To identify the barriers and facilitators in the implementation of fertility preservation (FP) shared decision-making (SDM) in oncology care.
Qualitative descriptive study.
Qualitative interviews with 16 female patients with cancer and seven healthcare providers were conducted between July 2022 and April 2024. Data were analyzed using directed content analysis, guided by the implementation science framework.
We identified 22 categories comprising 38 codes as barriers to SDM implementation and 17 categories comprising 26 codes as facilitators. Findings revealed that, at the innovation level, accessibility, feasibility, interdisciplinary collaboration, and quality improvement efforts were decisive in the implementation of FP SDM. At the individual level, healthcare providers' awareness and attitudes towards FP and SDM, as well as patients' knowledge, attitudes, and capabilities in FP SDM, were crucial factors in the implementation of FP SDM. In social, economic, and organizational contexts, support from significant others, social awareness about FP, multidisciplinary care, financial assistance, and educational resources were determinants in implementing FP SDM.
Implementing FP SDM among female patients with cancer necessitates a strategic approach that considers barriers and facilitators. Educating and promoting FP SDM among the public and healthcare providers, combined with incentivizing policies, can enhance individual knowledge and awareness while achieving systemic improvements, facilitating its successful implementation.
This study provides insights into barriers and facilitators and proposes strategic approaches to enhancing FP SDM implementation, contributing to improved quality of life for cancer survivors and advancements in clinical practice.
by Dong Min Jung, Yong Jae Kwon, Yong Wan Cho, Jong Geol Baek, Dong Jae Jang, Yongdo Yun, Seok-Ho Lee, Gahee Son, Hyunjong Yoo, Min Cheol Han, Jin Sung Kim
Volumetric modulated arc therapy (VMAT) for lung cancer involves complex multileaf collimator (MLC) motion, which increases sensitivity to interplay effects with tumour motion. Current dynamic conformal arc methods address this issue but may limit the achievable dose distribution optimisation compared with standard VMAT. This study examined the clinical utility of a VMAT technique with monitor unit limits (VMATliMU) to mimic conformal arc delivery and reduce interplay effects while maintaining plan quality. VMATliMU was implemented by applying monitor unit limitations during VMAT reoptimisation to minimise MLC encroachment into target volumes. Using mesh-type reference computational phantom CT images, treatment plans were generated for a simulated stage I lung cancer case prescribed to 45 Gy in three fractions. VMATliMU, conventional VMAT, VMAT with leaf speed limitations, dynamic conformal arc therapy, and constant dynamic conformal arc therapy were compared. Plans were optimised for multiple isodose line prescriptions (50%, 60%, 70%, 80%, and 90%) to investigate the impact of dose distribution. Evaluation parameters included MLC positional accuracy using area difference ratios, dosimetric indices, gradient metrics, and organ-at-risk doses. VMATliMU prevented MLC encroachment into the internal target volume across 60%–90% isodose lines, showing superior MLC accuracy compared with other methods. At the challenging 50% isodose line, VMATliMU had 4.5 times less intrusion than VMAT with leaf speed limits. VMAT plans had better dosimetric indices than dynamic conformal arc plans. VMATliMU reduced monitor units by 5.1%–19.2% across prescriptions. All plans met the clinical dose constraints, with the aortic arch below tolerance and acceptable lung doses. VMATliMU combines VMAT’s dosimetric benefits with the dynamic conformal arcs’s simplicity, minimising MLC encroachment while maintaining plan quality. Reduced monitor units lower low-dose exposure, treatment time, and interplay effects. VMATliMU is usable in existing planners with monitor unit limits, offering a practical solution for lung stereotactic body radiation therapy.Infertility resulting from cancer treatment is known to be a major factor that reduces the quality of life of young cancer survivors. However, discussions and decision-making about fertility preservation before cancer treatment have been insufficient owing to barriers in the clinical field. In addition, selecting a fertility preservation option requires a complex decision-making process that considers not only medical information but also the patient’s values and preferences. Hence, an environment that more easily supports patient decision-making about fertility preservation needs to be created. Therefore, this protocol will develop and test a web-based decision aid (DA) for fertility preservation among young patients with cancer, considering patient preferences and values, evaluate acceptability and usability of the developed DA and assess its effectiveness.
