BACKGROUND: Today, person-centred care is seen as a cornerstone of health policy and practice, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). The aim of this study was to explore Swedish health professionals\' perspectives on CSMR and analyse them with regard to potential conflicts that may arise from person-centred care, specifically in relation to shared decision-making.
METHODS: A qualitative study using both inductive and deductive content analysis was conducted based on semi-structured interviews. It was based on a purposeful sampling of 12 health professionals: seven obstetricians, three midwives and two neonatologists working at different hospitals in southern and central Sweden. The interviews were recorded either in a telephone call or in a video conference call, and audio files were deleted after transcription.
RESULTS: In the interviews, twelve types of expressions (sub-categories) of five types of conflicts (categories) between shared decision-making and CSMR emerged. Most health professionals agreed in principle that women have the right to decide over their own body, but did not believe this included the right to choose surgery without medical indications (patient autonomy). The health professionals also expressed that they had to consider not only the woman\'s current preferences and health but also her future health, which could be negatively impacted by a CSMR (treatment quality and patient safety). Furthermore, the health professionals did not consider costs in the individual decision, but thought CSMR might lead to crowding-out effects (avoiding treatments that harm others). Although the health professionals emphasised that every CSMR request was addressed individually, they referred to different strategies for avoiding arbitrariness (equality and non-discrimination). Lastly, they described that CSMR entailed a multifaceted decision being individual yet collective, and the use of birth contracts in order to increase a woman\'s sense of security (an uncomplicated decision-making process).
CONCLUSIONS: The complex landscape for handling CSMR in Sweden, arising from a restrictive approach centred on collective and standardised solutions alongside a simultaneous shift towards person-centred care and individual decision-making, was evident in the health professionals\' reasoning. Although most health professionals emphasised that the mode of delivery is ultimately a professional decision, they still strived towards shared decision-making through information and support. Given the different views on CSMR, it is of utmost importance for healthcare professionals and women to reach a consensus on how to address this issue and to discuss what patient autonomy and shared decision-making mean in this specific context.
Person-centered care is today a widespread approach, but accommodating individual patient preferences can be challenging, for example involving caesarean section on maternal request (CSMR). This study examines Swedish health professionals’ views on CSMR. Interviews with 12 health professionals reveal conflicts between CSMR and key aspects of person-centered care, in particular shared decision-making. While professionals acknowledge women’s autonomy, they question CSMR without medical need. Concerns include for example treatment quality and patient safety, and avoiding treatments that harm others. The Swedish context, balancing collective solutions with individualized care, complicates decision-making. Unlike countries with more private healthcare, where CSMR support might be higher, Swedish health professionals emphasize shared decision-making despite viewing the mode of delivery as primarily a professional decision. This study sheds light on the challenges in integrating CSMR into person-centered care frameworks.

OBJECTIVE: To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries.
METHODS: A qualitative interview study. The interviews were audiorecorded, transcribed and thematically analysed.
METHODS: Urban and rural settings in Ghana, South Africa and Rwanda.
METHODS: 59 patients with musculoskeletal injuries.
RESULTS: We found five common barriers and six common facilitators to injured patient experiences of accessing and receiving high-quality injury care. The barriers encompassed issues such as service and treatment availability, transportation challenges, apathetic care, individual financial scarcity and inadequate health insurance coverage, alongside low health literacy and information provision. Facilitators included effective information giving and informed consent practices, access to health insurance, improved health literacy, empathetic and responsive care, comprehensive multidisciplinary management and discharge planning, as well as both informal and formal transportation options including ambulance services. These barriers and facilitators were prevalent and shared across at least two countries but demonstrated intercountry and intracountry (between urbanity and rurality) variation in thematic frequency.
CONCLUSIONS: There are universal factors influencing patient experiences of accessing and receiving care, independent of the context or healthcare system. It is important to recognise and understand these barriers and facilitators to inform policy decisions and develop transferable interventions aimed at enhancing the quality of injury care in sub-Saharan African nations.

Therapeutic connections (TC) between patients and providers are foundational to patient-centered care, which is co-produced between patients and care providers. This necessitates that we understand what patients expect from TCs, the extent to which providers know what patients expect, and what providers expect. The purpose of this study was to examine nine TC dimensions and determine which are most important to patients, which dimensions providers believe are most important to patients, and which are most important to providers. An online survey of patients (n = 388) and care providers (n = 433) was conducted in the USA in March 2021. Respondents rated the extent to which the nine TC dimensions were important to them, followed by open-ended questions to expand upon what matters. The quantitative responses were rank-ordered and rankings were compared across groups. All groups ranked \"having the patient\'s best interest in mind no matter what\" as the top expectation. Patients also ranked \"caring commitment\" and being \"on the same page\" as highly important. Providers were relatively accurate in ranking what they believed was most important to patients. Respondents affirmed the TC dimensions in the qualitative results, adding nuance and context, such as patients feeling \"heard\" and noting providers that go \"above and beyond.\" Providers ranked dimensions differently for themselves, prioritizing \"full presence\" and \"emotional support\" of patients. This study is among the first to examine expectations for TC. TC could play an explanatory role in understanding variation in patient experience ratings and other outcomes.

