Family physicians' diagnostic gut feelings are measurable: construct validation of a questionnaire

Patient journey and timeliness of care for patients with breast cancer in Africa: a scoping review protocol

INTRODUCTION

Cancer is the leading cause of death worldwide, with breast cancer being one of the most commonly diagnosed types. Low-income and middle-income countries account for nearly half of all breast cancer cases and related fatalities. In Africa, mortality rates are higher and survival rates are lower compared with developed countries. Timeliness of care is a critical aspect of healthcare, but various studies and healthcare systems use different criteria and methods to measure it. Assessing the breast cancer care pathway and understanding the determinants of delayed care are essential for effective interventions. Therefore, this scoping review aims to evaluate the methods used to measure the timeliness of breast cancer care, identify specific points in the care pathway where delays are most frequently reported, and examine the factors affecting the timeliness of breast cancer care in Africa.

METHODS AND ANALYSIS

We will conduct this scoping review using the Arksey and O'Malley framework endorsed by the Joanna Briggs Institute. A scoping review of articles written in English concerning the timeliness of breast cancer care in the African context will be undertaken. Six electronic databases (MEDLINE, EMBASE, CINAHL, SCOPUS, WEB Of SCIENCE and PsycINFO) will be searched to identify published literature on timeliness of breast care in Africa. Two reviewers will independently screen the articles at both the abstract and full-text stages, guided by predetermined inclusion and exclusion criteria. The full texts of identified studies will be further examined and charted using a data extraction form guided by the Model of Pathways to Treatment framework. Publications describing the time to diagnosis and its associated factors in the contexts of breast cancer will be considered for inclusion, with no restrictions based on date of publication. Studies that are published in languages other than English and that do not focus on the timeliness of care or time-related aspects within the care pathway will be excluded. Evidence will be narratively synthesised and analysed.

ETHICS AND DISSEMINATION

Ethical approval is not needed as this scoping review does not involve collecting data from human participants. The results produced from this review will be submitted to a scientific peer-reviewed journal for publication and will be presented at scientific meetings.

Role of communicating diagnostic uncertainty in the safety-netting process: insights from a vignette study

BACKGROUND

Safety-netting is intended to protect against harm from uncertainty in diagnosis/disease trajectory. Despite recommendations to communicate diagnostic uncertainty when safety-netting, this is not always done.

AIMS

To explore how and why doctors safety-netted in response to several clinical scenarios, within the broader context of exploring how doctors communicate diagnostic uncertainty.

METHODS

Doctors working in internal medical specialties (n=36) from five hospitals were given vignettes in a randomised order (all depicting different clinical scenarios involving diagnostic uncertainty). After reading each, they told an interviewer what they would tell a 'typical patient' in this situation. A follow-up semistructured interview explored reasons for their communication. Interviews were recorded, transcribed and coded. We examined how participants safety-netted using a content analysis approach, and why they safety-netting with thematic analysis of the semistructured follow-up interviews using thematic analysis.

RESULTS

We observed n=78 instances of safety-netting (across 108 vignette encounters). We found significant variation in how participants safety-netted. Safety-netting was common (although not universal), but clinicians differed in the detail provided about symptoms to be alert for, and the action advised. Although many viewed safety-netting as an important tool for managing diagnostic uncertainty, diagnostic uncertainty was infrequently explicitly discussed; most advised patients to return if symptoms worsened or new 'red flag' symptoms developed, but they rarely linked this directly to the possibility of diagnostic error. Some participants expressed concerns that communicating diagnostic uncertainty when safety-netting may cause anxiety for patients or could drive inappropriate reattendance/over-investigation.

CONCLUSIONS

Participants safety-netted variously, even when presented with identical clinical information. Although safety-netting was seen as important in avoiding diagnostic error, concerns about worrying patients may have limited discussion about diagnostic uncertainty. Research is needed to determine whether communicating diagnostic uncertainty makes safety-netting more effective at preventing harm associated with diagnostic error, and whether it causes significant patient anxiety.

Safety-netting strategies for primary and emergency care: a codesign study with patients, carers and clinicians in Sweden

OBJECTIVES

To codesign safety-netting strategies for primary and emergency care settings by integrating the experiences and ideas of patients, carers and clinicians.

DESIGN

A codesign process involving two focus group discussions, eight individual interviews and five workshops. All sessions were audio recorded and transcribed verbatim. Data were analysed using qualitative content analysis and reported using the Consolidated criteria for Reporting Qualitative research guidelines.

SETTING

Primary and emergency care in Sweden, focusing on the Stockholm region.

PARTICIPANTS

7 (5 women) individuals with patient expertise, 1 (man) individual with carer expertise, 18 (12 women) individuals with clinical expertise.

RESULTS

Three main categories reflecting strategies for applying safety-netting were developed: first, conveying safety-netting advice, which involves understanding patient concerns, tailoring communication and using appropriate modalities for communicating; second, ensuring common understanding, which involves summarising information, asking a teach-back question and anticipating questions post consultation; and third, supporting safety-netting behaviour, which involves facilitating reconsultation, helping patients and carers to navigate the health system and explaining the care context and its purpose.

CONCLUSIONS

Our study highlights the collaborative nature of safety-netting, engaging both the clinician and patient, sometimes supported by carers, in an iterative process. Adding to previous research, our study also emphasises the importance of anticipating postconsultation inquiries and facilitating reconsultation.

Effect of metabolic syndrome and its components on the risk and prognosis of cervical cancer: A literature review

Despite the global implementation of preventive strategies against Human Papilloma Virus (HPV) infection, the incidence of invasive cervical cancer rose by nearly 1.3-fold, from 471,000 annual cases in 2000 to 604,000 cases in 2020. With over 340,000 deaths annually, cervical cancer is the fourth leading cause of cancer mortality in women globally. There is a need to understand other factors besides HPV such as metabolic syndrome (MetS) that potentially influence the onset and progression of cervical cancer. In this narrative review, we describe evidence showing that Metabolic syndrome (MetS) increases the risk for cervical cancer and worsens its prognosis. Combined screening for MetS and cervical cancer has potential to significantly reduce morbidity and mortality in women with cervical cancer.

Exploring the metabolomics profile of frailty- a systematic review

Background

Frailty is a multifaceted geriatric syndrome characterized by an increased vulnerability to stressful events. metabolomics studies are valuable tool for better understanding the underlying mechanisms of pathologic conditions. This review aimed to elucidate the metabolomics profile of frailty.

Method

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 statement. A comprehensive search was conducted across multiple databases. Initially, 5027 results were retrieved, and after removing duplicates, 1838 unique studies were subjected to screening. Subsequently, 248 studies underwent full-text screening, with 21 studies ultimately included in the analysis. Data extraction was performed meticulously by two authors, and the quality of the selected studies was assessed using the Critical Appraisal Skills Program (CASP) checklist.

Results

The findings revealed that certain Branched-chain amino acids (BCAAs) levels were lower in frail subjects compared to robust subjects, while levels of glutamate and glutamine were higher in frail individuals. Moreover, sphingomyelins and phosphatidylcholines (PC) displayed a decreasing trend as frailty advanced. Additionally, other metabolic derivatives, such as carnitine, exhibited significant associations with frailty. These metabolites were primarily interconnected through biochemical pathways related to the tricarboxylic acid and urea cycles. Notably, frailty was associated with a decrease in metabolic derivatives, including carnitine.

Conclusion

This study underscores the intricate relationship between essential metabolites, including amino acids and lipids, and their varying levels in frail individuals compared to their robust counterparts. It provides a comprehensive panel of metabolites, shedding light on their potential associations with frailty and expanding our understanding of this complex syndrome.

Patient Safety Domains in Primary Healthcare: A Systematic Review

Background

Healthcare systems should ensure the provision of quality services to patients without harming them. However, the provision of services is occasionally accompanied by harm or complications, most of which are preventable. Most studies have focused on secondary healthcare rather than primary healthcare (PHC). Thus, this study aimed to identify various dimensions and components of patient safety in PHC worldwide.

Methods

This systematic review study was conducted in November 2022 based on PRISMA reporting guidelines. Studies were retrieved from PubMed, Scopus, Cochrane Library, Web of Science, and EMBASE and searched for English documents using the keywords "patient safety" and "PHC" from 2000 to 2022. Finally, two reviewers extracted the data independently and analyzed using thematic content analysis.

Results

Overall, 23 out of the initially 4937 identified articles were selected for the final analysis based on the inclusion and exclusion criteria. Most of these studies used a qualitative-quantitative approach (61.9%, seven studies for both), and 64% had been conducted in European countries. Eventually, five dimensions and 22 components were identified for patient safety in PHC, including management measures, quality management, resources and technology, documents, and patient-related factors.

