An Integrative Review of Micro-Credentials and Digital Badges for Pharmacy Educators

Micro-credentials (MCs) and digital badges (DBs) have gained popularity in recent years as a means to supplement traditional degrees and certifications. MCs and DBs can play a significant role in supporting student-centered learning by offering personalized and flexible learning pathways, emphasizing real-world relevance and practical skills, and fostering a culture of continuous learning and growth. However, barriers currently exist within health professions education, including pharmacy education, that could limit the full adoption and implementation of MCs and DBs. Research on the use of MCs and DBs in Doctor of Pharmacy degree programs is sparse. In this integrative review, literature on the use of MCs and DBs in health professions education is reviewed, and perspectives on the benefits, issues, and potential future uses within Doctor of Pharmacy degree programs are presented.

Relationship and Attachment to Digital Health Technology During Cancer Treatment

OBJECTIVE

The aim of this study is to explore the relationship that people with cancer and their family caregivers develop with symptom management technology during chemotherapy.

DATA SOURCES

A longitudinal and multi-perspective interpretative phenomenological approach was adopted. Data were collected using one-to-one in-depth interviews with people with colorectal cancer using supportive digital health symptom management technology (n=3) and their family caregivers (n=4) at two time points during chemotherapy treatment. Data were analyzed using interpretative phenomenological analysis and followed COREQ guidelines.

CONCLUSION

People with cancer and their family caregivers can develop emotional bonds with supportive symptom management technology during cancer treatment. Digital health technology can be experienced as a person guiding them during their cancer treatment. Participants felt vulnerable after the technology was returned to the research team. Participants recognized that it was not the technology that successfully facilitated them through their initial chemotherapy cycles; rather, the technology helped them learn to manage their symptoms and promoted their self-efficacy, as well as how to emotionally respond.

IMPLICATIONS FOR NURSING PRACTICE

The relationship and psychological bonds people with cancer and their family caregivers develop with technology during treatment may be critically important for oncology nurses to be aware of should digital health be prescribed within the outpatient model of cancer care. This study indicates that technology may not be needed for a full treatment experience, as digital health can promote confidence and self-efficacy regarding symptom management and prepare people with cancer to be independent after the digital health technology is returned to the research team. However, further research is needed regarding individual preferences for digital health provision.

Benchmark Report on Utilization of Faculty Workload Models in Colleges and Schools of Pharmacy

This commentary offers a call to action to develop equity-minded, evidence-based faculty workload policies and practices within colleges and schools of pharmacy. The University of Maryland School of Pharmacy sponsored an investigation to characterize and compare peer schools' models for measuring and using faculty workload data. An external consulting group selected 28 colleges and schools of pharmacy based on characteristics similar to the University of Maryland School of Pharmacy and collected information, feedback, and data on how these programs assessed faculty workload. Exploratory emails and phone interviews were used to collect these data. Nine of the 28 programs participated in additional follow-up discussions. These interviews identified common themes, although there was wide variability in design and implementation of workload models, even among comparable institutions. These findings align with the national Faculty Workload and Rewards Project that explored how faculty workload models can perpetuate inequities and undermine productivity, satisfaction, and retention.

A Scoping Review for Debate-Style Journal Clubs in Health Professional Education

OBJECTIVES

The objectives of this scoping review are to (1) describe the available literature regarding the utility of the debate-style journal club for health professional learners on literature evaluation skills and (2) report the themes found within debate-style journal club research and assessments in the context of professional education.

FINDINGS

A total of 27 articles written in the English language were included in this scoping review. Published evaluations of debate-style journal clubs have been predominantly based in the pharmacy profession (48%, n = 13), but are reported in other health professions, such as medicine (22%, n = 6), dentistry (15%, n = 4), nursing (7%, n = 2), occupational therapy (4%, n = 1), and physical therapy (4%, n = 1), as well. The skills assessed in these studies often included critical literature evaluation, application of literature to patient care, critical thinking, knowledge retention, use of supporting literature, and debate-specific skills. Learners typically reported better understanding and application of the literature, and enjoying the experience more than traditional journal clubs, but note the increased assessor and learner time requirement for debating. Pharmacy learner-specific articles more often utilized a traditional, team-based debate format, incorporated grading rubrics for skill assessment and debate performance, and included a grading component for the debate in the course.

SUMMARY

Debate-style journal clubs are well-received by learners but require an additional time commitment. Debate platforms, format, rubric use and validation, and outcome assessment vary across published reports.

Application of complexity theory in health and social care research: a scoping review

BACKGROUND

Complexity theory has been chosen by many authors as a suitable lens through which to examine health and social care. Despite its potential value, many empirical investigations apply the theory in a tokenistic manner without engaging with its underlying concepts and underpinnings.

OBJECTIVES

The aim of this scoping review is to synthesise the literature on empirical studies that have centred on the application of complexity theory to understand health and social care provision.

