala. Intervjuerna utfördes med de undersköterskor, sjuksköterskor och läkare som var tillgängliga på plats vid besök och som hade kommit i kontakt med vårdförloppet sedan implementeringen. Elva individer deltog. Resultatet analyserades genom tematisk analys med bas i föreställningarna kring beteende, norm och kontroll som ligger till grund för de faktorer som lyfts i teorin om planerat beteende. Resultatet visade på att vårdpersonalen intention till att använda vårdförloppet påverkas av hur det förbättrar vården för patienterna, hur det underlättar dem i deras yrkesroll, hur deras omgivningen accepterar och använder vårdförloppet samt den kontroll de känner i användandet av vårdförloppet. Förbättringsområden gällande beteendeföreställningar, normföreställningar och kontrollföreställningar lyfts vilket kan bidra till att vårdpersonalen tillämpar vårdförloppet med större acceptans. / Sepsis is a potentially life-threatening condition that requires early identification and treatment to prevent fatalities or long-term consequences. Currently, there is no standardized course of care in place for detecting patients at risk of developing sepsis in Swedish hospitals, indicating a need for such intervention to improve the quality of care and patient outcomes. To ensure the intended purpose of the course of care, which is to provide equal care for all and improve patient outcomes, successful implementation and adoption by healthcare professionals are crucial. Acceptance of the intervention by healthcare professionals are necessary for this to occur. Grounded in the Theory of Planned Behavior, this study examined healthcare professionals' perceptions and experiences regarding their attitudes towards the intervention, the prevailing social norms, and their perceived control. These factors, according to the Theory of Planned Behavior, influence the healthcare professional’s intention to use the course of care. To investigate healthcare professionals' perceptions and experiences, interviews were conducted at three hospitals in region Östergötland: Linköping University Hospital, Vrinnevi Hospital in Norrköping, and Motala Hospital. The interviews were conducted with available nursing assistants, nurses, and physicians who had encountered the intervention since its implementation, a total of eleven participants. Thematic analysis was employed to analyze the data, focusing on the behavioral, normative, and control beliefs underlying the factors highlighted in the Theory of Planned Behavior. The findings revealed that healthcare professionals' intention to use the care pathway is influenced by how it enhances patient care, facilitates their professional roles, the acceptance and utilization of the intervention by people in their environment, and the perceived control they experience when using the intervention. Additionally, areas for improvement regarding behavioral, normative and control beliefs are highlighted, which may contribute to greater acceptance and utilization of the intervention by healthcare professionals.

Background: The World Health Organization recommends early breastfeeding initiation, within the first hour of life. Ugandan mothers with no formal schooling appear superior in fulfilling this recommendation compared to mothers with primary, secondary, or higher education. Aim: This secondary analysis of Ugandan Demographic and Health Survey data from 2016 aimed to statistically analyze the association between maternal education and early breastfeeding initiation, to find socio-economic and health care determinants that promote the behavior. Methods: Ugandan mothers (n=9,209, 15 to 49 years) were included in statistical analysis. Chi-squared testing and logistic regression were used to assess associations between maternal education (exposure) and fulfillment of early breastfeeding initiation less than 1 hour after birth (outcome). Results: Out of the eligible mothers in a weighted sample, 68% (n=6,281) fulfilled early breastfeeding initiation and 32% (n=2,928) did not meet the criteria. Maternal primary education significantly predicted the outcome of early breastfeeding initiation (p ≤ 0.05, AOR: 0.80, with 95% CI 0.67-0.95) in a negative direction, compared to uneducated mothers. This result was adjusted for maternal residence, education, occupation, and parity, along with the husband/partner's education. Moreover, educational attainment beyond the primary level indicated a non-significant association to the criteria fulfillment when compared to uneducated mothers. Conclusions: Ugandan maternal education does not seem to significantly promote early BFI behavior. Primary level education only indicated a significantly negative association compared to uneducated Ugandan mothers. Traditional lifestyle factors (lower level education, and corresponding level of occupation, and larger families) appeared to be associated with the desired behavior.

No description available.