Conclusion

The patient safety dimensions and components identified in this research can help develop a clear definition of patient safety and its assessment standards and criteria in PHC. Considering that most previous studies on patient safety in PHC were conducted in European and developed countries, it is suggested that researchers conduct more studies in developing countries to fill this research gap.

A park-based group mobility program for older adults with difficulty walking outdoors: a quantitative process evaluation of the Getting Older Adults Outdoors (GO-OUT) randomized controlled trial

BACKGROUND

Process evaluations of randomized controlled trials (RCTs) of community exercise programs are important to help explain the results of a trial and provide evidence of the feasibility for community implementation. The objectives of this process evaluation for a multi-centre RCT of outdoor walking interventions for older adults with difficulty walking outdoors, were to determine: 1) implementation fidelity (the extent to which elements of the intervention were delivered as specified in the original protocol) and 2) participant engagement (the receipt of intervention components by the participants) in the Getting Older Adults Outdoors (GO-OUT) trial.

METHODS

GO-OUT participants attended an active 1-day workshop designed to foster safe, outdoor walking skills. After the workshop, 190 people at 4 sites were randomized to an outdoor walk group (OWG) (n = 98) which met 2x/week for 10 weeks, or the weekly reminders (WR) group (n = 92) which received a phone reminder 1x/week for 10 weeks. The OWG had 5 components - warm-up, continuous distance walk, task-oriented walking activities, 2nd continuous distance walk, and cool-down. Data on implementation fidelity and participant engagement were gathered during the study through site communications, use of standardized forms, reflective notes of the OWG leaders, and accelerometry and GPS assessment of participants during 2 weeks of the OWG.

RESULTS

All sites implemented the workshop according to the protocol. Participants were engaged in all 8 activity stations of the workshop. WR were provided to 96% of the participants in the WR intervention group. The 5 components of the OWG sessions were implemented in over 95% of the sessions, as outlined in the protocol. Average attendance in the OWG was not high - 15% of participants did not attend any sessions and 64% of participants in the OWG attended > 50% of the sessions. Evaluations with accelerometry and GPS during week 3 and 9 OWG sessions suggest that participants who attended were engaged and active during the OWG.

CONCLUSIONS

This process evaluation helps explain the main study findings and demonstrates the flexibility required in the protocol for safe and feasible community implementation. Future research could explore the use of additional behaviour change strategies to optimize attendance for community implementation.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03292510 Date of registration: September 25, 2017.

Strategies to support midlife women to reduce their alcohol consumption: an Australian study using human-centred design

Alcohol consumption is causally associated with long-term health-related consequences, such as cancer and cardiovascular disease, and short-term harms, such as accidents and injuries. Alcohol consumption has increased among midlife women (aged 40-65) over the last two decades in high-income countries. This study aimed to centre women's voices by using co-design methodologies to investigate what women identify as strategies that could assist them and other women their age to reduce their alcohol consumption. Human-centred design workshops were undertaken with 39 women, and conventional qualitative content analysis was used to analyse information from written workshop materials to develop categories in the data and count their occurrence. Six categories, or strategies, emerged, listed here from most to least represented: 'Participate in alternative activities to drinking alcohol', 'Track alcohol consumption and set goals', 'Seek support from family and friends', 'Drink alcohol-free beverages', 'Reduce supply of alcohol in the home' and 'Seek professional support'. Our findings identify strategies that are realistic and feasible to midlife women; our sample, however, likely reflects a more affluent subsection of this group, and as such, any focus on individual-level strategies must be complemented by policies that increase equitable access to healthcare and act on the social and commercial determinants of health. An intersectional approach to alcohol and other drug research is required to examine how the interplay of gender and other markers of social identities shape alcohol consumption.

The linguistic validation of the gut feelings questionnaire in Turkish

BACKGROUND

'Gut feelings' are frequently used by general practitioners in the clinical decision-making process, especially in situations of uncertainty. The Gut Feelings Questionnaire (GFQ) has been developed in the Netherlands and is now available in English, French, German, Polish, Spanish, and Catalan, enabling cross-border studies on the subject. However, a Turkish version of the GFQ is lacking.

OBJECTIVES

A Turkish version of the GFQ.

METHODS

A linguistic validation procedure was conducted, which took place in six phases: forward translation (step 1), backward translation (step 2), first consensus (step 3), cultural validation (step 4), second consensus (step 5), and final version (step 6).

RESULTS

The absence of literal equivalent of the term 'gut feelings' in Turkish was determined. The word 'intuition' was chosen as the Turkish literal equivalent of 'gut feelings'. There were also some challenges in finding the exact meanings of words and expressions in Turkish literature. However, we succeeded in finding adequate and responsible solutions. A Turkish version of the GFQ is available now.

CONCLUSION

With these validated GFQs, Turkish GPs can facilitate studies of the role of 'gut feelings' in clinical reasoning.

Why are older adults living with the complexity of multiple long-term conditions, frailty and a recent deterioration in health under-served by research? A narrative synthesis review of the literature

Older adults living with the complexity of multiple long-term conditions (MLTC), frailty and a recent deterioration in health are under-served by research. As a result, current treatment guidelines are often based on data from studies of younger and less frail participants, and often single disease focused. The aims of this review were (i) to identify why older adults living with the complexity of MLTC, frailty and a recent deterioration in health are under-served by research and (ii) to identify strategies for increasing their recruitment and retention. Although a range of factors have been suggested to affect the participation of older adults with MLTC and frailty in research, this review shows that much less is known about the inclusion of older adults living with the complexity of MLTC, frailty and a recent deterioration in health. Researchers should focus on strategies that minimise participation burden for these patients, maintaining an adaptive and flexible approach, to increase their recruitment and retention. Future research should include qualitative interviews to provide further insights into how best to design and conduct research to suit the needs of this population group.

Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Purpose

This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC).

Materials and methods

PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis.

Results

Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC.

Conclusion

Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists' time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.

How patients in general practice voice and value their gut feelings about health: a qualitative interview study

BACKGROUND

GPs consider their gut feelings a valuable tool in clinical reasoning. Research suggests patients' gut feelings may be a useful contribution to that process. Describing these feelings more precisely could improve primary care professionals' (PCPs) recognition of patients' gut feelings and insight into the underlying reasons. These descriptions would also enable a thorough examination of the validity of patients' gut feelings and their contribution to professionals' clinical reasoning.

AIM

To gather the words and phrases that patients or their relatives use to share their gut feelings with primary care professionals and what they convey and imply.

DESIGN AND SETTING

Qualitative study of Dutch and Belgian patients visiting an out-of-hours GP service or a GP's office.

METHOD

Face-to-face semi-structured interviews were carried out with 47 patients. Interviews were coded using a descriptive content analysis in an iterative process until data sufficiency.

RESULTS

Patients or their relatives expressed their gut feelings by using words relating to trusting or not trusting the situation, or to changes in normal patterns. Their gut feelings are most often felt as a sense of alarm. In general, patients experiencing a sense of alarm, particularly mothers of sick children, were convinced that something was wrong and had often learned to trust their gut feeling. A gut feeling was the main reason to contact a PCP. Patients generally felt that their gut feelings were taken seriously.

CONCLUSION

The findings of this study provide an insight into how patients and relatives may express their gut feelings about their own or their relative's health and how they share these feelings with healthcare professionals. This may help clinicians improve their recognition of patients' gut feelings, being particularly alert to a patient or relative using phrases that relate to feelings of not trusting a situation, things seeming wrong or different from normal, and experiencing a sense of alarm. Further research should be carried out into the validity of patients' gut feelings.

Gut feeling for the diagnosis of cancer in general practice: a diagnostic accuracy review

OBJECTIVES

Diagnostic delay in cancer is a challenge in primary care. Although screening tests are effective in diagnosing some cancers such as breast, colorectal and cervical cancers, symptom-based cancer diagnosis is often difficult due to its low incidence in primary care and the influence of patient anxiety, doctor-patient relationship and psychosocial context. A general practitioner's gut feeling for cancer may play a role in the early diagnosis of cancer in primary care where diagnostic resources are limited. The aim of this study is to summarise existing evidence about the test accuracy of gut feeling (index test) in symptomatic adult patients presenting to general practice, compared with multidisciplinary team-confirmed diagnosis of cancer (reference standard).

DESIGN

Diagnostic accuracy review following Cochrane methods was performed.

DATA SOURCES

MEDLINE, EMBASE, Cochrane Library, the Database of Abstracts of Reviews of Effects and Medion databases.

ELIGIBILITY CRITERIA

Cross-sectional, cohort and randomised studies of test accuracy that compared gut feeling (index test) with an appropriate cancer diagnosis (reference standard). No language or publication status restrictions were applied. We included all studies published before 25 March 2022.

DATA EXTRACTION AND SYNTHESIS

Methodological quality was appraised, using Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) criteria. Meta-analysis with hierarchical summary receiver operating characteristic (HSROC) models was used.

