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.

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.
CONCLUSIONS: 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.

BACKGROUND: Patient experience surveys gather information on various aspects of care via numerous survey items. Identifying the most critical areas of patient experience to prioritize for quality care improvement can be challenging. The objective of this study was to determine which care experience items are the drivers influencing patients\' overall rating of cancer care.
METHODS: Data from 2750 adult patients with cancer from the second wave of the Swiss Cancer Patient Experiences study were analyzed. This cross-sectional survey was conducted in eight Swiss hospitals from September 2021 to February 2022. Stepwise logistic regression examined the relationship between overall care rating and 29 patient experience items covering different patient-centered care dimensions while adjusting for sociodemographic and health variables.
RESULTS: Overall, patients rated their cancer care experience at 8.9 out of 10. Stepwise regression identified seven drivers contributing to overall care rating. The strongest drivers were \"professionals worked well together\" (odds ratio [OR], 4.81) and \"tests were not repeated\" (OR, 2.09) from the coordination and integration dimension, \"offered support for symptoms during treatment\" (OR, 2.11) from the physical comfort dimension, followed by \"hospital staff ensured available home support\" (OR, 1.99), \"offered to see health professional for concerns\" (OR, 1.91), \"treatment options were explained\" (OR, 1.75), and \"involved in treatment decisions as desired\" (OR, 1.68).
CONCLUSIONS: This study evaluated the care experiences of patients with cancer with a comprehensive tool that identified seven key factors independently associated with overall care rating. By concentrating on these areas, hospitals can not only improve the patient care experience but also efficiently allocate resources to quality improvement initiatives.

BACKGROUND: The Joint Commission emphasizes the importance of cultural competence and effective communication in quality medical care, particularly during end-of-life (EOL), when decisions are influenced by diverse cultural and religious backgrounds. For Orthodox Jewish patients, the philosophical framework used for EOL decision-making may conflict with that used in traditional Western medical ethics. In this paper, we explore the complexities of EOL decision-making for devout Jewish patients and highlight how approaches may differ from a Western ethical framework.
OBJECTIVE: This paper aims to familiarize clinicians with EOL preferences of Orthodox Jewish patients, organized into an ethical framework called \'casuistic deontology\'. Leading with an open-minded approach emphasizing cultural humility, we explore ways in which integrating this perspective can allow for culturally appropriate and compassionate EOL care.
METHODS: Using a case study methodology, we focus on a 79-year-old Orthodox Jewish male hospitalized with severe injuries. The patient\'s medical course is analyzed, highlighting how the decisions made by his family in consultation with their Rabbi may differ from the decisions made with a philosophy of a Western ethical framework.
CONCLUSIONS: This case illustrates the ethical tensions that may arise when Western medical practices intersect with Orthodox Jewish beliefs, particularly regarding brain death, resuscitation, and artificial nutrition. We underscore the need for cultural sensitivity when approaching EOL decision-making, allowing for compassionate and comprehensive care that respects religious perspectives. This paper helps provide a structure for clinicians to navigate the complex EOL care needs for the devout Jewish patient in a manner consistent with their cultural and religious identity.

OBJECTIVE: This case study delineates a minimally invasive and effective approach for the aesthetic and functional restoration of teeth in a patient with Rubinstein-Taybi syndrome (RTS), focusing on the challenges and strategies tailored to their specific dental care needs.
RESULTS: A 20-year-old patient diagnosed with RTS presented at the Pediatric Dentistry Department for a comprehensive dental assessment and care. The individual\'s genetic condition manifested in unique dental and craniofacial anomalies, complicating standard dental procedures. Following an initial consultation that underscored limited cooperation due to intellectual disabilities, a customized treatment plan was developed. This included behavior modification techniques to acclimate the patient to dental settings and procedures. Utilizing \"simplified technologies\" such as volumetric polymerization composites and self-etching primer and adhesive systems, tooth 36 was successfully treated. The approach showcased the potential for dental care in RTS patients with minimal sedation, prioritizing patient comfort and cooperation.
CONCLUSIONS: The successful dental treatment of the RTS patient highlights the importance of patient-centered, minimally invasive approaches in managing individuals with special healthcare needs. Emphasizing continuity of care and prioritizing restorative treatments facilitated significant improvements in oral health and patient cooperation. This case contributes to the sparse literature on dental care for RTS patients, advocating for specialized strategies to address their comprehensive oral health needs. The findings underscore the necessity for interdisciplinary collaboration and innovative care protocols to ensure effective and empathetic dental treatment for individuals with RTS.