METHODS

This scoping review considered primary research using complexity theory-informed approaches, published in English between 2012 and 2021. Cochrane Database of Systematic Reviews, MEDLINE, CINAHL, EMBASE, Web of Science, PSYCHINFO, the NHS Economic Evaluation Database, and the Health Economic Evaluations Database were searched. In addition, a manual search of the reference lists of relevant articles was conducted. Data extraction was conducted using Covidence software and a data extraction form was created to produce a descriptive summary of the results, addressing the objectives and research question. The review used the revised Arksey and O'Malley framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR).

RESULTS

2021 studies were initially identified with a total of 61 articles included for extraction. Complexity theory in health and social care research is poorly defined and described and was most commonly applied as a theoretical and analytical framework. The full breadth of the health and social care continuum was not represented in the identified articles, with the majority being healthcare focused.

DISCUSSION

Complexity theory is being increasingly embraced in health and care research. The heterogeneity of the literature regarding the application of complexity theory made synthesis challenging. However, this scoping review has synthesised the most recent evidence and contributes to translational systems research by providing guidance for future studies.

CONCLUSION

The study of complex health and care systems necessitates methods of interpreting dynamic prcesses which requires qualitative and longitudinal studies with abductive reasoning. The authors provide guidance on conducting complexity-informed primary research that seeks to promote rigor and transparency in the area.

REGISTRATION

The scoping review protocol was registered at Open Science Framework, and the review protocol was published at BMJ Open (https://bit.ly/3Ex1Inu).

Increasing the PharmD Pipeline, Encouraging Student Success, and Supporting the Underserved Through Pre-Pharmacy Advising

Academic advising for pre-pharmacy students lacks best practice recommendations specific to the pharmacy profession. When considering contemporary challenges in pharmacy education, adoption of high-quality advising approaches will likely have a positive influence on professional school enrollment, general student success, and educational access for the traditionally underserved. As pre-health academic advising is an important component of student professional development, standardizing best-practice strategies in and around pharmacy programs will "[strengthen] the pharmacy pipeline" and "[raise] the profile of pharmacy" as stated in the 2021-2024 Strategic Plan Priorities, Goals and Objectives issued by the American Association of Colleges of Pharmacy (AACP). An investment is needed to codify such practices in pre-pharmacy advising and scale these techniques across pharmacy schools positioned to serve undergraduates.

A bridge from uncertainty to understanding: The meaning of symptom management digital health technology during cancer treatment

Objective

Digital health technology is valued as a tool to provide person-centred care and improve health outcomes amongst people with cancer and their family caregivers. Although the evidence to date shows encouraging effectiveness, there is limited knowledge regarding the lived experience and personal meaning of using supportive technology during cancer treatment. The aim of this study was to explore the lived experiences of people with colorectal cancer receiving chemotherapy using digital health symptom management technology and their family caregivers.

Methods

A longitudinal and multi-perspective interpretative phenomenological analytical approach was adopted including three people with newly diagnosed colorectal cancer and four family caregivers.

Findings

Three superordinate themes and related subthemes were identified. The first theme (The 3 Cs of symptom management technology) centred on the continuity of care that participants felt while using the technology. The second theme (Digital health technology as a psychosocial support) offered insights into the psychological benefits using technology incurred as they navigated their cancer diagnosis including sense of control and psychological safety. The final theme (Impact of digital health technology on family caregivers) details the supportive effect the technology had on family caregivers' role, responsibilities and well-being during the cancer experience.

Conclusion

Digital health technology can act as a bridge from uncertainty to an understanding regarding a cancer diagnosis and its treatment. Digital health technology can support peoples' understanding of cancer and enhance self-management practices, while being a psychological support in navigating the uncertain and often worrying period of receiving cancer treatment.

A protocol for a scoping review of methodologies used to explore patient experience in post-acute rehabilitation settings

Background: Patient experience is routinely collected in the clinical environment in many different ways throughout various person-provider encounters, but so far limited research focused on understanding the methods of using it to improve the quality of healthcare. This paper presents a protocol for a methodological scoping review examining the methods of obtaining, analysing, reporting, and using patient experience data for quality improvement in rehabilitation settings. Methods: The scoping review will be conducted according to the guidelines from the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis and the methodological framework by Arksey & O’Malley. A comprehensive search of the literature will be performed using a three-step search strategy: an initial limited search of two databases was already performed and helped to identified relevant key words and index terms. The developed search string will be adapted and applied across four databases. This will be followed by search of the reference lists of selected sources and hand-search relevant data-hubs. Studies with a clear focus on patient experience or feedback collected or used for healthcare improvement in rehabilitation context, will be included. A data extraction framework will be developed and piloted to guide the literature screening and data charting. Qualitative content analysis will be employed to address research questions and the results will be presented – beside the descriptive format - as a map of data in chart and tabular formats. Conclusions: This scoping review will show the extent and scope of the literature on the applied methods of collecting, communicating, and using patient experience for quality improvement in post-acute rehabilitation settings and will evaluate and map the evidence on these topics. The findings will inform a research project entitled “An exploration into the use of patient experience to inform improvement in a National Rehabilitation Hospital”.