OBJECTIVE: To evaluate the content and usability of a new direct observation tool for assessing competency in delivering person-centred care based on the Gothenburg Centre for Person-Centred Care (gPCC) framework.
METHODS: This is a qualitative study using think-aloud techniques and retrospective probing interviews and analyzed using deductive content analysis.
METHODS: Sessions were conducted remotely via Zoom with participants in their homes or offices.
METHODS: 11 participants with lengthy experience of receiving, delivering and/or implementing gPCC were recruited using purposeful sampling and selected to represent a broad variety of stakeholders and potential end-users.
RESULTS: Participants generally considered the content of the four main domains of the tool, that is, person-centred care activities, clinician manner, clinician skills and person-centred care goals, to be comprehensive and relevant for assessing person-centred care in general and gPCC in particular. Some participants pointed to the need to expand person-centred care activities to better reflect the emphasis on eliciting patient resources/capabilities and psychosocial needs in the gPCC framework. Think-aloud analyses revealed some usability issues primarily regarding difficulties or uncertainties in understanding several words and in using the rating scale. Probing interviews indicated that these problems could be mitigated by improving written instructions regarding response options and by replacing some words. Participants generally were satisfied with the layout and structure of the tool, but some suggested enlarging font size and text spacing to improve readability.
CONCLUSIONS: The tool appears to satisfactorily cover major person-centred care activities outlined in the gPCC framework. The inclusion of content concerning clinician manner and skills was seen as a relevant embellishment of the framework and as contributing to a more comprehensive assessment of clinician performance in the delivery of person-centred care. A revised version addressing observed content and usability issues will be tested for inter-rater and intra-rater reliability and for feasibility of use in healthcare education and quality improvement efforts.

UNASSIGNED: Effective communication is vital in nursing, influencing patient safety, satisfaction, and care quality. The AIDET framework is a proven tool for reducing patient anxiety and enhancing their experience. However, perceptions and experiences of Filipino nursing students with AIDET remain unexplored.
UNASSIGNED: This study explored Filipino nursing students\' use of AIDET, focusing on benefits, challenges, and improvements.
UNASSIGNED: A qualitative, interpretive phenomenological approach informed by the philosophy of Martin Heidegger was employed. This 2023 study, conducted at a university in Angeles City, Philippines, explored Filipino nursing students\' experiences with the AIDET communication framework. Thirty participants were purposefully selected to participate in facilitated discussions following a semi-structured interview guide. Thematic content analysis of the transcribed audio recording identified recurring themes in their narratives, focusing on the meanings they ascribed to their experiences using AIDET.
UNASSIGNED: Four themes emerged: (a) Streamlined nurse-patient interaction (organizes communication, rapport building, alleviate anxiety, acknowledgment, and empowerment as sub-themes), (b) Enhances patient-centered care (empathy and compassion, improved patient experience as sub-topics), (c) Challenges with specific patient populations (patient preferences, language barrier, patient condition, acknowledgment of cultural differences as sub-themes), and (d) AIDET in nursing education strengthening application through practice, optimizing frequency and timing, promoting deeper understanding, enhancing feedback mechanism) as student nurses\' recommendations.
UNASSIGNED: Early integration of AIDET in nursing education is essential for student nurses to enhance communication, improve patient satisfaction, and deliver patient-centered care, equipping them with valuable communication skills.