RESULTS

Of 1286 potentially relevant studies identified, six met the inclusion criteria. For two of the six studies, data could not be extracted despite contacting authors. No studies satisfied all QUADAS-2 criteria. After meta-analysis of data from the remaining studies, the summary point of HSROC had a sensitivity of 0.40 (95% CI: 0.28, 0.53) and a specificity of 0.85 (95% CI: 0.75, 0.92).

CONCLUSIONS

Gut feeling for cancer when used in symptomatic adult patients in general practice has a relatively low sensitivity and high specificity. When the prevalence of cancer in the symptomatic population presenting in general practice exceeds 1.15%, the performance of gut feeling reaches the National Institute for Health and Care Excellence 3% positive predictive value threshold for action, which recommends urgent access to specialist care and further investigations. The findings support the continued and expanded use of gut feeling items in referral pathways.

Psychological distress, perceived stress and nocebo effect (multifood adverse reaction) in irritable bowel syndrome patients

BACKGROUND

Psychological distress and perceived stress may complicate the clinical presentation, course, and treatment of patients with functional gastrointestinal disorders. The correlation between psychological distress, perceived stress, and the nocebo effect (multifood adverse reaction) in patients with irritable bowel syndrome (IBS) was the main aim of the present study.

MATERIALS AND METHODS

In this cross-sectional correlation study, data on 4,763 Iranian adults, 748 of whom by purposive sampling were patients with IBS (65.1% female), working in 50 different health centers affiliated to the Isfahan University of Medical Sciences across Isfahan province were examined. For assessing dietary intake, a 106-item self-administered Dish-based Semi-Quantitative Food Frequency Questionnaire that was specifically designed and validated for Iranian adults was used. General Heath Questionnaire 12 and Stressful Life event Questionnaire were used to assess psychological distress and perceived stress. By using a modified Persian version of the Rome III questionnaire, IBS was assessed. Based on researcher-made definition of nocebo effect (multiitem food intolerance), 164 people had the nocebo phenomenon in IBS group.

RESULTS

Age, sex, education, marital status, antidepressant use, and specifically chronic underlying disease (odds ratio [OR]: 3.54, 95% confidence interval [CI]: 1.73-7.23) of general characteristics had a significant correlation (P <.05) with presenting nocebo responses in IBS patients. Psychological distress (OR: 1.415; 95% CI: 0.992-2.020; P = 0.056) had a significant correlation with nocebo effect and did not find significant correlation with perceived stress (OR: 0.999; 95% CI: 0.990-1.008; P = 0.865). Data were analyzed by Chi-square test, analysis of variance, and OR.

CONCLUSION

The present study showed that psychological distress with chronic underlying disease and antidepressant use are important elements in presenting multifood adverse reactions that we named here as the nocebo effect in IBS patients. Reducing psychological distress and managing chronic underlying diseases appear to be an effective factor in reducing the nocebo phenomenon in IBS patients. For managing the nocebo responses in IBS patients, these findings may help clinicians to improve their interventions. Further studies are required to confirm these findings.

Psychiatric morbidities among patients with type-2 diabetes mellitus attending outpatient department in a rural area of North India

Background

Both diabetes mellitus and psychiatric morbidities are widely prevalent diseases which show a discerning upward trend globally. Coexistence of diabetes and psychiatric morbidities usually manifests as impaired quality of life and poor treatment adherence.

Objectives

The study aimed to estimate the prevalence of psychiatric morbidities among rural diabetic patients and to determine their association with different variables.

Methodology

The present cross-sectional study was conducted in CHC of Rural Health Block attached with PG Department of Community Medicine GMC (Government Medical College) Jammu. The eligible diabetic patients attending medical outpatient department services were enrolled using a consecutive sampling method. DAS scale was used to assess psychiatric morbidity among the study subjects.

Results

The findings revealed that the prevalence of psychiatric morbidity in the study participants was 38.9%, 68.5% and 25.64% for depression, anxiety and stress, respectively. Psychiatric morbidities were slightly higher in female patients and were significantly associated with age, marital status, sedentary lifestyle, history of substance abuse, duration of diabetes, presence of complications and underlying morbidities (P < 0.05).

Conclusions

The prevalence of anxiety and depression among rural diabetic patients was found to be quite high. Diabetic patients need thorough screening for psychiatric evaluation, and there is an urgent need for psychiatric counselling at regular intervals.

Ruling out acute coronary syndrome in primary care with a clinical decision rule and a capillary, high-sensitive troponin I point of care test: study protocol of a diagnostic RCT in the Netherlands (POB HELP)

INTRODUCTION

Chest pain is a common reason for consultation in primary care. To rule out acute coronary syndrome (ACS), general practitioners (GP) refer 40%-70% of patients with chest pain to the emergency department (ED). Only 10%-20% of those referred, are diagnosed with ACS. A clinical decision rule, including a high-sensitive cardiac troponin-I point-of-care test (hs-cTnI-POCT), may safely rule out ACS in primary care. Being able to safely rule out ACS at the GP level reduces referrals and thereby alleviates the burden on the ED. Moreover, prompt feedback to the patients may reduce anxiety and stress.

METHODS AND ANALYSIS

The POB HELP study is a clustered randomised controlled diagnostic trial investigating the (cost-)effectiveness and diagnostic accuracy of a primary care decision rule for acute chest pain, consisting of the Marburg Heart Score combined with a hs-cTnI-POCT (limit of detection 1.6 ng/L, 99th percentile 23 ng/L, cut-off value between negative and positive used in this study 3.8 ng/L). General practices are 2:1 randomised to the intervention group (clinical decision rule) or control group (regular care). In total 1500 patients with acute chest pain are planned to be included by GPs in three regions in The Netherlands. Primary endpoints are the number of hospital referrals and the diagnostic accuracy of the decision rule 24 hours, 6 weeks and 6 months after inclusion.

ETHICS AND DISSEMINATION

The medical ethics committee Leiden-Den Haag-Delft (the Netherlands) has approved this trial. Written informed consent will be obtained from all participating patients. The results of this trial will be disseminated in one main paper and additional papers on secondary endpoints and subgroup analyses.

TRIAL REGISTRATION NUMBERS

NL9525 and NCT05827237.

Prevalence and determinants of depression among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar

Aims

To assess the prevalence of depression and its associated factors among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar.

Methods

A cross-sectional study was conducted from January to April 2021 where 683 adult patients with Type 2 diabetes mellitus were selected by cluster sampling technique using probability-proportionate to size sampling. Diabetes mellitus was defined as having HA1c of greater than or equal to 6.5%, and patients were assessed for depression using the Patient Health Questionnaire-9. The relationship between depression, glycemic control, and background characteristics was analyzed using Chi-square, and binary logistic regression analyses. Adjusted logistic regression models estimated the significant factors that were independently associated with depression.

Results

20.1% of the study participants had depression with the vast majority of them having mild depression (70.8%). More than three-quarters had uncontrolled diabetes mellitus (81.5%). Male patients were at higher risk for developing depression (AOR =1.98, 1.25-3.14) when compared to female patients. On the other hand, being Qatari was associated with a lower risk for depression compared to non-Qatari patients (AOR =0.56, 0.34-0.90), and treatment with insulin-containing regimens was associated with a lower risk for depression as compared to treatment with non-insulin- containing regimens (AOR =0.49, 0.30-0.78).

Conclusions

Prevalence of depression among patients with Type 2 diabetes attending family medicine clinics in Qatar is high. Therefore, utilizing a multidisciplinary health care plan for screening and management of depression in patients with diabetes in a primary health care setting is highly recommended.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Anxiety and depression among people with type 2 diabetes visiting diabetes clinics of Pokhara Metropolitan, Nepal: a cross-sectional study

OBJECTIVES

To estimate the prevalence of anxiety and depression and identify the associated factors among people with type 2 diabetes mellitus (T2DM) visiting diabetes clinics of Pokhara Metropolitan, Nepal.

DESIGN

Cross-sectional study.

SETTING

Three diabetes clinics in Pokhara Metropolitan, Nepal, from May to July 2021.

PARTICIPANTS

283 people with T2DM visiting selected diabetes centres of Pokhara Metropolitan.

OUTCOME MEASURES

Anxiety and depression were the outcome measures. Face-to-face interviews were conducted using a structured questionnaire comprising information related to participants' sociodemographic profile and several factors along with Hospital Anxiety and Depression-Anxiety subscale and Patient Health Questionnaire-9 to assess the levels of anxiety and depression, respectively. Pearson's Χ² tests and binary logistic regression were performed to examine association between dependent and independent variables at 5% level of significance.