Cette étude avait pour but de faciliter et décrire la transformation des pratiques de counseling des cliniciens de soins primaires (SP) qui ont participé à une communauté de pratique interprofessionnelle sur l’entretien motivationnel (CPI-EM). Réalisé au moyen d’un devis qualitatif, cette recherche-action participative (RAP) (Kemmis et McTaggart, 2005, Kemmis et al., 2014) a permis de rassembler 16 cliniciens de SP (infirmières cliniciennes, nutritionnistes, kinésiologues, médecins de famille et psychologue). Ces derniers ont été répartis en quatre CPI-EM qui ont évolué parallèlement au cours de sept rencontres sur une période de dix mois. Des données qualitatives ont été colligées dans le journal de bord de la doctorante tout au long de l’étude. L’observation participante des CPI-EM a été menée notamment selon la démarche du groupe de codéveloppement professionnel (GCP) (voir Article I). Des groupes de discussion focalisée ont aussi été animés lors de la dernière rencontre des CPI-EM. L’observation non-participante de consultations infirmière/patient, suivie d’entrevues individuelles semi- structurées auprès des participants observés ont conclu la collecte de données. L’approche générale inductive décrite par Thomas (2006) a guidé l’analyse des données. Les résultats révèlent deux types de processus impliqués dans l’apprentissage de l’EM chez les cliniciens participants (voir Article II et Article III). D’une part, ces derniers ont cheminé au cours de processus d’appropriation caractérisés par un changement paradigmatique passant d’une perception de leur rôle professionnel d’experts à celui de guides en santé. Leurs traits personnels, leurs expériences cliniques et la perpétuation d’une culture de soins centrés sur les cliniciens plutôt que sur les patients ont influencé leur parcours de formation. D’autre part, ils ont franchi quatre processus impliqués dans l’implantation de l’EM en SP: l’ambivalence, l’introspection, l’expérimentation et la mobilisation. Leurs traits personnels, leur perception de l’EM comme priorité clinique, ainsi que le soutien organisationnel ont constitué les facteurs d’influence de ces processus. À la lumière des résultats, un programme de formation à l’EM est proposé pour accompagner de manière humaniste et motivationnelle la transformation des pratiques de counseling en SP. La facilitation externe de CPI-EM mobilisant une variété de techniques d’enseignement est ainsi suggérée (voir Article IV). Comme retombées, l'amélioration des pratiques collaboratives, de la satisfaction professionnelle, de la santé psychologique au travail et du leadership clinique a été documentée (voir Article V). L'autonomisation (« empowerment ») des infirmières a également été rapportée, qui aurait à son tour bonifiée la satisfaction des patients à l’égard de la pratique des infirmières participantes basée sur l’EM. Cette étude décrit la contribution de la CPI à faciliter l’appropriation de l’EM et son implantation en SP. Le programme de formation a soutenu les changements paradigmatiques et comportementaux ciblés pour et par les cliniciens participants, notamment grâce à la facilitation externe de communautés de pratique et le contexte interdisciplinaire de la RAP. En plus de l’amélioration des pratiques de counseling, diverses retombées ont été documentées attestant du potentiel de cette approche. / This research aimed to facilitate and describe the transformation of the counselling practices of primary care clinicians who participated in an interprofessional community of practice on motivational interviewing (ICP-MI). Using a qualitative design, this participatory action research (Kemmis and McTaggart, 2005, Kemmis et al., 2014) brought together 16 primary care clinicians (nurses, nutritionists, kinesiologists, family physicians and a psychologist). They were divided into four ICP-MIs that have progressed in parallel during seven meetings spread over a period of ten months. Qualitative data has been collected through the research journal of the doctoral student during the study. The participant observation of ICP-MI meetings was conducted partly using the six-step approach of the professional co-development group (see Article I). Focus groups were also facilitated at the last meeting of each ICP-MI. The non-participant observation of the nurse/patient consultations followed by semi-structured individual interviews with observed participants concluded the data collection. The inductive general approach described by Thomas (2006) guided the research activities related to data analysis. The results revealed two types of processes involved in MI learning among the participating clinicians (see Article II and Article III). On the one hand, they have developed through processes of MI appropriation as the clinicians underwent a paradigmatic shift from a perception of their professional role as health experts to that of health guides. Their personal traits, their clinical background, and the perpetuation of a culture of clinician-centred rather than patient-centred care have influenced these processes. On the other hand, they followed four processes involved in MI implementation in primary care: ambivalence, introspection, experimentation, and mobilization. The clinicians’ personal traits, their perception of MI as a clinical priority as well as organizational support constituted the factors of influence of these processes. Therefore, a training program on MI was developed to support in a humanistic and motivational way the 6 transformation of counselling practices in primary care. The external facilitation of ICP-MI using a variety of training activities is thus suggested (see Article IV). The improvement of collaborative practices, professional satisfaction, psychological health at work and clinical leadership has been documented as a benefit (see Article V). Nurse empowerment has also been reported, which in turn has enhanced patient satisfaction with primary care nursing practice based on MI. This research describes the contribution of ICP to facilitate MI appropriation and its implementation in primary care. The training program facilitated the paradigmatic and behavioural changes targeted for and by the participating clinicians, especially through external facilitation of communities of practice and the interdisciplinary context of this participatory study. In addition to improving counselling practices, various benefits have been documented supporting the potential of this approach.