A Call for Simplification and Integration of Doctor of Pharmacy Curricular Outcomes and Frameworks

Pharmacy education faces an upcoming revision of accreditation standards designed to outline degree program requirements for training the next generation of pharmacists. At the same time, pharmacy educators are increasingly expected to integrate multiple other educational frameworks and recommendations from distinct groups into their curricula. With this list of expectations constantly expanding and changing, education leaders are forced to spend valuable time and resources trying to satisfy "checklists" instead of enhancing their programs. The following commentary discusses concerns about the growing complexity of the standards and frameworks used in the accreditation process, overlap and redundancy in these various requirements, and relevant comparisons between pharmacy and medical education. We outline recommendations regarding purposeful integration of frameworks with the goal of simplifying accreditation requirements and enhancing program flexibility to deliver innovative, high-quality curricula.

Patients’ Perspectives regarding Digital Health Technology to Support Self-management and to Improve Integrated Stroke Care: Qualitative Interview Study (Preprint)

BACKGROUND

Digital technologies such as mobile apps and robotics have the potential to involve stroke patients better in the care process and to promote self-management. However, barriers exist that constrain the adoption and acceptance of technology in clinical practice. Examples of barriers are privacy concerns, challenges regarding usability, and the perception that there is no need for health-related technology. To address these barriers, co-design can be used to enable patients to reflect on their experiences of a service and to tailor digital technologies to the needs and preferences of end users regarding content and usability.

OBJECTIVE

This study aims to explore the perspectives of stroke patients toward how digital health technology could support self-management regarding health and well-being, as well as integrated stroke care.

METHODS

A qualitative study was conducted to understand patient perspectives. Data were collected in co-design sessions during the ValueCare study. Patients from a Dutch hospital who experienced an ischemic stroke (n=36) within the past 18 months were invited to participate. Data collection took place between December 2020 and April 2021 via one-to-one telephone interviews. A short self-report questionnaire was used to collect data on sociodemographics, disease-specific information, and technology use. All interviews were audio-taped and transcribed verbatim. The interview data were analyzed using a thematic approach.

RESULTS

Patients held mixed attitudes toward digital health technologies. Some patients viewed digital technology as a convenient product or service, while others expressed no desire or need to use technology for self-management or care. Digital features suggested by stroke patients included (1) information about the causes of stroke, medication, prognosis, and follow-up care; (2) an online library with information regarding stroke-related health and care issues; (3) a personal health record by which patients can retrieve and manage their own health information; and (4) online rehabilitation support to empower patients to exercise at home. Regarding the user interface of future digital health technology, patients emphasized the need for easy-to-use and simple designs.

CONCLUSIONS

Stroke patients mentioned credible health information, an online library with stroke-related health and care information, a personal health record, and online rehabilitation support as the main features to include in future digital health technologies. We recommend that developers and designers of digital health for stroke care listen to the "voice of the stroke patients" regarding both functionality and the characteristics of the interface.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12877-022-03333-8.

Older adults and family caregivers’ experience of digital health technology in frailty care: A systematic review and meta-ethnography protocol

Background: Digital health technology has been identified as a valuable tool to support older adults with frailty needs in their home setting. Despite the numerous technologies and evaluations of these innovations, a synthesis of the older person and family caregivers’ experience using technology for support self-management has not been conducted to date.

Methods and analysis: A systematic review and meta-ethnography will be conducted in accordance with the PRISMA and eMERGe reporting guidelines. Four peer-reviewed empirical evidence databases will be searched (Medline (Ovid), CINAHL, EMBASE, PsycINFO) using a defined search strategy. Studies containing qualitative data on the experiences of older people or family caregivers of using digital health technology to support frailty care will be included. Covidence software will be used to screen studies and extract data. The Critical Appraisal Skills Programme (CASP) checklist for qualitative research will be used by two independent reviewers to appraise all included papers. A meta-ethnography will be undertaken in accordance with the seven-phase method described by Noblit and Hare: (1) Getting started, (2) Deciding what is relevant to the initial interest, (3) Reading the studies, (4) Determining how the studies are related, (5) Translating the studies into one another, (6) Synthesizing translations and (7) Expressing the synthesis.

Discussion: To the best of our knowledge, this will be the first systematic review to integrate and synthesize the findings of qualitative studies of older citizens’ experience of digital health technology. The findings of this meta-ethnography will endeavour to inform future research, policy and clinical practice. In particular, the results will help to inform the design of future digital health technology to meet the needs of older adults.

PROSPERO registration number: CRD42022314608.

'Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies' (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial

Background

Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023.

Methods

A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data.

Discussion

This study will provide new insights into the feasibility and effectiveness of a value-based methodology for integrated care supported by ICT for older people, their informal caregivers, and health and social care practitioners in seven different European settings.

Trial registration

ISRCTN registry number is 25089186. Date of trial registration is 16/11/2021.

Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review protocol

Background: Education is recognised as a constitutional right, however, access to and participation in higher education can be challenging for some students. This has led to the development of various international and local initiatives promoting inclusion, which has increased student representation from marginalised groups. In order to support growing student diversity, teaching and learning (T&L) strategies must encompass inclusive pedagogical principles. Technological advancements have improved opportunities for online T&L strategies and these are becoming an integral component of curricula in undergraduate nursing programmes. Online simulation-based learning (SBL) has gathered momentum in nursing education over the past twenty years. However, it is unclear from the evidence-base how inclusive this educational approach is, and how it can best support the growing diversity among nursing students. This paper outlines the protocol for a scoping review that aims to systematically and comprehensively map the available published and unpublished literature on inclusive pedagogy in online SBL in undergraduate nursing education.  Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for systematic review protocols (PRISMA-P) guided this protocol. Arksey and O'Malley (2005) six-stage methodology framework, the Joanna Briggs Institute (JBI) guidelines (Peters et al., 2020) and the PRISMA extension for scoping reviews (PRISMA-ScR) will guide the proposed scoping review (Tricco et al., 2018). Conclusion: It is envisaged that this scoping review will give a broad overview of the evidence for inclusive pedagogy in online SBL at this point. The findings of this review will be used to inform future policy and the pedagogical and technological design of online SBL activities and assist nurse educators to meet the current requirement of inclusive practice.

Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review protocol

Background: Education is recognised as a constitutional right, however, access to and participation in higher education can be challenging for some students. This has led to the development of various international and local initiatives promoting inclusion, which has increased student representation from marginalised groups. In order to support growing student diversity, teaching and learning (T&L) strategies must encompass inclusive pedagogical principles. Technological advancements have improved opportunities for online T&L strategies and these are becoming an integral component of curricula in undergraduate nursing programmes. Online simulation-based learning (SBL) has gathered momentum in nursing education over the past twenty years. However, it is unclear from the evidence-base how inclusive this educational approach is, and how it can best support the growing diversity among nursing students. This paper outlines the protocol for a scoping review that aims to systematically and comprehensively map the available published and unpublished literature on inclusive pedagogy in online SBL in undergraduate nursing education.  Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for systematic review protocols (PRISMA-P) guided this protocol. Arksey and O'Malley (2015) six-stage methodology framework, the Joanna Briggs Institute (JBI) guidelines (2005) and the PRISMA extension for scoping reviews (PRISMA-ScR) will guide the proposed scoping review. Conclusion: It is envisaged that this scoping review will give a broad overview of the evidence for inclusive pedagogy in online SBL at this point. The findings of this review will be used to inform future policy and the pedagogical and technological design of online SBL activities and assist nurse educators to meet the current requirement of inclusive practice.

Older adults and family caregivers’ experience of digital health technology in frailty care: A systematic review and meta-ethnography protocol

Background: Digital health technology has been identified as a valuable tool to support older adults with frailty needs in their home setting. Despite the numerous technologies and evaluations of these innovations, a synthesis of the older person and family caregivers’ experience using technology for support self-management has not been conducted to date. Methods and analysis: A systematic review and meta-ethnography will be conducted in accordance with the PRISMA and eMERGe reporting guidelines. Four peer-reviewed empirical evidence databases will be searched (Medline (Ovid), CINAHL, EMBASE, PsycINFO) using a defined search strategy. Studies containing qualitative data on the experiences of older people or family caregivers of using digital health technology to support frailty care will be included. Covidence software will be used to screen studies and extract data. The Critical Appraisal Skills Programme (CASP) checklist for qualitative research will be used by two independent reviewers to appraise all included papers. A meta-ethnography will be undertaken in accordance with the seven-phase method described by Noblit and Hare: (1) Getting started, (2) Deciding what is relevant to the initial interest, (3) Reading the studies, (4) Determining how the studies are related, (5) Translating the studies into one another, (6) Synthesizing translations and (7) Expressing the synthesis. Discussion: To the best of our knowledge, this will be the first systematic review to integrate and synthesize the findings of qualitative studies of older citizens’ experience of digital health technology. The findings of this meta-ethnography will endeavour to inform future research, policy and clinical practice. In particular, the results will help to inform the design of future digital health technology to meet the needs of older adults. PROSPERO registration number: Submitted 05/04/2022 and currently under review.

Building research capacity and culture: Exploring nurses' experience of implementing a nurse-led clinical trial

AIM

To explore the experiences of a nursing team who implemented an international nurse-led clinical trial in practice and understand the facilitators to their involvement.

BACKGROUND

The role and responsibilities of the clinical nurse are advancing to encompass research activity to help inform evidence-based practice. However, several personal and organisational challenges can inhibit nurses' capacity to implement and undertake research within clinical practice.

METHODS

Three focus groups were conducted with members of a nursing team (N=18). Thematic analysis was employed, and themes were identified and agreed upon by the research team.

FINDINGS

Five themes were identified: 'Previous experience of and attitudes to participation in clinical research', 'Decision-making regarding participation in the clinical trial', 'Facilitators of participation in the clinical trial', 'Challenges of research in nursing practice' and 'Future orientation towards research'.