RESULTS

The prevalence of anxiety and depression was 31.4% (95% CI 26.2% to 37.5%) and 36.4% (95% CI 30.8% to 42.0%), respectively. Anxiety was found to be associated with a lower level of perceived social support (adjusted OR (AOR) 2.442, 95% CI 1.020 to 5.845), multiple complications (AOR 2.758, 95% CI 1.015 to 7.334) and comorbidities (AOR 2.110, 95% CI 1.004 to 4.436), severe COVID-19 fear (AOR 2.343, 95% CI 1.123 to 4.887) and sleep dissatisfaction (AOR 1.912, 95% CI 1.073 to 3.047). Economical dependency (AOR 1.890, 95% CI 1.026 to 3.482), no insurance (AOR 2.973, 95% CI 1.134 to 7.093), lower perceived social support (AOR 2.883, 95% CI 1.158 to 7.181), multiple complications (AOR 2.308, 95% CI 1.585 to 6.422) and comorbidities (AOR 2.575, 95% CI 1.180 to 5.617), severe COVID-19 fear (AOR 2.117, 95% CI 1.009 to 4.573), alcohol use (AOR 2.401, 95% CI 1.199 to 4.806) and sleep dissatisfaction (AOR 1.995, 95% CI 1.093 to 3.644) were found to be associated with depression.

CONCLUSION

This study showed high prevalence levels of anxiety and depression among people with T2DM. Strengthening social support and focusing on people with diabetes suffering from comorbidity and complications could help to reduce their risk of mental health problems.

The GP’s perceived role and use of language concerning the existential dimension of palliative patients: a Dutch interview study

Background

Palliative patients have to cope with their disease and impending death. Knowing what this means for a patient is crucial for person-centred care. Although guidelines state it is a GP core task to explore existential issues of palliative patients, this is not standard practice.

Aim

Exploring Dutch GPs’ perceived role regarding addressing the existential dimension of palliative patients, and which vocabulary GPs use when doing this.

Design and setting

Qualitative study amongst Dutch GPs. Participants were recruited by purposive sampling and snowballing, considering gender, working experience and ideological personal beliefs.

Method

Semi-structured in-depth interviews were performed, transcribed and analysed using content analysis.

Results

Seventeen GPs participated. Three themes were identified: Language, Perceived role and Practice. Interviewees generally saw it as their role to pay attention to the existential dimension of palliative patients. However, not all knew how to define this role, or how to refer patients with existential struggles to a spiritual counsellor. The multidisciplinary Dutch guideline ‘Existential and Spiritual Aspects of Palliative Care’ seemed largely unknown. Interviewees mostly fulfilled their role in an intuitive, pragmatic way. Questions such as “What does it mean for you to be seriously ill?” or “Do you have support from someone or something?” fitted daily practice.

Conclusion

This study emphasizes the importance of basic GP education in exploring existential issues. The coexistence of a professionally obliged attention and an intuitive approach seems to be in conflict. We recommend appropriate training for GPs, research on the potential enhancement of collaboration between GPs and spiritual counsellors and implementation of the relevant guideline on well-known platforms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-022-01789-6.

Prospective Observational Study on the Prevalence and Diagnostic Value of General Practitioners' Gut Feelings for Cancer and Serious Diseases

BACKGROUND

General practitioners (GPs) have recognized the presence of gut feelings in their diagnostic process. However, little is known about the frequency or determinants of gut feelings or the diagnostic value of gut feelings for cancer and other serious diseases.

OBJECTIVE

To assess the prevalence of gut feelings in general practice, examine their determinants and impact on patient management, and measure their diagnostic value for cancer and other serious diseases.

DESIGN

This prospective observational study was performed using the Gut Feelings Questionnaire (GFQ).

PARTICIPANTS

Participants included 155 GPs and 1487 of their patients, from four Spanish provinces.

MAIN MEASURES

Sociodemographic data from patients and GPs; the reasoning style of GPs; the characteristics of the consultation; the presence and kind of gut feeling; the patient's subsequent contacts with the health system; and new cancer and serious disease diagnoses reported at 2 and 6 months post-consultation.

KEY RESULTS

GPs experienced a gut feeling during 97% of the consultations: a sense of reassurance in 75% of consultations and a sense of alarm in 22% of consultations. A sense of alarm was felt at higher frequency given an older patient, the presence of at least one cancer-associated symptom, or a non-urban setting. GPs took diagnostic action more frequently after a sense of alarm. After 2 months, the sense of alarm had a sensitivity of 59% for cancer and other serious diseases (95% CI 47-71), a specificity of 79% (95% CI 77-82), a positive predictive value of 12% (95% CI 9-16), and a negative predictive value of 98% (95% CI 86-98).

CONCLUSIONS

Gut feelings are consistently present in primary care medicine, and they play a substantial role in a GP's clinical reasoning and timely diagnosis of serious disease. The sense of alarm must be taken seriously and used to support diagnostic evaluation in patients with a new reason for encounter.

The effect of group logotherapy on spirituality and preoperative anxiety in patients seeking open heart surgery referring to Tehran Heart Center in 2020

BACKGROUND AND PURPOSE

Most patients experience anxiety before heart surgery. On the other hand, spiritual health can improve the candidate patient's adaptation to surgery. Therefore, this study aimed to investigate the effect of group logotherapy on spirituality and anxiety of patients undergoing cardiac surgery.

MATERIALS AND METHODS

In this quasi-experimental study, 60 hospitalized candidates for cardiac surgery were randomly assigned to two groups (30 in the experimental group, 30 in the control group). To measure anxiety and relationship with God, Beck Anxiety Questionnaire and the researcher-made scale about relationship with God (reconstruction of Lawrence's scale of perception of God) were used, respectively. In the intervention group, in addition to drug therapy, individuals received two sessions of group discussion and spiritual skills training using the behavioral-cognitive method with emphasis on spiritual thoughts and problem-solving methods, but the control group received only drug therapy. Data were analyzed using SPSS software.

RESULTS

In the experimental group, the anxiety scores mean in the posttest and follow-up were significantly lower than the pretest (P < 0.05), while the mean anxiety in the control group in the posttest stage was not significantly different, but at the follow-up stage, it was significantly lower than the pretest, but the decrease in mean anxiety in the experimental group was greater (P < 0.05). The mean subscales of relationship with god (influence, divine providence, acceptance, presence, challenge, benevolence) were significantly higher in the experimental and control groups in the follow-up stage than the pretest, but the increase in the mean of these variables was more in the experimental group in the follow-up stage (P < 0.05).

CONCLUSION

Findings showed that the components of relationship with God are a good predictor of pre-surgery anxiety, so by focusing on spiritual training of patients who are candidates for surgery, the incidence or severity of anxiety can be reduced.

Using nasal sprays to prevent respiratory tract infections: a qualitative study of online consumer reviews and primary care patient interviews

OBJECTIVES

Nasal sprays could be a promising approach to preventing respiratory tract infections (RTIs). This study explored lay people's perceptions and experiences of using nasal sprays to prevent RTIs to identify barriers and facilitators to their adoption and continued use.

DESIGN

Qualitative research. Study 1 thematically analysed online consumer reviews of an RTI prevention nasal spray. Study 2 interviewed patients about their reactions to and experiences of a digital intervention that promotes and supports nasal spray use for RTI prevention (reactively: at 'first signs' of infection and preventatively: following possible/probable exposure to infection). Interview transcripts were analysed using thematic analysis.

SETTING

Primary care, UK.

PARTICIPANTS

407 online customer reviews. 13 purposively recruited primary care patients who had experienced recurrent infections and/or had risk factors for severe infections.

RESULTS

Both studies identified various factors that might influence nasal spray use including: high motivation to avoid RTIs, particularly during the COVID-19 pandemic; fatalistic views about RTIs; beliefs about alternative prevention methods; the importance of personal recommendation; perceived complexity and familiarity of nasal sprays; personal experiences of spray success or failure; tolerable and off-putting side effects; concerns about medicines; and the nose as unpleasant and unhygienic.

CONCLUSIONS

People who suffer disruptive, frequent or severe RTIs or who are vulnerable to RTIs are interested in using a nasal spray for prevention. They also have doubts and concerns and may encounter problems. Some of these may be reduced or eliminated by providing nasal spray users with information and advice that addresses these concerns or helps people overcome difficulties.

Young people who have fallen through the mental health transition gap: a qualitative study on primary care support

BACKGROUND

Owing to poor continuity of care between child and adult mental health services, young people are often discharged to their GP when they reach the upper boundary of child and adolescent mental health services (CAMHS). This handover is poorly managed, and GPs can struggle to support young people without input from specialist services. Little is known about young people's experiences of accessing mental health support from their GP after leaving CAMHS.

AIM

To explore the experiences and perspectives of young people and the parents/carers of young people receiving primary care support after CAMHS and to identify barriers and facilitators to accessing primary care.

DESIGN AND SETTING

Qualitative study with young people and parents in two English counties: London and West Midlands.

METHOD

Narrative interviews were conducted with 14 young people and 13 parents who had experienced poor continuity of care after reaching CAMHS transition boundary. Data were analysed using reflexive thematic analysis.