Count Neipperg (1775-1829), the morganatic husband of Maria Luigia of Habsburg, Napoleon\'s former wife, presented with typical heart failure symptoms and died of bilateral bronchopneumonia. Neipperg\'s case is an example of the conflict in the medical field, which led to the birth of modern evidence-based medicine (EBM), and although Neipperg died almost 200 years ago, his case presents the same critical issues that more complex geriatric patients face today. First, the attending physicians provided divergent opinions without reaching an agreement. For example, Francesco Rossi correctly diagnosed heart disease by evaluating the patient\'s signs and symptoms, a clinical approach that is an early example of modern EBM. By contrast, Giacomo Tommasini made a misdiagnosis based on the philosophical principles of John Brown\'s vitalist theory, as reworded by Giovanni Rasori. Second, Tommasini\'s medical report also includes evidence of the Geriatric 5Ms for older patient care, such as multi-complexity, multimorbidity, medication, mobility, and the mind. Moreover, both physicians considered \"what matters most\" for the patient and his family. Third, the Count\'s status and political role were identified as the social and structural determinants of health (SSDoH) and used to justify the exceptional intensity of the health care provided. Subsequently, the ante litteram application of EBM and a clinical evaluation based on Geriatrics 5Ms principles anticipate current multidisciplinary management focused on the patient rather than a single disease. The systematic revision of past clinical cases not examined before could open new windows in the dissemination of the geriatric methodology and discipline.

Patient-centered care (PCC) is an innovative approach to the diagnosis and treatment of malignancy that aims to improve patients\' experience during the management of their disease. However, despite growing interest, the concept and specifics of PCC remain unclear. This consensus document addresses this gap by providing a literature review and a clear definition of PCC and outlines its main components as observed in real-world practice. These components include daytime diagnostic and treatment procedures, in-hospital and community-based infusion centers, home-based diagnostic and treatment services, smart healthcare solutions, and integration of traditional Chinese medicine. This document delves into the implementation of PCC and explores its potential benefits.

OBJECTIVE: Beyond causing physical discomfort, overactive bladder (OAB) is distressing to patients across a variety of psychosocial domains. In this qualitative component of a larger mixed methods study, we explore patients\' lived experience with OAB to understand how this condition impacts individuals on a personal and social level, as well as their experiences interacting with the health care system.
METHODS: A total of 20 patients and 12 physicians completed a questionnaire and semi-structured interview. The interview guide, developed in an iterative fashion by the authors, included questions about treatment decision making as well as experiences living with or treating OAB; this manuscript focuses on the questions probing lived experiences and interactions between patients and physicians. The interviews were recorded, transcribed and inductively coded and analyzed according to the principles of interpretive description to develop themes.
RESULTS: Analysis of patient and physician interviews yielded five key themes: isolation due to OAB diagnosis, social stigma associated with noticeable OAB symptoms, embarrassment from interactions with the health care system, feeling invalidated and dismissed by physicians, and OAB patients as a \"vulnerable\" population with \"desperation\" for cure.
CONCLUSIONS: OAB causes patients marked distress beyond their physical symptoms; it causes feelings of isolation from friends and family and makes them feel embarrassed to discuss their condition with loved ones and physicians alike. Efforts to destigmatize OAB, validate patient experiences, and improve access to OAB care may help diminish the psychosocial burden of OAB.

In this multi-professional review, we will provide the in-depth knowledge required to work in the expanding field of obesity treatment. The prevalence of obesity has doubled in adults and quadrupled in children over the last three decades. The most common treatment offered has been lifestyle treatment, which has a modest or little long-term effect. Recently, several new treatment options-leading to improved weight loss-have become available. However, long-term care is not only about weight loss but also aims to improve health and wellbeing overall. In the era of personalized medicine, we have an obligation to tailor the treatment in close dialogue with our patients. The main focus of this review is new pharmacological treatments and modern metabolic surgery, with practical guidance on what to consider when selecting and guiding the patients and what to include in the follow-up care. Furthermore, we discuss common clinical challenges, such as patients with concurrent eating disorder or mental health problems, and treatment in the older adults. We also provide recommendations on how to deal with obesity in a non-stigmatizing way to diminish weight stigma during treatment. Finally, we present six microcases-obesity treatment for persons with neuropsychiatric disorders and/or intellectual disability; obesity treatment in the nonresponsive patient who has \"tried everything\"; and hypoglycemia, abdominal pain, and weight regain after metabolic surgery-to highlight common problems in weight-loss treatment and provide personalized treatment suggestions.

BACKGROUND: The 2022 National Academy of Sciences, Engineering, and Medicine report on equity in organ transplantation highlighted limited transparency and accountability for organ offer declines and recommended prioritizing patient engagement in decisions regarding organ offers. Yet, there is no guidance on how to incorporate patients in organ offers. We elected to study the experiences of patients on the waitlist and their perception of a novel Organ Offer Review Card (OORC).
METHODS: A prototype OORC was created using Donornet refusal codes. Sixty randomly selected kidney waitlist patients at a single center were asked to participate in a web-based survey focusing on current medical decision-making preferences and perceptions of the prototype OORC.
RESULTS: Among the 43 patients reached, 17 (39.5%) completed the survey. Most participants (88.2%) expressed it was important to be involved in the decision-making about organ offers, with 100.0% of respondents wanting to know why an organ was declined. Regarding the prototype OORC, 94.1% thought it helped them understand the factors and priorities considered when selecting an organ, and 88.2% said it increased their belief that their team was acting in their best interest.
CONCLUSIONS: An OORC could increase transparency and communication during the waitlist process while enhancing trust in the transplant team.