CONCLUSION

Through their experiences of implementing a nurse-led clinical trial within practice, nurses recognised a number of facilitators and challenges to their participation. The perceived relevance of the clinical trial to the nurses' practice, potential to improve patient care and appreciation of the nurse leader's expertise and understanding of their context were key motivators. Reciprocal trust with the nurse leader who was encouraging, motivating, supportive and accessible resulted in the engagement and commitment of the nursing team.

IMPLICATIONS FOR NURSING MANAGEMENT

This paper offers a perspective that can inform senior nursing management teams when implementing and conducting evidence-based research amongst nursing teams and in doing so meet the needs of developing research capacity amongst clinical nurses.

Marketing mobile influenza vaccine clinics on a college campus

BACKGROUND

Influenza vaccination rates fall below public health targets. Compared with the general population, vaccination rates on college campuses are even lower. Since 2013, the University of Georgia College of Pharmacy and University Health Center (UHC) Pharmacy have collaborated to increase access to influenza vaccines by holding clinics at locations across campus. In an effort to increase awareness, this partnership expanded to include the UHC Marketing Department. Through this initiative, a coordinated marketing campaign was implemented to promote immunization opportunities.

OBJECTIVES

To examine the impact of a collaborative, multimodal marketing campaign on individuals receiving the influenza vaccine at mobile clinics on a college campus and explore reasons why recipients chose to get vaccinated.

METHODS

A 7-item survey was developed and administered at mobile influenza vaccine clinics across campus during the fall of 2018. The survey asked participants for basic demographics, the marketing strategies that they encountered, the strategy had the most impact on their decision to get vaccinated at the clinic, and their motivation for receiving the vaccine.

RESULTS

The survey was administered at 11 campus-based clinics, with a 71% response rate. A total of 59% respondents were students, and 41% were faculty or staff. The most common marketing strategies recognized by participants were e-mail (45%), friend or colleague (35%), paper/digital flyers (24%), UHC website (9%), and mobile clinic signage (7%). The most common motivating factors for getting vaccinated were lowering the risk of getting sick (87%), protecting others (64%), and being encouraged by a relative or friend (34%). The number of people vaccinated after the marketing campaign was 1150, a 69% increase compared with the previous year.

CONCLUSION

The marketing strategies described in this paper resulted in an increase in the number of vaccine recipients at campus-based mobile clinics. Implementing a multimodal, coordinated marketing campaign can help universities improve their vaccination efforts.

People with cancer and their family caregivers' personal experience of using supportive eHealth technology: A narrative review

PURPOSE

To synthesise existing qualitative evidence regarding the experiences of people living with cancer and their family caregivers using eHealth technology in their home setting.

METHOD

A narrative review using a systematic approach was utilised. Five databases (PubMed, CINAHL, EMBASE, PsycINFO and the Cochrane Library) were searched using a tailored search strategy to identify primary research articles published between January 2005 and May 2021. Studies were quality appraised using the Critical Appraisal Skills Programme's Qualitative Studies Checklist and the Mixed Method Appraisal Tool, where relevant. Identified studies were appraised by three reviewers and data were extracted for analysis. Key themes were identified and agreed upon by the authors.

RESULTS

28 empirical studies were included in the review. Five major themes emerged: (i) understanding of cancer and its care (ii) alignment and integration of eHealth technology into daily life (iii) connection and collaboration with healthcare professionals, family and peers (iii) reassurance and sense of safety (iv) and the psychosocial impact on the self during the cancer experience.

CONCLUSIONS

eHealth technology can have positive role in the lives of people with cancer and their family caregivers, beyond the intended health outcomes of the intervention. Individual preferences amongst people with cancer and their family caregivers using eHealth technology must be considered, especially regarding cancer information delivery, content and support methods. This review underlines a critical need for further in-depth evidence on the personal meaning and relationships people with cancer and their family caregivers develop with eHealth technology in an ambulatory care setting.

Use of complexity theory in health and social care: a scoping review protocol

INTRODUCTION

Despite the use of a wide variety of improvement tools and approaches, healthcare organisations continue to struggle in several key areas. Complexity-informed approaches have the potential to offer health and social care a new paradigm for understanding, designing, implementing and evaluating solutions, yet so far has failed to gain the traction anticipated some years ago. There is a growing need for high quality syntheses of the existing knowledge base in this area and given the diversity of theory and approaches, a scoping review is the best approach to curate this knowledge.

METHODS

A scoping review of relevant literature from January 2000 to present, using the refined Arksey and O'Malley six-stage framework will be conducted. This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews. A three-step search strategy will be used. An initial search of databases will be undertaken to identify key search terms followed by an analysis of retrieved papers title and abstract text words, and of index terms used to describe the articles. A second search using all identified keywords and index terms will then be undertaken across all included databases. Third, the reference lists of identified reports and articles will be searched. Authors of primary articles will be contacted and a search for grey material performed. Finally, a complete search strategy of one major database will be included.

ETHICS AND DISSEMINATION

As this is a scoping review, ethical approval is not required. The results of the scoping review will be published in a peer-reviewed journal and presented at national and international conferences and will guide a large research project investigating teamwork. All data will be stored in accordance with best General Data Protection Regulation practice.