RESULTS

Three themes were identified: unmet mental health needs, disjointed care, and taking responsibility for the young person's mental health care. Barriers included the perception that GPs couldn't prescribe certain medication, anxiety caused by the general practice environment, and having to move to a new practice at university. Young people's positive experiences were more likely to include having a long-term relationship with their GP and finding that their GP made time to understand their needs and experiences.

CONCLUSION

GPs could help to meet the unmet needs of young people unable to access specialist mental health services after leaving CAMHS. There is a need for comprehensive handover of care from CAMHS to GPs, which could include a joint meeting with the young person and a member of the CAMHS team. Future research should focus on interventions which improve continuity of care for young people after leaving CAMHS, and collaborative working across community mental health services.

The contribution of respiratory and hearing protection use to psychological distress in the workplace: a scoping review

OBJECTIVE

Workers from various industries use personal protective equipment (PPE) including masks, respirators, and hearing protection to reduce their exposures to workplace hazards. Many studies have evaluated the physiological impacts of PPE use, but few have assessed the psychological impacts. The aim of the present study was to carry out a scoping review to compile existing evidence and determine the extent of knowledge on workplace mask, respirator or hearing protection use as a psychosocial hazard (stressor) that could result in a stress response and potentially lead to psychological injury.

METHODS

The scoping review followed recognized methods and was conducted using Ovid Emcare, PubMed, Sage Journals, ScienceDirect, Scopus, SpringerLink, Google Scholar and preprint databases (OSF Preprints and medRxiv). Articles on the stressors associated with the use of masks, respirators, and hearing protection were included. The extracted data included author(s) name, year of publication, title of article, study design, population data, stressors assessed, and key findings.

RESULTS

We retrieved 650 articles after removal of duplicates, of which 26 were deemed eligible for inclusion for review. Identified factors associated with PPE use that could potentially create a stress response were identified: communication impacts, physical impacts, psychological illness symptoms, cognitive impacts, and perceived PPE-related impacts. Evidence for respirators suggest that there may be psychological injury associated with their use. However, hearing protection appears to have a protective effect in reducing psychological symptoms such as anxiety, depression, and aggression.

CONCLUSIONS

Mask or respirator use may lead to an increase in work-related stress. Whereas hearing protection may have protective effects against psychological symptoms and improves speech intelligibility. More research is needed to better understand potential psychosocial impacts of mask, respirator and/or hearing protection use.

Determining Covid-19 Vaccine Literacy Levels of Nursing Students

This study aimed to determine nursing students' levels of COVID-19 vaccine literacy and the affecting variables. This descriptive research was carried out on 391 students receiving education at Bursa Uludağ University Nursing Department between January and March 2022. Research data were collected using a "Student Introduction Form" and the "COVID-19 Vaccine Literacy Scale". The mean total score of the nursing students included in the study on the COVID-19 Vaccine Literacy Scale was 2.80±0.44. The mean scores of the students on the subscales were 2.41±0.58 for functional skills, 2.99±0.55 for interactive/critical skills. There was a significant difference between the students' grades, place of residence, and income status and their mean total COVID-19 Vaccine Literacy Scale score and mean interactive/critical skills subscale score (p<0.05). On the other hand, the variables of gender, COVID-19 positivity, and COVID-19 positivity in family member(s) were not associated with COVID-19 Vaccine Literacy (p>0.05). In this study, it was determined that the COVID-19 vaccine literacy levels of nursing students were moderate and that some of the variables affected vaccine literacy.

NHS Health Check programme: a rapid review update

OBJECTIVE

To update a rapid review published in 2017, which evaluated the NHS Health Check programme.

METHODS

An enlarged body of evidence was used to readdress six research objectives from a rapid review published in 2017, relating to the uptake, patient experiences and effectiveness of the NHS Health Check programme. Data sources included MEDLINE, PubMed, Embase, Health Management Information Consortium (HMIC), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Global Health, PsycINFO, the Cochrane Library, NHS Evidence, Google Scholar, Google, ClinicalTrials.gov and the ISRCTN registry, Web of Science, Science Citation Index, The Cochrane Library, NHS Evidence, OpenGrey and hand searching article reference lists. These searches identified records from between January 1996 and December 2019. Screening, data extraction and quality appraisal using the Critical Appraisals Skills Programme checklists were performed in duplicate. Grading of Recommendations Assessment, Development and Evaluations was implemented. Data were synthesised narratively.

RESULTS

697 studies were identified, and 29 new studies included in the review update. The number of published studies on the uptake, patient experiences and effectiveness of the NHS Health Check programme has increased by 43% since the rapid review published in 2017. However, findings from the original review remain largely unchanged. NHS Health Checks led to an overall increase in the detection of raised risk factors and morbidities including diabetes mellitus, hypertension, raised blood pressure, cholesterol and chronic kidney disease. Individuals most likely to attend the NHS Health Check programme included women, persons aged ≥60 years and those from more socioeconomically advantaged backgrounds. Opportunistic invitations increased uptake among men, younger persons and those with a higher deprivation level.

CONCLUSIONS

Although results are inconsistent between studies, the NHS Health Check programme is associated with increased detection of heightened cardiovascular disease risk factors and diagnoses. Uptake varied between population subgroups. Opportunistic invitations may increase uptake.

Integrating Clinical Signs at Presentation and Clinician's Non-analytical Reasoning in Prediction Models for Serious Bacterial Infection in Febrile Children Presenting to Emergency Department

OBJECTIVE

Development and validation of clinical prediction model (CPM) for serious bacterial infections (SBIs) in children presenting to the emergency department (ED) with febrile illness, based on clinical variables, clinician's "gut feeling," and "sense of reassurance.

MATERIALS AND METHODS

Febrile children presenting to the ED of Children's Clinical University Hospital (CCUH) between April 1, 2017 and December 31, 2018 were enrolled in a prospective observational study. Data on clinical signs and symptoms at presentation, together with clinician's "gut feeling" of something wrong and "sense of reassurance" were collected as candidate variables for CPM. Variable selection for the CPM was performed using stepwise logistic regression (forward, backward, and bidirectional); Akaike information criterion was used to limit the number of parameters and simplify the model. Bootstrapping was applied for internal validation. For external validation, the model was tested in a separate dataset of patients presenting to six regional hospitals between January 1 and March 31, 2019.

RESULTS

The derivation cohort consisted of 517; 54% (n = 279) were boys, and the median age was 58 months. SBI was diagnosed in 26.7% (n = 138). Validation cohort included 188 patients; the median age was 28 months, and 26.6% (n = 50) developed SBI. Two CPMs were created, namely, CPM1 consisting of six clinical variables and CPM2 with four clinical variables plus "gut feeling" and "sense of reassurance." The area under the curve (AUC) for receiver operating characteristics (ROC) curve of CPM1 was 0.744 (95% CI, 0.683-0.805) in the derivation cohort and 0.692 (95% CI, 0.604-0.780) in the validation cohort. AUC for CPM2 was 0.783 (0.727-0.839) and 0.752 (0.674-0.830) in derivation and validation cohorts, respectively. AUC of CPM2 in validation population was significantly higher than that of CPM1 [p = 0.037, 95% CI (-0.129; -0.004)]. A clinical evaluation score was derived from CPM2 to stratify patients in "low risk," "gray area," and "high risk" for SBI.

CONCLUSION

Both CPMs had moderate ability to predict SBI and acceptable performance in the validation cohort. Adding variables "gut feeling" and "sense of reassurance" in CPM2 improved its ability to predict SBI. More validation studies are needed for the assessment of applicability to all febrile patients presenting to ED.

Vital signs, clinical rules and gut feeling: observational study among fever patients

BACKGROUND

General practitioners (GPs) decide which patients with fever need referral to the emergency department (ED). Vital signs, clinical rules and gut feeling can influence this critical management decision.

AIM

to investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling.

DESIGN & SETTING

prospective observational study at two out-of-hours GP cooperatives METHOD: during two nine-day periods, GPs performed their regular work-up in patients ≥18 y with fever (≥38.0°C). Subsequently, researchers measured missing vital signs for completion of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score. We investigated associations between the number of referrals, positive SIRS/qSOFA scores and GPs' gut feeling.

RESULTS

GPs measured and recorded all vital signs required for SIRS/qSOFA calculation in 24 of 108 (22.2%) assessed patients and referred 45 (41.7%) to the ED. Higher respiratory rates, temperatures, clinical rules and gut feeling were associated with referral. During 7-day follow-up, 9 (14.3%) of 63 initially not referred patients were admitted to hospital.

CONCLUSION

GPs measured and recorded all vital signs for SIRS and qSOFA in 1 in 5 patients with fever and referred half of 63 SIRS positive and almost all of 22 qSOFA positive patients. Some vital signs and gut feeling were associated with referral, but none were consistently present in all referred patients. The vast majority of patients who were not initially referred remained at home during follow-up.