BACKGROUND: Dementia Care Management is an evidence-based model of care. It has proven its efficacy and cost-effectiveness and has been applied to different settings and different target groups. However, it is not available in routine care in Germany. The scientific evidence has influenced the National Dementia Strategy, in which one measure is to examine the possibility and requirements to implement it into routine care. The aim of this study is to implement Dementia Care Management into routine care in a selected region in Germany and evaluate the effect on participants.
METHODS: For the duration of 12 months, n=90 patients and their informal caregivers with cognitive impairment are recruited in different routine settings in primary care (general hospital, physicians\' network, ambulatory nursing service, counselling service) by partners in primary care. They receive an adapted Dementia Care Management (DeCM) to the specific setting using participatory methods. DeCM is delivered by specifically qualified dementia care managers and consists of a comprehensive assessment of healthcare needs followed by algorithm-based and person-based support in healthcare planning, implementing and monitoring. The duration of the intervention is 6 months and data assessments are conducted prior to (baseline), at the end of (follow-up 1, FU1) and 6 months after the end of the intervention (follow-up 2, FU2). Primary outcomes are unmet needs at FU1 and FU2. Secondary outcomes are antidementia drug treatment, neuropsychiatric symptoms and caregiver burden at FU1 and FU2. Further outcomes are cognition, frailty and health-related quality of life. A separate process evaluation accompanies the implementation.
BACKGROUND: The Ethics Committee of University Medicine Greifswald, Germany, has reviewed and approved the study (registration number BB110/22). All participants provide written informed consent prior to participation. The results will be disseminated in regional workshops, press, online media and talks. They will be submitted to international peer-reviewed scientific journals for publication and presented at scientific meetings and conferences. Furthermore, results will be discussed with the funder and presented to the steering committee of the National Dementia Strategy.
BACKGROUND: NCT05529277.

BACKGROUND: Cardiovascular diseases remain a leading cause of death worldwide. Recovery from myocardial infarction is challenging as the causes of symptoms span multiple aspects of health not just physical conditions. Evidence has shown a gap between the waycare is provided in the clinical setting and the person\'s needs and preferences. The implementation of person-centred care (PCC) interventions can promote recovery from myocardial infarction by allowing a greater understanding of the person\'s perception and its role on the overall recovering process. This study aims to culturally adapt an evidence-based PCC intervention to enhance self-efficacy in patients after myocardial infarction within a Portuguese healthcare context.
METHODS: The Portuguese person-centred care for myocardial infarction recovery (P2MIR) intervention is set to be developed from an evidence-based intervention, rooted in the ethics of PCC. An intervention of PCC for patients with acute coronary syndrome, which has been successfully implemented and evaluated in the Swedish healthcare context will be validated, culturally adapted and harmonised to the Portuguese healthcare context by using qualitative methods. To evaluate its acceptability, appropriateness and feasibility, a sample of stakeholders, consisting of a sample of healthcare professionals and a sample of people who suffered a myocardial infarction, will be recruited from a hospital, including both inpatient and outpatient departments. The stakeholders will be invited to semistructured focus group discussions, aiming to gather their perceptions about the P2MIR intervention, which will be previously presented to them. Data analysis will be conducted using content analysis following a deductive-inductive approach to further inform the intervention adaptation process to its final intervention in a Portuguese healthcare context.
BACKGROUND: The study has been reviewed and approved by the Health Ethics\' Committees of the Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal (registry number 20170700050). The results will be disseminated through peer-reviewed journals and conference presentations.

OBJECTIVE: This study aimed to develop a patient-centred approach to the burden of acute type A aortic dissection (ATAAD) through modelling. The main objective was to identify potential improvements in managing this life-threatening cardiovascular condition and to provide evidence-based recommendations to optimise outcomes.
METHODS: We developed a predictive model along patient pathways to estimate the burden of ATAAD through the years of life lost (YLLs) metric. The model was created based on a systematic review of the literature and was parameterised using demographic data from the German healthcare environment. The model was designed to allow interactive simulation of different scenarios resulting from changes in key impact factors.
METHODS: The study was conducted using data from the German healthcare environment and results from the literature review.
METHODS: The study included a comprehensive modelling of ATAAD cases in Germany but did not directly involve participants.
METHODS: There were no specific interventions applied in this study based on the modelling design.
METHODS: The single outcome measure was the estimation of YLL due to ATAAD in Germany.
RESULTS: Our model estimated 102 791 YLL per year for ATAAD in Germany, with 62 432 and 40 359 YLL for men and women, respectively. Modelling an improved care setting yielded 93 191 YLL or 9.3% less YLL compared with the current standard while a worst-case scenario resulted in 113 023 or 10.0% more YLL. The model is accessible at https://acuteaorticdissection.com/ to estimate custom scenarios.
CONCLUSIONS: Our study provides an evidence-based approach to estimating the burden of ATAAD and identifying potential improvements in the management of pathways. This approach can be used by healthcare decision-makers to inform policy changes aimed at optimising patient outcomes. By considering patient-centred approaches in any healthcare environment, the model has the potential to improve efficient care for patients suffering from ATAAD.