This protocol outlines the development of a web-based DA for fertility preservation targeting females of reproductive age diagnosed with cancer. It includes alpha testing to evaluate the usability and acceptability of the DA, as well as beta testing to assess its effectiveness outside of clinical settings, both based on an online survey. The web-based DA for fertility preservation consists of three modules: 1) an information collection module, 2) an option suggestion module and 3) a value communication module. The information collection module collects information essential to select appropriate fertility preservation options. The option suggestion module returns all applicable fertility preservation options based on the patient’s characteristics, which are essential for determining the appropriate option, such as menarche status and desire for pregnancy. The value communication module provides information on the extent to which each fertility preservation option satisfies the patient’s values and preferences. After the development of the DA, a small group of young patients with cancer (n=10) and health providers (n=5) will be asked to use this web-based DA for fertility preservation and assess the acceptability and usability of this DA based on a survey (alpha-testing). By reflecting the feedback of acceptability and usability testing, the DA will be updated for improvement, and clinical field testing (beta-testing pilot trial) will be performed using the updated DA. Beta-testing will be conducted on young patients with cancer (aged 18–40 years) before they receive any curative cancer treatment (n=32). These patients with cancer will be randomly allocated to the DA group (intervention group) or the usual care group (control group). The DA group will use the web-based DA before treatment, and the control group will not have access to the web-based DA and will be asked to decide whether to consult a fertility preservation specialist. The primary outcome of the beta testing will be the level of decisional conflict, and the secondary outcomes will include knowledge, decision self-efficacy, decision readiness, depression severity, quality of life, counselling on fertility preservation and decision-making about fertility preservation. Outcomes, including decisional conflict, knowledge, decision self-efficacy, quality of life and depression severity, will be measured before the intervention (T0), 1 week after the intervention (T1) and 1 month after the intervention (T2). The readiness for decision-making will be assessed at T1 for the intervention group only. Counselling on fertility preservation and decision-making about fertility preservation will be assessed once after testing (T2) for both the intervention and control groups.
The study will be conducted in accordance with ethical standards and was approved by the Institutional Review Board at the National Cancer Centre, Korea (IRB No. NCC2024-0050). All study participants will provide written informed consent before participation. The results generated from this study will be presented at conferences or scientific meetings and disseminated through publication in a peer-reviewed journal.
NCT07038174 (beta-testing phase).
To identify illegitimate tasks performed by registered nurses (RNs) in surgical care and explore why they perform them through the lens of gender theory and nursing history.
A qualitative study guided by gender theory, nursing history and the Fundamentals of Care framework.
RNs (n = 48) at three surgical wards attended a lecture on gender theory and a lecture on nursing history, each followed by focus group interviews (n = 12) with 6–8 participants. The analysis included two steps: (A) a content analysis of the interviews to identify illegitimate tasks and (B) a gender analysis using Connell's framework and nursing history.
The RNs describe their work situation in clinical practice as fragmented by illegitimate tasks. The results show how this can be explained as induced by gender theory and nursing history, with the main theme RNs support overall patient care and work climate at the cost of nursing care—a behaviour explained by gender theory and nursing history, presented in four categories: (1) performing administrative tasks and information processing outside the nursing profession, (2) maintaining a pleasant workplace, (3) being constantly available, facilitating and compensating for physicians and (4) backing up nursing assistants.
Contemporary RNs frequently utilise their resources to carry out a wide range of illegitimate tasks. The findings illustrate that RNs remain influenced by their history and still integrate traditionally female-associated tasks and behaviours into the workplace, often without conscious awareness. This knowledge can be used to understand why RNs perform illegitimate tasks without being asked to do so. Primarily, managers and also RNs must consider their complex situation from this perspective to implement systematic organisational changes that ensure patients receive the nursing care they need.
There is a global shortage of registered nurses (RNs). Patients suffer from missed nursing care. RNs describe their work as fragmented, with frequent interruptions and illegitimate tasks they feel expected to prioritise, even if not prompted by routines or requests. RNs are influenced by nursing history, integrating traditionally female-associated tasks and behaviours into the workplace, often subconsciously. When nurse managers and RNs become aware of these problems, it can pave the way for change, which can free up nursing resources and improve patient care. By becoming aware of what constitutes illegitimate tasks and understanding why nurses perform them, organisational changes can be made to fully utilise RNs' competencies. The findings point to a systemic issue that calls for strategic leadership from managers to drive substantive change.
This study aimed to develop a grounded theory that explains how nurses' experiences as patients or family members influence their provision of patient-centred care.
A grounded theory approach.
Twenty clinical nurses in South Korea participated; nine had experiences as patients and 11 as family members during hospitalisation. Data were collected through semi-structured, in-depth interviews from January to October 2021. Participants were purposively sampled for diverse experiences, and all interviews were audio-recorded and transcribed verbatim. Data analysis followed grounded theory using the constant comparative method, with theoretical saturation reached after 20 interviews.
The theory developed was built around the core category of ‘transforming nursing practice through empathy and reflection in hospitalization experiences’. Participants experienced healthcare services in a wide range of areas, including nursing interactions, patient rights, the healthcare delivery system and hospital facilities. Based on these experiences, participants developed a deep understanding and empathy for the emotions and needs of patients and families, gaining new insights and reflections on their nursing practice. It led to a transformation in participants' attitudes and behaviours towards patient-centred care.
This study demonstrates that reflective practice and empathy developed through personal hospitalisation are important factors in leading to the shift towards patient-centred care. These findings provide a theoretical framework for emphasising experiential learning opportunities in nursing education and training to apply patient-centred approaches in practice.