Role of the prescriber in supporting patients to discontinue benzodiazepines: a qualitative study

BACKGROUND

Given the prevalence of long-term benzodiazepine (BZD) prescribing, increased monitoring through the implementation of prescription monitoring programmes (PMPs) may be the necessary impetus to promote BZD deprescribing. Despite evidence promoting the importance of patient-centred care, GPs have not been sufficiently supported to implement these principles through current deprescribing practice.

AIM

To investigate patients' perception of their prescriber's influence on ceasing BZD use, including their willingness to take their advice, and to understand how a patient's stage of change influences the barriers and facilitators they perceive to discontinuing BZDs.

DESIGN AND SETTING

An online survey and qualitative interviews with 22 long-term users of BZD (≥6 months), aged 18-69 years, recruited from the general population in Victoria, Australia.

METHOD

Two groups of users of BZD participated, one in the process of reducing their BZD and one not reducing, and were categorised according to their stage of change. Data underwent thematic analysis to identify barriers and facilitators to reducing BZDs both at the patient level and the prescriber level.

RESULTS

BZD patients' perceptions of the prescriber influence were characterised by prescribing behaviours, treatment approach, and attitude. Barriers and facilitators to reducing their BZD were mapped against their stage of change. Irrespective of their stage of change, participants reported they would be willing to try reducing their BZD if they trusted their prescriber.

CONCLUSION

This study illustrates that, with a few key strategies at each step of the deprescribing conversation, GPs are well positioned to tackle the issue of long-term BZD use in a manner that is patient centred.

Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

BACKGROUND

Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study's aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing.

METHODS

In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients' evaluation of the session, their treatment satisfaction, and patients' and therapists' ratings of therapeutic alliance. We also collected qualitative comments on both sides' experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses.

RESULTS

No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements.

CONCLUSIONS

Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.

Clinical implementation of an oncology-specific family health history risk assessment tool

BACKGROUND

The presence of hereditary cancer syndromes in cancer patients can have an impact on current clinical care and post-treatment prevention and surveillance measures. Several barriers inhibit identification of hereditary cancer syndromes in routine practice. This paper describes the impact of using a patient-facing family health history risk assessment platform on the identification and referral of breast cancer patients to genetic counselling services.

METHODS

This was a hybrid implementation-effectiveness study completed in breast cancer clinics. English-literate patients not previously referred for genetic counselling and/or gone through genetic testing were offered enrollment. Consented participants were provided educational materials on family health history collection, entered their family health history into the platform and completed a satisfaction survey. Upon completion, participants and their clinicians were given personalized risk reports. Chart abstraction was done to identify actions taken by patients, providers and genetic counsellors.

RESULTS

Of 195 patients approached, 102 consented and completed the study (mean age 55.7, 100 % women). Sixty-six (65 %) met guideline criteria for genetic counseling of which 24 (36 %) were referred for genetic counseling. Of those referred, 13 (54 %) participants attended and eight (33 %) completed genetic testing. On multivariate logistic regression, referral was not associated with age, cancer stage, or race but was associated with clinical provider (p = 0.041). Most providers (71 %) had higher referral rates during the study compared to prior. The majority of participants found the experience useful (84 %), were more aware of their health risks (83 %), and were likely to recommend using a patient-facing platform to others (69 %).

CONCLUSIONS

65 % of patients attending breast cancer clinics in this study are at-risk for hereditary conditions based on current guidelines. Using a patient-facing risk assessment platform enhances the ability to identify these patients systematically and with widespread acceptability and recognized value by patients. As only a third of at-risk participants received referrals for genetic counseling, further understanding barriers to referral is needed to optimize hereditary risk assessment in oncology practices.

TRIAL REGISTRATION

NIH Clinical Trials registry, NCT04639934 . Registered Nov 23, 2020 -- Retrospectively registered.

Uptake and effectiveness of a tailor-made online lifestyle programme targeting modifiable risk factors for dementia among middle-aged descendants of people with recently diagnosed dementia: study protocol of a cluster randomised controlled trial (Demin study)

INTRODUCTION

Descendants of patients with dementia have a higher risk to develop dementia. This study aims to investigate the uptake and effectiveness of an online tailor-made lifestyle programme for dementia risk reduction (DRR) among middle-aged descendants of people with recently diagnosed late-onset dementia.

METHODS AND ANALYSIS

Demin is a cluster randomised controlled trial, aiming to include 21 memory clinics of which 13 will be randomly allocated to the passive (poster and flyer in a waiting room) and 8 to the active recruitment strategy (additional personal invitation by members of the team of the memory clinic). We aim to recruit 378 participants (40-60 years) with a parent who is recently diagnosed with Alzheimer's disease or vascular dementia at one of the participating memory clinics. All participants receive a dementia risk assessment (online questionnaire, physical examination and blood sample) and subsequently an online tailor-made lifestyle advice regarding protective (Mediterranean diet, low/moderate alcohol consumption and high cognitive activity) and risk factors (physical inactivity, smoking, loneliness, cardiovascular diseases (CVD), hypertension, high cholesterol, diabetes, obesity, renal dysfunction and depression) for dementia. The primary outcome is the difference in uptake between the two recruitment strategies. Secondary outcomes are change(s) in (1) the Lifestyle for Brain Health score, (2) individual health behaviours, (3) health beliefs and attitudes towards DRR and (4) compliance to the tailor-made lifestyle advice. Outcomes will be measured at 3, 6, 9 and 12 months after baseline. The effectiveness of this online tailor-made lifestyle programme will be evaluated by comparing Demin participants to a matched control group (lifelines cohort).

ETHICS AND DISSEMINATION

This study has been approved by the Dutch Ministry of Health, Welfare and Sport according to the Population Screening Act. All participants have to give online informed consent using SMS-tan (transaction authentication number delivered via text message). Findings will be disseminated through peer-reviewed journals and (inter)national conferences.

TRIAL REGISTRATION NUMBER

NTR7434.

Navigating complexity of child abuse through intuition and evidence-based guidelines: a mix-methods study among child and youth healthcare practitioners

BACKGROUND

Dutch child and youth health care (CYHC) practitioners monitor and assess the well-being of children. One of their main concerns is identifying cases of child abuse, which is an arduous and sensitive task. In these contexts, CYHC-practitioners use both evidence-based guidelines aimed at increasing the quality of care through rationalised decision-making, and intuition. These two practices are seen as being at odds with each other, yet empirical research has shown that both are necessary in healthcare. This study aims to unravel how intuition is perceived and used by Dutch CYHC-practitioners when identifying and working with cases of child abuse, and how this relates to their evidence-based guidelines.

METHODS

A sequential exploratory mixed-methods design: in-depth semi-structured interviews with CYHC-physicians focused on perceptions on intuition, which were followed by a survey amongst CYHC-practitioners on the recognition and use of the concept.

RESULTS

The majority of CYHC-practitioners recognise and use intuition in their daily work, stating that it is necessary in their profession. CYHC-practitioners use intuition to 1) sense that something is 'off', 2) differentiate between 'normal' and 'abnormal', 3) assess risks, 4) weigh secondary information and 5) communicate with parents. At the same time, they warn of its dangers, as it may lead to 'tunnel vision' and false accusations.

CONCLUSION

Intuition is experienced as an integral part of the work of CYHC-practitioners. It is understood as particularly useful in cases of child abuse, which are inherently complex, as signs and evidence of abuse are often hidden, subtle and unique in each case. CYHC-practitioners use intuition to manage and navigate this complexity. There is an opportunity for guidelines to support reflection and intuition as a 'good care' practice.

Accuracy of the general practitioner's sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

OBJECTIVES

Dyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner's (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs' sense of alarm when confronted with dyspnoea and chest pain.

DESIGN AND SETTINGS

Prospective observational study in general practice.

PARTICIPANTS

Patients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation.

PRIMARY OUTCOME MEASURES

Life-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.

RESULTS

25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77).

CONCLUSIONS

Where the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds.

TRIAL REGISTRATION NUMBER

NCT02932982.

The extent to which family physicians record their patients' exercise in medical records: a scoping review

OBJECTIVE

Exercise is an effective modality for the prevention and treatment of chronic conditions and family physicians are the healthcare providers tasked to manage patients' chronic disease status. However, little is known about the exercise documentation in family-physician records. Therefore, a scoping review was conducted to describe family-physician-recorded exercise-related advice to patients in electronic medical records.

DESIGN

Scoping review.

SETTING

Primary care clinics.

SEARCH STRATEGY

PubMed, Medline, SPORTDiscus, Google, Dissertations & Theses Global, OCLC PapersFirst (via First Search) and included references were searched between 1 January 1990 and 10 June 2018. Extracted information included year, geographic origin, data input structure, input frequency and content of exercise inputs in family physicians' electronic medical records. The primary outcomes are the structure, purpose and frequency of inputs.