REGISTRATION

This scoping review protocol has been registered with Open Science Framework.

Real time remote symptom monitoring during chemotherapy for cancer: European multicentre randomised controlled trial (eSMART)

OBJECTIVE

To evaluate effects of remote monitoring of adjuvant chemotherapy related side effects via the Advanced Symptom Management System (ASyMS) on symptom burden, quality of life, supportive care needs, anxiety, self-efficacy, and work limitations.

DESIGN

Multicentre, repeated measures, parallel group, evaluator masked, stratified randomised controlled trial.

SETTING

Twelve cancer centres in Austria, Greece, Norway, Republic of Ireland, and UK.

PARTICIPANTS

829 patients with non-metastatic breast cancer, colorectal cancer, Hodgkin's disease, or non-Hodgkin's lymphoma receiving first line adjuvant chemotherapy or chemotherapy for the first time in five years.

INTERVENTION

Patients were randomised to ASyMS (intervention; n=415) or standard care (control; n=414) over six cycles of chemotherapy.

MAIN OUTCOME MEASURES

The primary outcome was symptom burden (Memorial Symptom Assessment Scale; MSAS). Secondary outcomes were health related quality of life (Functional Assessment of Cancer Therapy-General; FACT-G), Supportive Care Needs Survey Short-Form (SCNS-SF34), State-Trait Anxiety Inventory-Revised (STAI-R), Communication and Attitudinal Self-Efficacy scale for cancer (CASE-Cancer), and work limitations questionnaire (WLQ).

RESULTS

For the intervention group, symptom burden remained at pre-chemotherapy treatment levels, whereas controls reported an increase from cycle 1 onwards (least squares absolute mean difference -0.15, 95% confidence interval -0.19 to -0.12; P<0.001; Cohen's D effect size=0.5). Analysis of MSAS sub-domains indicated significant reductions in favour of ASyMS for global distress index (-0.21, -0.27 to -0.16; P<0.001), psychological symptoms (-0.16, -0.23 to -0.10; P<0.001), and physical symptoms (-0.21, -0.26 to -0.17; P<0.001). FACT-G scores were higher in the intervention group across all cycles (mean difference 4.06, 95% confidence interval 2.65 to 5.46; P<0.001), whereas mean scores for STAI-R trait (-1.15, -1.90 to -0.41; P=0.003) and STAI-R state anxiety (-1.13, -2.06 to -0.20; P=0.02) were lower. CASE-Cancer scores were higher in the intervention group (mean difference 0.81, 0.19 to 1.43; P=0.01), and most SCNS-SF34 domains were lower, including sexuality needs (-1.56, -3.11 to -0.01; P<0.05), patient care and support needs (-1.74, -3.31 to -0.16; P=0.03), and physical and daily living needs (-2.8, -5.0 to -0.6; P=0.01). Other SCNS-SF34 domains and WLQ were not significantly different. Safety of ASyMS was satisfactory. Neutropenic events were higher in the intervention group.

CONCLUSIONS

Significant reduction in symptom burden supports the use of ASyMS for remote symptom monitoring in cancer care. A "medium" Cohen's effect size of 0.5 showed a sizable, positive clinical effect of ASyMS on patients' symptom experiences. Remote monitoring systems will be vital for future services, particularly with blended models of care delivery arising from the covid-19 pandemic.

TRIAL REGISTRATION

Clinicaltrials.gov NCT02356081.

Interpersonal and communication skills development in nursing preceptorship education and training programmes: a scoping review protocol

The preceptorship model is an education-focused model for teaching and learning within a clinical environment in nursing. It formulates a professional educational relationship between a staff nurse (preceptor) and student nurse and is based on the provision of providing patient care. Preceptorship is widely acknowledged in the literature as a positive pedagogical approach in clinical nursing education in terms of knowledge and skill acquisition, confidence, and professional socialisation of undergraduate nursing students. However, the literature also widely reports negative interpersonal experiences within this professional educational relationship resulting in negative educational experiences and in some cases, negative patient experiences. Therefore, the authors set out to examine what teaching strategies are being implemented by nurse educators to encourage the development of interpersonal and communication skills in facilitating positive interpersonal relationships between the preceptor, nursing student and patient. This paper outlines the protocol for an exploratory scoping review that aims to systematically and comprehensively map out the available published and unpublished literature on the teaching strategies to develop interpersonal and communication skills in preceptorship education and training programmes. To conduct a systematic and comprehensive scoping review, the review will be guided by the Joanna Briggs Institute and Arksey & O' Malley (2005) six-stage iterative framework, as well as PRISMA-ScR framework guidelines, to ensure the quality of the methodological and reporting approaches to the review. It is anticipated that the results of the scoping review will inform nurse educators on the current educational practices for developing interpersonal and communication skills in preceptorship education and training programmes and identify any educational practices that are worthy of further consideration for future research.

