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Health advocacy (HA) is acknowledged as a core competence in medical education. However, varying and sometimes conflicting conceptualisations of HA exist, making it challenging to integrate the competence consistently. While this diversity highlights the need for a deeper understanding of HA conceptualisations, a comprehensive analysis across the continuum of medical education is absent in the literature. This protocol has been developed to clarify the conceptual dimensions of the HA competence in literature as applied to medical education.
The review will be conducted in line with the JBI (formerly Joanna Briggs Institute) methodology for scoping reviews. A comprehensive literature search was developed and already carried out in eight academic databases and Google Scholar, without restrictions on publication date, geography or language. Articles that describe the HA role among students and physicians who receive or provide medical education will be eligible for inclusion. Two independent reviewers will independently complete title and abstract screening prior to full-text review of selected articles and data extraction on the final set. A descriptive-analytical approach will be applied for summarising the data.
This scoping review does not involve human participants, as all evidence is sourced from publicly available databases. Therefore, ethical approval is not required for this study. The findings from this scoping review will be disseminated through submission to a high-quality peer-reviewed journal and presented at academic conferences. By clarifying the conceptualisations of HA, this review aims to contribute to a shared narrative that will strengthen the foundation for integrating the HA role into medical education.
A preliminary version of this protocol was registered on the Open Science Framework on 9 December 2024, and can be accessed at the following link: https://osf.io/ed2br. We have also registered our scoping review protocol as a preprint at medRxiv:
Diagnosis in the early stages of dementia can lead to successful delay in associated cognitive decline. However, up to 76% of Australians diagnosed with dementia have already advanced beyond the early stage of disease. BrainTrack is an evidence-based mobile application (app) designed in Australia to promote brain health self-awareness, self-determination to promote help-seeking and, ultimately, a timelier dementia diagnosis. We will evaluate user experience, implementation and social return-on-investment outcomes of BrainTrack and will report dementia-related concerns, dementia literacy, knowledge, stigma and motivation for behaviour change and explore their associations with demographic characteristics.
A multimethods, concurrent, two-study observational design will be used. Study 1 will evaluate BrainTrack user experience and implementation outcomes, changes in users’ dementia literacy, dementia knowledge, perceptions of dementia-related stigma and help-seeking at five time points (baseline, 1, 3, 6 and 12 months). People residing in all states and territories of Australia will be recruited to the study via the BrainTrack app. Data collection will occur online and through teleconferencing. Approximately 1000 participants will complete all five surveys. Google Analytics data will measure adoption. App usage data will identify app use patterns. A sample of continuing app users (~n=80) and those who cease app use within 6 months (~n=20) will be interviewed to obtain in-depth information about their app use and help-seeking experience. Dementia Australia Helpline data will quantify help-seeking calls triggered by BrainTrack use. In Study 1, longitudinal outcomes will be analysed using mixed models. The economic and social value of BrainTrack will be assessed using social return on investment analysis. In Study 2, general practitioners (~n=20) currently practising in Australia will participate in semi-structured interviews conducted via online teleconferencing. Interviews will elicit perceptions of the usefulness of BrainTrack for initiating and facilitating discussions with patients about cognition and dementia. Qualitative data will be analysed thematically, followed by deductive analysis guided by the Theoretical Domains Framework.
This study has received Human Research Ethics Committee approval from Deakin University Human Research Ethics Committee (Study 1: HREC Reference Number 2022–220) and Deakin University Human Ethics Advisory Group, Faculty of Health (Study 2: Reference Number 202_2022). Informed consent will be obtained prior to participation, either verbally for interviews or online for surveys. Study findings will be published in peer-reviewed journals and communicated to key stakeholders.
Concussions can have significant implications on the health and quality of life of older adults. As most concussion research previously focused on children, athletes and military populations, there is a need to better understand the concussion-specific treatments for adults aged 65 and older. The aim of our systematic review is to review the existing literature on the effectiveness of concussion treatments on outcomes in adults aged 65 and older.
This systematic review will be conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines and the Cochrane’s Handbook for Systematic Reviews of Interventions. A comprehensive search of electronic databases (MEDLINE, Embase, CINAHL, AgeLine, APA PsycNet and Cochrane CENTRAL) will be performed and reference lists of included articles will be searched. We will conduct a two-step screening process and data extraction. The data analysis will integrate a narrative approach with vote-counting. The risk of bias in the included studies will be assessed, and the quality of evidence for each outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
The results of this systematic review will contribute to the current knowledge on concussion treatments and outcomes in older adults. This work is essential for identifying effective interventions and guiding future guidelines for this under-represented population. No ethical approval is needed for the review, and we plan to present the results at an international research conference and in a peer-reviewed journal. This protocol is registered in PROSPERO (CRD # pending).
To describe the development of a shared decision making intervention for planning end-of-life care for patients with kidney failure, their relatives and health professionals in kidney services.
End-of-life care conversations within standard disease management consultations are challenging for patients with kidney failure, their relatives and health professionals. End-of-life care planning is about making difficult decisions in advance, which is why health professionals need shared decision making skills to be able to initiate end-of-life conversations. Health professionals report needing more skills to raise the issue of end-of-life care options within consultations and patients want to be able to discuss issues important to them about future care plans.
The development design was guided by the UK Medical Research Council's framework and a user-centred approach was applied. Four workshops were conducted with end users. The Template for Intervention Description and Replication for Population Health and Policy interventions was used to shape which questions needed to be answered through the workshops and to present the intervention. The International Patient Decision Aid Standards (IPDAS) criteria set the standards to be achieved.
Areas considered significant to a shared decision making intervention were training of health professionals, conversations about end-of-life care, planning and evaluation of the decisions, reporting decisions in health records and repetition of consultation. The development process went through 14 iterations.
An intervention named DESIRE was developed that comprises: (1) a training programme for health professionals; (2) shared decision making conversations; and (3) a patient decision aid. The intervention met 30 out of 33 IPDAS criteria.
DESIRE is intended to support shared decision making about planning end-of-life care among patients with kidney failure, their relatives and health professionals. The study provides important tools for the stakeholders engaged that can be used within different models of care.
International guidelines recommend health professionals involve patients with kidney failure in making decisions about end-of-life care, but there is variation in how this is implemented within and across kidney services. Furthermore, patients, relatives and health professionals find it challenging to initiate conversations about end-of-life care.
The study resulted in the development of a complex intervention, called DESIRE, about shared decision making and planning end-of-life care for patients with kidney failure, their relatives and health professionals in kidney services, including a training programme for health professionals, shared decision making conversations and a patient decision aid.
The research contributes a shared decision making intervention to patients in the later stage of kidney failure, their relatives and health professionals. We believe that the DESIRE intervention could be introduced during consultations with health professionals at an earlier stage of the patient's illness trajectory, as well as being applied to other chronic diseases.
This intervention development research is reported according to the GUIDance for the rEporting of intervention Development (GUIDED) checklist and the DEVELOPTOOLS Reporting Checklist.
Patients, relatives and health professionals have been involved throughout the research process as part of the research team and advisory board. For this study, the advisory board has particularly contributed to the development process of the DESIRE intervention by actively participating in the four workshops, in the iterations between the workshops and in the preparation of the manuscript.
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