RESULTS

Of a possible 1758 documents, 83 remained after a title and abstract scan and 22 after a full-text review. These documents included 32 findings of physical activity/exercise medical record documentation: counselling/advising patients (50.0%), status (12.5%), embedded questionnaires (12.5%), status as a risk factor (12.5%), health promotion documentation (6.3%), inactivity status (3.1%) and grading (3.1%). The frequency of exercise inputs in primary care records vary from as low as 0.4% of patients with documentation of physical activity health promotion inputs to as high as 87.8% of patients with exercise or physical activity status recorded. The majority of included documents (63.6%) were focused on patients with identified chronic conditions.

CONCLUSION

The findings suggest that the structure and purpose of exercise documentation is often unclear or unspecified. Studies that present exercise information from family-physician medical records tend to focus on patients with specific chronic conditions and present little detail about the field from which information was extracted. The review found that the proportion of patients with physical activity or exercise information is often less than half.

Prevalence and diagnostic value of GPs' gut feelings for cancer and serious diseases: protocol for a prospective observational study of diagnostic validity

INTRODUCTION

Cancer diagnosis in primary care is an important challenge for general practitioners (GPs) due to the relatively low frequency of any single type of cancer and the heterogeneous signs and symptoms that can be present. In addition to analytical reasoning, GPs may become aware of gut feelings (GFs) as they suspect that a patient may have cancer or another serious disease. We aimed to investigate the prevalence and the predictive value of GFs for the diagnosis of cancer and serious diseases.

METHODS AND ANALYSIS

Prospective observational study of diagnostic validity. Participation will be offered to GPs from Majorca and Zaragoza (Spain). They will recruit all patients with a new reason for encounter during one or two workdays. GPs will complete the Gut Feelings Questionnaire (GFQ). Variables regarding patient, GP and consultation will be collected. Two and 6 months after the first visit, incident diagnoses of cancer or other serious diseases, diagnostic tests performed, referrals and new visits will be recorded. Analysis will include a descriptive analysis of the variables and prevalence of GFs, and the sensitivity, specificity, predictive values and likelihood ratios of the GFs (sense of alarm and sense of reassurance) for diagnosing cancer and other serious diseases, as measured with the GFQ.

ETHICS AND DISSEMINATION

The study has obtained approval from the Majorcan Primary Care Research Committee and from the Balearic Islands Ethical Committee, with reference number IB 3210/16 PI. The results may help GPs to make more accurate decisions about which patients need further examinations to rule out or to confirm a diagnosis of cancer or a serious disease, and which ones do not. The results will be published as part of the PhD project of the first author and in open access journals, and will be presented at medical conferences.

Experienced physician descriptions of intuition in clinical reasoning: a typology

Background

Diagnostic intuition is a rapid, non-analytic, unconscious mode of reasoning. A small body of evidence points to the ubiquity of intuition, and its usefulness in generating diagnostic hypotheses and ascertaining severity of illness. Little is known about how experienced physicians understand this phenomenon, and how they work with it in clinical practice.

Methods

Descriptions of how experienced physicians perceive their use of diagnostic intuition in clinical practice were elicited through interviews conducted with 30 physicians in emergency, internal and family medicine. Each participant was asked to share stories of diagnostic intuition, including times when intuition was both correct and incorrect. Multiple coders conducted descriptive analysis to analyze the salient aspects of these stories.

Results

Physicians provided descriptions of what diagnostic intuition is, when it occurs and what type of activity it prompts. From stories of correct intuition, a typology of four different types of intuition was identified: Sick/Not Sick, Something Not Right, Frame-shifting and Abduction. Most physician accounts of diagnostic intuition linked this phenomenon to non-analytic reasoning and emphasized the importance of experience in developing a trustworthy sense of intuition that can be used to effectively engage analytic reasoning to evaluate clinical evidence.

Conclusions

The participants recounted myriad stories of diagnostic intuition that alerted them to unusual diagnoses, previous diagnostic error or deleterious trajectories. While this qualitative study can offer no conclusions about the representativeness of these stories, it suggests that physicians perceive clinical intuition as beneficial for correcting and advancing diagnoses of both common and rare conditions.

Value of parental concern and clinician's gut feeling in recognition of serious bacterial infections: a prospective observational study

Background

Serious bacterial infections (SBI) are a significant cause of mortality worldwide. Parental concern and clinician’s gut feeling that there is something wrong has been associated with increased likelihood of developing SBI in primary care studies. The aim of this study is to assess the diagnostic value of parental concern and gut feeling at the emergency department of a tertiary hospital.

Methods

This prospective observational study included children with fever attending the emergency department of Children’s Clinical University hospital in Riga between October 2017 and July 2018. Data were collected via parental and clinician questionnaires. “Gut feeling” was defined as intuitive feeling that the child may have a serious illness, and “Sense of reassurance” as a feeling that the child has a self-limiting illness. “Parental concern” was defined as impression that this illness is different from previous illnesses. SBI included bacterial meningitis, sepsis, bacteraemia, pneumonia, urinary tract infection, appendicitis, bacterial gastroenteritis, and osteomyelitis. Pearson’s Chi-Squared test or Fisher’s exact test were used to compare the variables between children with and without SBI. Positive likelihood ratio was calculated for “gut feeling”, “sense of reassurance”, and parental concern.

Results

The study included 162 patients aged 2 months to 17.8 years. Forty-six patients were diagnosed with SBI. “Sense of reassurance” expressed by all clinicians was associated with lower likelihood of SBI (positive likelihood ratio 8.8, 95% confidence interval 2.2–34.8). “Gut feeling” was not significantly predictive of the patient being diagnosed with SBI (positive likelihood ratio 3.1, 95% confidence interval 1.9–5.1), The prognostic rule-in value of parental concern was insignificant (positive likelihood ratio 1.4, 95% confidence interval 1.1–1.7).

Conclusion

Sense of reassurance was useful in ruling out SBI. Parental concern was not significantly predictive of SBI.

Electronic supplementary material

The online version of this article (10.1186/s12887-019-1591-7) contains supplementary material, which is available to authorized users.

"Fat Kids Are Adorable": The Experiences of Mothers Caring for Overweight Children in Indonesia

This study aims to explore mothers' experiences in caring for overweight children under five years of age. This study used a descriptive phenomenology approach, with in-depth interviews with ten mothers who had overweight children under five years of age (2-5 years) selected by purposive sampling. The data was then analyzed using thematic analysis based on Collaizi's approach. This study produced eight themes illustrating that mothers were not only unaware of the children's overweight condition, but even felt more pleased to have overweight kids. This caused mothers not to give the optimum effort in limiting their children's food intake. The low awareness mothers had towards their children's overweight condition indicated the need for an intervention program that focuses on overweight children under five years of age to empower the family and increase family awareness in managing obesity early.

Gut Feelings Questionnaire in daily practice: a feasibility study using a mixed-methods approach in three European countries

OBJECTIVES

The validated Gut Feelings Questionnaire (GFQ) is a 10-item questionnaire based on the definitions of the sense of alarm and the sense of reassurance. The purpose of the GFQ is to determine the presence or absence of gut feelings in the diagnostic reasoning of general practitioners (GPs).The aim was to test the GFQ on GPs, in real practice settings, to check whether any changes were needed to improve feasibility, and to calculate the prevalence of the GPs' sense of alarm and sense of reassurance in three different countries.

SETTING

Primary care, six participating centres in Belgium, France and the Netherlands.

PARTICIPANTS

We performed a think-aloud study with 24 experienced Dutch GPs, GP trainees and medical clerks who filled in the GFQ after diagnosing each of six case vignettes. We then performed a feasibility study in two phases, using a mixed-method approach, with 42 French and Dutch GPs in the first phase and then 10 Belgian, 10 Dutch and 10 French GPs in the second phase. All GPs filled in the GFQ after each of eight consultations with patients presenting new complaints and were subsequently interviewed about the use of the GFQ.

OUTCOME MEASURES

GPs' experiences on using the GFQ in real practice, more specifically the average time needed for filling in the questionnaire.The prevalence of GPs' sense of alarm and sense of reassurance.

RESULTS

The modified version of the GFQ, created without altering the sense of the validated items, was easy to use in daily practice. The prevalence of the GPs' sense of alarm occurred during 23%-31% of the included consultations.

CONCLUSIONS

After a two-step study and several minor adaptations, the final version of the GFQ proved to be a feasible and practical tool to be used for prospective observational studies in daily practice.

Cross-cultural translation and validation of the 'gut feelings' questionnaire into Spanish and Catalan

Background: The gut feelings questionnaire (GFQ) is the only tool developed to assess the presence of a ‘sense of alarm’ or a ‘sense of reassurance’ in the diagnostic process of general practitioners (GPs). It was created in Dutch and English and has validated versions in French, German and Polish.