Interpersonal and communication skills development in nursing preceptorship education and training programmes: a scoping review protocol

The preceptorship model is an education-focused model for teaching and learning within a clinical environment in nursing. It formulates a professional educational relationship between a staff nurse (preceptor) and student nurse and is based on the provision of providing patient care. Preceptorship is widely acknowledged in the literature as a positive pedagogical approach in clinical nursing education in terms of knowledge and skill acquisition, confidence, and professional socialisation of undergraduate nursing students. However, the literature also widely reports negative interpersonal experiences within this professional educational relationship resulting in negative educational experiences and in some cases, negative patient experiences. Therefore, the authors set out to examine what teaching strategies are being implemented by nurse educators to encourage the development of interpersonal and communication skills in facilitating positive interpersonal relationships between the preceptor, nursing student and patient. This paper outlines the protocol for an exploratory scoping review that aims to systematically and comprehensively map out the available published and unpublished literature on the teaching strategies to develop interpersonal and communication skills in preceptorship education and training programmes. To conduct a systematic and comprehensive scoping review, the review will be guided by the Joanna Briggs Institute and Arksey & O' Malley (2005) six-stage iterative framework, as well as PRISMA-ScR framework guidelines, to ensure the quality of the methodological and reporting approaches to the review. It is anticipated that the results of the scoping review will inform nurse educators on the current educational practices for developing interpersonal and communication skills in preceptorship education and training programmes and identify any educational practices that are worthy of further consideration for future research.

A Precepting-Focused Advanced Pharmacy Practice Experience in Academia

Description of the Opportunity:

Traditional advanced pharmacy practice experiences (APPEs) in academia provide students exposure to job responsibilities and expectations of pharmacy faculty members. The purpose of this manuscript is to describe the development and structure of a precepting-focused academic APPE, APPE student perceptions of the experience, and introductory pharmacy practice experience (IPPE) student perceptions of being precepted by APPE students.

Innovation:

An academic pharmacy APPE was developed to emphasize preceptor development in addition to traditional academic pharmacy topics and responsibilities. Pre- and post-experience surveys were completed by APPE students to collect perceptions of academic pharmacy and precepting. During the experience, APPE students, under the supervision of faculty, precepted IPPE students, who were given the opportunity to assess the APPE student’s precepting ability by completing a survey following the experience. Descriptive statistics were used to analyze the results.

Findings:

Nine students completed the academic APPE and the corresponding pre- and post-surveys. All students indicated the rotation increased their understanding of academia, and the majority (7/9) indicated an increased confidence in their precepting ability. Eighty-five IPPE students evaluated the APPE students, and the majority (78%) rated the quality of instruction from APPE students as “similar” to faculty instruction.

Conclusion:

The structure of this experience allowed APPE students to gain exposure to academia and increase confidence in precepting, while facilitating the delivery of the IPPE program. Results indicate offering an academic APPE with an emphasis on experiential teaching is a potential strategy to prepare future pharmacy preceptors.

Nursing & Midwifery students' experience of immersive virtual reality storytelling: an evaluative study

Background

Immersive Virtual Reality (iVR) storytelling is a concept that merges ground-breaking virtual reality technology with the traditional art of storytelling. Virtual reality storytelling offers a rare opportunity to present abstract experiences that challenge boundaries, heighten emotions, and convey previously intangible concepts. Scientific research into immersive virtual reality storytelling is still in its infancy, particularly regarding the field of education in Nursing and Midwifery. Therefore, this study set out to investigate the subjective experience of using an immersive virtual reality storytelling experience as an active pedagogy.

Methods

This was an evaluative study incorporating a multimodal approach encompassing a cross-sectional survey and observational study conducted in a large University in Ireland, offering major undergraduate and graduate degree programmes in the fields of Nursing and Midwifery. Students were invited to view the innovative virtual reality storytelling experience “Wonderful You” (BHD Immersive) that tells the story of the first 9 months of a baby’s life inside the woman’s womb. On completion, students were asked to complete an anonymous survey about their experience. Observational studies were also carried out, examining the student’s engagement and interaction with the iVR experience. A combination of statistical and thematic qualitative analysis was employed to interpret the respective summative rating scale and open-ended response questions in the evaluation survey. Data captured from the observations were grouped into categories and analysed capturing key themes.

Results

A response rate of 71.2% (n = 94) identified iVR storytelling as a memorable learning experience that triggered students’ engagement and motivation to learn. IVR storytelling enabled students to visualise and better understand abstract concepts. Qualitative analysis of narrative responses revealed the positive evaluations of the iVR storytelling experience. Observational studies further revealed students were highly engaged and interacted positively with the iVR storytelling experience.

Conclusions

The full potential of this new medium of iVR storytelling has yet to be seen. However, this study provides an encouraging insight into the positive attributes of iVR storytelling that engages students and creates authentic active learning experiences.

Polypharmacy and potential drug-drug interactions for people with HIV in the UK from the Climate-HIV database

Objectives

People with HIV (PWHIV) are likely to need therapies for comorbidities as they age. We assessed risk of drug–drug interactions (DDIs) in PWHIV.