Experiential learning approaches, such as simulation, role playing or caregiver training, can bridge the gap between clinical practice and patient expectations. Supportive work environments that encourage reflection on patient experiences help nurses maintain patient-centred practices despite challenges, leading to professional growth and improved patient outcomes.
This study adhered to the COREQ checklist for reporting.
No patient or public involvement.
Identifying patients with chest pain potentially due to acute coronary syndrome (ACS) early is crucial for triage nurses. They need a reliable, validated screening tool.
This study aims to develop an initial screening scale to detect ACS in patients presenting with chest pain in the emergency department.
We analyzed electronic medical records of 3131 chest pain patients from 103,041 emergency department visits between January 2018 and December 2019. ACS diagnosis was confirmed by cardiologists through clinical symptoms, electrocardiograms, and cardiac enzyme levels. The study proceeded in four stages: (1) identifying potential ACS predictors through a literature review, (2) validating these predictors with experts, (3) comparing data between ACS and non-ACS patients and (4) developing a screening scale based on identified predictors. Statistical methods included univariate analysis and binary logistic regression. The scale's accuracy was assessed using ROC curve analysis and compared to existing tools.
Eight significant ACS predictors were identified: male sex, age over 49 for males and over 65 for females, typical symptoms, initial pain scale score of 6 or higher, pain duration of at least 10 min, history of ACS, hypertension, and dyslipidemia. Each predictor was scored, with typical symptoms and severe pain receiving higher scores, totaling up to 10 points. A score of 6 or more indicated high ACS risk, demonstrating accuracy comparable to the HEART and TIMI score systems.
This study developed a new ACS screening scale for use by triage nurses in emergency departments. This scale can facilitate early detection and intervention for patients at high risk of ACS.
We aimed to assess the quality and reliability of pressure injury-related videos uploaded on YouTube, analyse the sources and contents, and examine the correlation between video parameters. We searched YouTube using two keywords, “pressure ulcer” and “pressure sore”, on August 20, 2022. We sorted the videos according to their number of views and included the top 100 videos for each keyword. The quality of videos was assessed using the Global Quality Scale (GQS), while their reliability was evaluated by the modified DISCERN (mDISCERN) tool. In addition, we evaluated the videos in which content was included, analysed the correlations and differences between GQS, mDISCERN, and video parameters. We initially found a total of 100 videos for each keyword and finally included and analysed 77 videos. The mean scores for the mDISCERN and GQS were 2.35 ± 0.98 and 3.09 ± 0.99, respectively. Both GQS and mDISCERN showed statistically significant correlations with each other (rho = 0.54, p < 0.0001*) and with the length of the videos, respectively (rho = 0.36, p = 0.001*), (rho = 0.29, p = 0.01*). Of the videos created by physicians, 8 (57.1%) included content related to treatment, while of the videos created by nonphysician health personnel, 22 (57.9%) included content related to prevention. Analysing whether there were differences in video parameters based on the sources, we observed significant differences between sources in GQS (p < 0.0001*), mDISCERN (p < 0.0001*), and video length (p = 0.001*). In the post-hoc analysis, videos uploaded by physicians or nonphysician health personnel showed higher quality and reliability than videos uploaded by other sources. Therefore, the results of this study could be useful for healthcare providers, as well as patients and caregivers, to search for high-quality and reliable YouTube videos related to pressure injury.
To investigate fundamental care delivery regarding oral care in a surgical context, and to compare patients' self-reported oral health with registered nurse assessments.
A descriptive and comparative study, with a consecutive selection.
A patient oral health rating tool, including questions about performed oral care, was distributed to patients (n = 50), at four surgical wards in Sweden. The response rate was 72%. Oral health status was assessed by a registered nurse using the Revised Oral Assessment Guide (ROAG), and a comparison between patient and registered nurse assessment was performed by calculating Cohen's kappa coefficient and percentage agreement.
Patients (38%) reported severe oral symptoms, mostly dry lips and not an adequate amount of saliva, and 80% were not offered help with oral care. ROAG assessments revealed that 74% had problems with oral health. Almost half of the patients (48%) needed assistance with oral care but only 10% received help. Registered nurses assessed the patient's oral health as worse than the patient's self-assessment did.
There are deficiencies in fundamental care delivery regarding oral care in a surgical care context. Oral health assessments need to be performed by registered nurses. Routines for systematic oral assessments and for oral care need to be implemented by nurse managers to ensure that patients' fundamental care needs are fulfilled.
Oral health assessments need to be performed regularly by registered nurses since it is insufficient that patients self-assess their oral health. Nurse managers need to provide and implement routines for nurse assessments and oral care in surgical care contexts.
There are deficiencies in patients' oral health and oral care, and registered nurses need to perform oral health assessments. Nurse managers need to implement routines for registered nurse assessments and oral care.
Patients admitted to a surgical ward were included in the study after being screened for inclusion criteria. After participants signed informed consent, they filled in a questionnaire about oral health and oral care, and a registered nurse performed an oral health assessment.
This study was carried out according to the STROBE checklist.