Owing to long-term treatment, frequent consultations, and complications, the evaluation of patients with head and neck cancer (HNC) must be improved. This study explored an opportunity for improving patient experience (PE) evaluation of patients with HNC to achieve a patient-centered, integrative evaluation model based on patient needs. The study comprised four phases: (1) a systematic literature review of PE factors for patient quality of life (QoL) and establishment of PE factor categories as a framework, (2) a review of current cancer or HNC PE evaluation tools, (3) identification of potential PE evaluation items based on patient needs by conducting user research, and (4) suggestion of integrative HNC PE evaluation items through expert validation. As a result, the 39 potential items were initially identified from the literature review and user research. After conducting two survey rounds with experts, 25 items were suggested as HNC PE evaluation items. These underscore the importance of highlighting the patient\'s participation, the medical staff\'s comprehensive information delivery, empathy, and collaborative communication, the hospital\'s support of communication channels, the medical environment for patient emotional support, the education program, and systematic patient satisfaction data management. PE evaluation items that consider the diverse perspectives of stakeholders involved in HNC treatment and factors of comprehensive PE will contribute to improving HNC patient-centered care (PCC).

BACKGROUND: After a pilot phase in 2017, nursing visits (PV) were implemented in an intensive care unit (ICU) at a university hospital. So far, published findings on the impact of PV on the primary nursing organisation system (process-responsible nursing [PP]) could not be identified.
OBJECTIVE: Primary aim was to investigate the effects of PV on PP from the nurses perspective. Secondary aims included comparison with the results of the pilot phase (t0) to determine further effects, general conditions of the PP and the overall evaluation.
METHODS: A quantitative evaluation study using a standardised questionnaire was used.
RESULTS: The survey was conducted in September to October 2023 (t1) with a response rate of 74.6% (n = 47). On a scale of 1-6 (strongly agree; strongly disagree), 100.0% of the process-responsible nurses (PP; n = 8) and 77.0% of the nurses without process responsibility (P; n = 30) rated the PV at levels 1-3 (p = 0.328) as contributing to the evaluation of care planning for patients with process responsibility. PV provided support for the implementation of PP (PP: 100.0%, n = 8; P: 79.5%, n = 31; p = 0.318) and had a statistically significant effect (r = 0.97, p = 0.035) on improving the quality of care and care planning for patients with procedural responsibility. The nurses indicated with levels 1-3 that the patients were more consciously brought into the focus of nursing care through the PV (t1: 74.4%, n = 35; t0: 86.4%, n = 38; p = 0.953). The PV should take place weekly and was rated with a median of 2 (IQR t1: 1-3; t0:1-2).
CONCLUSIONS: PV support the implementation of PP and patient-centred care in the ICU.
UNASSIGNED: HINTERGRUND: An einem Universitätsklinikum wurde die Pflegevisite (PV) auf einer Intensivstation (ITS) nach einer Pilotphase im Jahr 2017 implementiert. Bisher fehlt es an publizierten Erkenntnissen zur Auswirkung der PV auf das Pflegeorganisationssystem Primary Nursing (Prozessverantwortliche Pflege [PP]). ZIEL: Primäres Ziel war, Auswirkungen der PV auf die PP aus Sicht der Pflegenden zu untersuchen. Als sekundäre Ziele sollten mit einem Vergleich zu den Ergebnissen der Pilotierungsphase (t0) u. a. weitere Auswirkungen, Rahmenbedingungen der PV und die Gesamtbewertung ermittelt werden.
METHODS: Die quantitative Evaluationsstudie erfolgte mittels eines standardisierten Fragebogens.
UNASSIGNED: Die Befragung fand von 09. bis 10.2023 (t1) mit einem Rücklauf von 74,6 % (n = 47) statt. Auf einer Skala von 1–6 (stimme voll zu; stimme überhaupt nicht zu) trug die PV bei 100,0 % der prozessverantwortlich Pflegenden (PP; n = 8) und 77,0 % der Pflegenden ohne Prozessverantwortung (P; n = 30) mit den Stufen 1–3 (p = 0,328) dazu bei, die Pflegeplanung bei prozessverantwortlich betreuten Patientinnen und Patienten zu evaluieren. Die PV stellte eine Unterstützung für die Umsetzung der PP dar (PP: 100,0 %, n = 8; P: 79,5 %, n = 31; p = 0,318) und hatte einen statistisch signifikanten Effekt (r = 0,97; p = 0,035) auf die Verbesserung der Pflegequalität und Pflegeplanung für prozessverantwortlich betreute Patientinnen und Patienten. Die Teilnehmenden gaben mit den Stufen 1–3 an, dass die Patientinnen und Patienten durch die PV bewusster in den Fokus der Pflege gerückt werden (t1: 74,4 %, n = 35; t0: 86,4 %, n = 38; p = 0,953). Die PV sollte wöchentlich stattfinden und wurde im Median mit einer 2 (IQR t1: 1–3; t0:1–2) bewertet.
UNASSIGNED: PV unterstützen die Umsetzung von PP sowie die Patientinnen- und Patientenzentrierung auf der ITS.