To identify barriers and facilitators to implementing an electronic shared decision-making tool for managing anticoagulant-related drug-drug interactions that affect bleeding risk in routine clinical care.

Preimplementation qualitative study using semistructured interviews.

Three academic medical centres in the southeastern and western USA. Interviews were conducted between 27 March and 25 September 2024.

36 participants, including 19 clinicians involved in prescribing or managing anticoagulants and seventeen patients prescribed anticoagulants, were recruited using purposive and convenience sampling.

Participants identified multiple barriers and facilitators to tool implementation. Common barriers included limited visit time, challenges integrating the tool into existing workflows, role and scope-of-practice constraints, and variation in patient digital literacy. Facilitators included clear visualisation of bleeding risk, access to supporting evidence, familiar interface design and perceived potential to support patient engagement and shared decision-making. Several determinants functioned as both barriers and facilitators, depending on clinical context and user role.

This preimplementation qualitative study identified context-specific determinants that influence the adoption of an electronic shared decision-making tool for anticoagulant-related drug–drug interactions. Findings highlight the importance of early attention to workflow integration, role alignment and usability to support uptake in routine care. Addressing these factors during design and implementation may inform strategies to support adoption and future evaluation in real-world clinical settings.

To explore barriers and facilitators to a good death in patients with respiratory disease when advanced respiratory support, including non-invasive ventilation (NIV) and continuous positive airway pressure (CPAP), is used. Specifically, we examined healthcare professionals’ perspectives on what constitutes a good death in this context, how treatment failure is recognised, how decisions to continue or withdraw therapy are made, and the impact of providing this care on staff.

Qualitative study using semistructured interviews and reflexive thematic analysis.

Secondary care services in a large UK National Health Service Trust, including acute medicine, general medicine, respiratory medicine and palliative care.

25 healthcare professionals (19 female, 6 male) from multidisciplinary backgrounds, including doctors, nurses and physiotherapists. Participants self-identified as experienced in the provision of NIV/CPAP at the end of life. Staff working primarily in intensive care units were excluded.

None.

Not applicable.

Healthcare professionals described the complexity of caring for patients dying while receiving or recently withdrawn from NIV/CPAP. Five interrelated themes were identified: beliefs around dying well, symptom management during active treatment, recognition of treatment failure, negotiated decision-making and the process of withdrawal. Staff reported tensions between providing active treatment and ensuring comfort, inconsistent practices regarding symptom control and withdrawal, and conflicts within multidisciplinary teams. Nurses highlighted hidden psychological and relational labour in supporting patients, while doctors often described delays in decision-making to align families with treatment withdrawal.

Caring for patients using NIV/CPAP at the end of life presents ethical, clinical and emotional challenges for staff, patients and families. Variation in practices and perspectives highlights the need for structured training, interdisciplinary approaches and greater recognition of the often hidden relational and emotional labour involved in this work, particularly among nursing colleagues. Further research should evaluate strategies to support consistent and compassionate withdrawal practices.

Prehospital notification by emergency medical services (EMS) can activate hospital resources before the patient arrives, which has been shown to improve in-hospital care for stroke patients. Optimising prehospital and handover processes in stroke care requires considering end-user perspectives to enhance acceptance and effectiveness of the developed solutions. The aim of this study was to identify current barriers in the preclinical-clinical phase of stroke care.

Within the investigator-initiated CAEHR project (CArdiovascular diseases—Enhancing Healthcare through cross-sectoral Routine data integration), an interface for transferring data from the electronic prenotification system to the hospital information system is implemented. A mixed-methods approach with semi-structured interviews as well as a cross-sectional online survey was used to gather feedback from healthcare professionals at a single stroke centre in Germany as well as from the participating EMS personnel. Data collection for the interviews was conducted between January and August 2023 and for the online survey between May and September 2023.

Interviews were conducted with 10 healthcare professionals, including seven from the neurological clinic and three from EMS. Additionally, 39 EMS employees took part in a cross-sectional online survey.

Challenges identified were educational and training aspects affecting preclinical processes and patient handover procedures, along with the opportunity for establishing more uniform protocols. Participants emphasised the importance of detailed patient information. Electronic prenotification was seen as an important step regarding structured information transmission, reducing the risk of information loss in stroke care.

The study highlights the importance of addressing organisational processes in addition to technical interfaces for implementing effective stroke care processes.

German Clinical Trials Register, DRKS00029103.