Methods

The Climate‐HIV electronic recording system was used to cross‐sectionally analyse records from PWHIV aged ≥ 18 years attending four UK HIV units with a current antiretroviral (ARV) prescription in February 2018. Antiretroviral and non‐ARV medications were categorized by clinical significance of DDIs (University of Liverpool DDI tool). Potential DDIs were predicted using treatment guidelines for commonly recorded comorbidities.

Results

Among 4630 PWHIV (44% female), 41% were ≥ 50 years old. The average number of non‐ARV comedications increased from < 1 for patients aged ≤ 24 years to > 5 for patients aged ≥ 75 years; 65% were taking one or more non‐ARV comedications. The median (interquartile range) number of non‐ARVs was 1 (0–2) and 2 (1–5) for those aged < 50 and ≥ 50 years, respectively. Common comorbidities/concurrent health conditions occurred more frequently in patients aged ≥ 50 years vs. < 50 (53% vs. 34%). Boosted protease inhibitors were associated with the highest proportion of contraindicated comedications; dolutegravir and raltegravir had the fewest. For non‐ARVs, sildenafil and quetiapine were most likely to result in DDIs. Guideline‐recommended treatments for hepatitis C, hepatitis B, and tuberculosis had the highest proportions of contraindications when combined with ARV regimens, while treatments for hepatitis C, malignancy, and mental health conditions had the highest proportion of combinations potentially causing DDIs requiring dose monitoring or adjustment.

Conclusions

Non‐ARV use by PWHIV is high and increases with age. Treatment decisions for ageing PWHIV should consider guideline recommendations for comorbidities.

Curricular Exposure to Postgraduate Residency Training Through an Introductory Pharmacy Practice Experience

Objective. To evaluate the impact of a residency-focused introductory pharmacy practice experience (IPPE) on student perceived knowledge of and attitudes toward postgraduate residency training. Methods. Second- and third-year student pharmacists completed a required four-hour experience at a residency training site. Students completed a five-item survey before and after the experience, indicating their perceived knowledge of residency training components as well as their own postgraduate plans. Students also submitted a written reflection following the experience. Paired t tests were used to compare pre- and post-survey responses. Qualitative analysis was completed to identify common themes in student reflections and code for positive, neutral, or negative student experience. Results. A total of 276 students completed the Introduction to Postgraduate Residency Training IPPE in summer 2016. Post-experience survey responses indicated a significant increase in students' perceived knowledge of residency programs; however, plans to pursue residency training did not significantly change after completing the experience. Twenty-five independent themes were identified in reading student reflections, with the most common theme (included in 55% of reflections) being that the experience "clarified resident day-to-day responsibilities." The majority (95%) of students perceived the experience as valuable. Conclusion. A residency-focused IPPE increased student pharmacists' perceptions of knowledge about postgraduate residency training and was viewed by students as a beneficial experience.

Adaptation and Implementation of a Mobile Phone-Based Remote Symptom Monitoring System for People With Cancer in Europe

BACKGROUND

There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings.

OBJECTIVE

This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone-based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care.

METHODS

There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center.

RESULTS

The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT.

CONCLUSIONS

Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries.

The assessment and management of chemotherapy-related toxicities in patients with breast cancer, colorectal cancer, and Hodgkin's and non-Hodgkin's lymphomas: A scoping review

PURPOSE

The purpose of the eSMART (Electronic Symptom Management using the Advanced Symptom Management System (ASyMS) Remote Technology) study is to evaluate the use of mobile phone technology to manage chemotherapy-related toxicities (CRTs) in people with breast cancer (BC), colorectal cancer (CRC), Hodgkin's lymphoma (HL), and non-Hodgkin lymphoma (NHL)) across multiple European sites. One key objective was to review the published and grey literature on assessment and management of CRTs among patients receiving primary chemotherapy for BC, CRC, HL, and NHL to ensure that ASyMS remained evidence-based and reflected current and local practice.

METHODS

Three electronic databases were searched for English papers, with abstracts available from 01/01/2004-05/04/2014. For the grey literature, relevant clinical practice guidelines (CPGs)/evidence-based resources (EBRs) from the main international cancer organisations were reviewed as were symptom management (SM) protocols from the sites.

RESULTS

After full-text screening, 27 publications were included. The majority (n = 14) addressed fatigue and focused on BC patients. Relevant CPGs/EBRs were found for fatigue (n = 4), nausea/vomiting (n = 5), mucositis (n = 4), peripheral neuropathy (n = 3), diarrhoea (n = 2), constipation (n = 2), febrile neutropenia/infection (n = 7), palmar plantar erythrodysesthesia (PPE) (n = 1), and pain (n = 4). SM protocols were provided by >40% of the clinical sites.

CONCLUSIONS

A need exists for empirical research on SM for PPE, diarrhoea, and constipation. Research is needed on the efficacy of self-care strategies in patients with BC, CRC, HL, and NHL. In general, consistency exists across CPGs/EBRs and local guidelines on the assessment and management of common CRTs.