Objectives: To obtain a cross-cultural translation of the GFQ into Spanish and Catalan and to assess the structural properties of the translated versions.

Methods: A six-step procedure including forward and backward translations, consensus, and cultural and linguistic validation was performed for both languages. Internal consistency, factor structure, and content validity were assessed.

Results: Internal consistency was high for both questionnaires (Cronbach’s alpha for GFQ-Spa = 0.94 and GFQ-Cat = 0.95). The principal component analysis identified one factor with the sense of alarm and the sense of reassurance as two opposites, explaining 76% of the total variance for the GFQ-Spa, and 77% for the GFQ-Cat.

Conclusion: Spanish and Catalan versions of the GFQ were obtained. Both have been cross-culturally adapted and showed good structural properties.

Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care

BACKGROUND

Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention.

METHODS

Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving naïve understanding, structural analysis and comprehensive understanding.

RESULTS

Two major themes captured clinicians' perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following one's perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines.

CONCLUSIONS

In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision- and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors.

Diagnostic Reasoning and Cognitive Biases of Nurse Practitioners

BACKGROUND

Diagnostic reasoning is often used colloquially to describe the process by which nurse practitioners and physicians come to the correct diagnosis, but a rich definition and description of this process has been lacking in the nursing literature.

METHOD

A literature review was conducted with theoretical sampling seeking conceptual insight into diagnostic reasoning.

RESULTS

Four common themes emerged: Cognitive Biases and Debiasing Strategies, the Dual Process Theory, Diagnostic Error, and Patient Harm. Relevant cognitive biases are discussed, followed by debiasing strategies and application of the dual process theory to reduce diagnostic error and harm.

CONCLUSION

The accuracy of diagnostic reasoning of nurse practitioners may be improved by incorporating these items into nurse practitioner education and practice. [J Nurs Educ. 2018;57(4):203-208.].

Empathy, burn-out and the use of gut feeling: a cross-sectional survey of Danish general practitioners

OBJECTIVE

Research has suggested that physicians' gut feelings are associated with parents' concerns for the well-being of their children. Gut feeling is particularly important in diagnosis of serious low-incidence diseases in primary care. Therefore, the aim of this study was to examine whether empathy, that is, the ability to understand what another person is experiencing, relates to general practitioners' (GPs) use of gut feelings. Since empathy is associated with burn-out, we also examined whether the hypothesised influence of empathy on gut feeling use is dependent on level of burn-out.

DESIGN

Cross-sectional questionnaire survey. Participants completed the Jefferson Scale of Physician Empathy and The Maslach Burnout Inventory.

SETTING

Primary care.

PARTICIPANTS

588 active GPs in Central Denmark Region (response rate=70%).

PRIMARY OUTCOME MEASURES

Self-reported use of gut feelings in clinical practice.

RESULTS

GPs who scored in the highest quartile of the empathy scale had fourfold the odds of increased use of gut feelings compared with GPs in the lowest empathy quartile (OR 3.99, 95% CI 2.51 to 6.34) when adjusting for the influence of possible confounders. Burn-out was not statistically significantly associated with use of gut feelings (OR 1.29, 95% CI 0.90 to 1.83), and no significant interaction effects between empathy and burn-out were revealed.

CONCLUSIONS

Physician empathy, but not burn-out, was strongly associated with use of gut feelings in primary care. As preliminary results suggest that gut feelings have diagnostic value, these findings highlight the importance of incorporating empathy and interpersonal skills into medical training to increase sensitivity to patient concern and thereby increase the use and reliability of gut feeling.

The gap in human resources to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico

BACKGROUND

The purpose of this study was to estimate the gap between the available and the ideal supply of human resources (physicians, nurses, and health promoters) to deliver the guaranteed package of prevention and health promotion services at urban and rural primary care facilities in Mexico.

METHODS

We conducted a cross-sectional observational study using a convenience sample. We selected 20 primary health facilities in urban and rural areas in 10 states of Mexico. We calculated the available and the ideal supply of human resources in these facilities using estimates of time available, used, and required to deliver health prevention and promotion services. We performed descriptive statistics and bivariate hypothesis testing using Wilcoxon and Friedman tests. Finally, we conducted a sensitivity analysis to test whether the non-normal distribution of our time variables biased estimation of available and ideal supply of human resources.

RESULTS

The comparison between available and ideal supply for urban and rural primary health care facilities reveals a low supply of physicians. On average, primary health care facilities are lacking five physicians when they were estimated with time used and nine if they were estimated with time required (P < 0.05). No difference was observed between available and ideal supply of nurses in either urban or rural primary health care facilities. There is a shortage of health promoters in urban primary health facilities (P < 0.05).

CONCLUSION

The available supply of physicians and health promoters is lower than the ideal supply to deliver the guaranteed package of prevention and health promotion services. Policies must address the level and distribution of human resources in primary health facilities.

Improving team-based care for children: shared well child care involving family practice nurses

INTRODUCTION

Well child care (WCC) is the provision of routine preventative care and vaccinations to infants and children. In Canada, physicians provide the majority of this type of care, whereas in other developed countries, nurses provide most WCC. New models of shared care between nurses and family physicians should be explored.

OBJECTIVE

This pilot project aimed to evaluate the feasibility and acceptability of shared nurse-physician WCC for a cohort of healthy children.

METHODS

A total of 20 participants had nurse-physician alternating WCC visits, which were compared with physician-provided WCC visits. The feasibility was evaluated through chart audits and the acceptability was evaluated through interviews with the physicians, nurses, and the patients' parents.

RESULTS

The results showed that physicians and nurses discuss a similar percentage of Rourke Baby Record topics, and that families and clinic staff were accepting of this new model of care.

CONCLUSION

This intervention could liberate time for Canadian family physicians, thereby improving access to care.

The linguistic validation of the gut feelings questionnaire in three European languages

Background

Physicians’ clinical decision-making may be influenced by non‐analytical thinking, especially when perceiving uncertainty. Incidental gut feelings in general practice have been described, namely, as “a sense of alarm” and “a sense of reassurance”.

A Dutch Gut Feelings Questionnaire (GFQ) was developed, validated and afterwards translated into English following a linguistic validation procedure.

The aims were to translate the GFQ from English into French, German and Polish; to describe uniform elements as well as differences and difficulties in the linguistic validation processes; to propose a procedural scheme for future GFQ translations into other languages.

Methods

We followed a structured, similar and equivalent procedure. Forward and backward-translations, repeated consensus procedures and cultural validations performed in six steps. Exchanges between the several research teams, the authors of the Dutch GFQ, and the translators involved continued throughout the procedure.

Results

12 translators, 52 GPs and 8 researchers in the field participated to the study in France, Germany, Switzerland and Poland. The collaborating research teams created three versions of the 10-item GFQ. Each research team found and agreed on compromises between comparability and similarity on one hand, and linguistic and cultural specificities on the other.

Conclusions

The gut feeling questionnaire is now available in five European languages: Dutch, English, French, German and Polish. The uniform procedural validation scheme presented, and agreed upon by the teams, can be used for the translation of the GFQ into other languages. Comparing results of research into the predictive value of gut feelings and into the significance of the main determinants in five European countries is now possible.

Electronic supplementary material

The online version of this article (doi:10.1186/s12875-017-0626-0) contains supplementary material, which is available to authorized users.

Exercising alcohol patients don't lack motivation but struggle with structures, emotions and social context - a qualitative dropout study

BACKGROUND

Exercise is an important component of a healthy lifestyle, the development of which is a relapse prevention strategy for those with alcohol use disorder. However, it is a challenge to create exercise interventions with a persistent behavioural change. The aim of this qualitative study was to investigate perceived barriers to participation in an exercise intervention among alcohol use disorder patients, who dropped out of the intervention program. Furthermore, this study aims to propose possibilities for a better practice of future intervention studies based on the participants' experiences and suggestions.

METHODS

Qualitative interviews with 17 patients who dropped out from an exercise intervention in an outpatient treatment centre about their experiences and reasons for dropping out. Social cognitive theory informed the development of the interview guides and systematic text condensation was used for analysis.

RESULTS

Analysis revealed three central themes: 1) Structural barriers described as the type of exercise and the timing of the intervention, 2) Social barriers described as need for accountability and unsupportive relations, and 3) Emotional barriers described as fear, guilt and shame, and negative affect of the intervention on long term.

CONCLUSIONS

Future exercise interventions should include socio-psychological support during the first weeks, begin shortly after treatment initiation instead of concurrently, and focus on garnering social support for participants in both the intervention context and among their existing network in order to best reduce barriers to participation.

TRIAL REGISTRATION

This study was retrospectively registered at Current Controlled Trials ISRCTN74889852 on 11 July 2013.