Demands and influencing factors of digital transition care service in discharged older patients:a cross-sectional study

Objective:To identify the group classification of discharged older adults’digital transition care demands and analyze its influencing factors.Methods:From July to August 2022,we used stratified random sampling to recruit older patients who were discharged between July 2021 and July 2022 from tertiary hospitals in Shanghai.We used latent profile analysis to classify the older patients into distinct groups based on their service demands:low,medium,and high.We use multiple logistic regression to explore the factors influencing the different demand levels.Results:The degree of discharged older patients’demand was classified as low(Category 1(C1),34.2%),medium(Category 2(C2),49.5%),high-demand levels(Category 3(C3),16.3%).Compared to those have C2,older adults in C1 are more likely to be male(Odds Ratio(OR)=2.81,P=0.02),have 2 chronic diseases(OR=3.91,P=0.03),and are less likely to be junior high and below(OR=0.09,P=0.00),hospitalized for 1–2 times in the past year(1 times:OR=0.19,P=0.07;2 times:OR=0.14,P=0.02),living with children(OR=0.32,P=0.05),have less insurance(OR=0.48,P=0.03),less understanding of digital transitional care(OR=0.47,P=0.01),have less eHealth literacy(OR=0.80,P=0.00),have less degree of importance attributed by family(OR=0.52,P=0.03);Compared to those have medium demand level,older adults in high demand level are more likely to have self and spouse as primary income(self:OR=26.35,P=0.00;spouse:OR=24.06,P=0.02),walking to the nearest health facility(self:6.74,P=0.03),have higher eHealth literacy(OR=1.88,P=0.00),degree of importance within the family(OR=5.19,P=0.01),higher self’s influence on medical decisions-making(OR=5.69.P=0.01).They are less likely to be in 60–79 years group(OR=0.00–0.37,P=0.00–0.03),Household Annual Income<5,000 CNY(OR=0.05,P=0.02).Conclusion:Digital transitional care demands of discharged older patients can be divided into three categories.Constructing a digital transitional care service system that aligns with the demands of discharged older patients is essential.Communication,care plan development,and follow-up are the most fundamental services.Additionally,it is essential to understand the characteristics of high-demand populations to provide tailored services and identify vulnerable populations from health and social perspectives to offer cost-effective transitional care services.

Lived experiences with unmet supportive care needs in pediatric cancer:Perspective of Chinese children and their parents

Objective:Unmet supportive care needs(SCNs)impact pediatric cancer patients and their parents.This study aimed to explore the unmet SCNs from the perspective of Chinese children with cancer and their parents through lived experiences.Methods:The data of this study was collected using face-to-face semi-structured interviews.The participants were recruited from the oncology units of three children’s hospitals in China’s cities(Shanghai,Guangzhou,and Hefei)from October 2020 to December 2021.Data were analyzed using Colaizzi’s sevenstep phenomenological analysis method.Results:Eight pediatric cancer patients and twenty-four parents were enrolled in the study.Four main themes and eight subthemes(both children’s and parent’s perspectives)were generated:1)meeting the ongoing needs along the cancer trajectory(can you tell me what comes next;our needs are growing);2)communicating with a family focus(they only talk to my parents;let each family member have a voice);3)providing care beyond the treatment(I am bigger than my body[the children’s needs for emotional consolidation and information about their prognosis];there are things beyond treatment);4)getting support from the community(I am not a monster[the children were unhappy about being treated differently];we want to connect with the resources near us).Conclusion:This study revealed multiple unmet SCNs from the perspective of Chinese children with cancer and their parents.The findings call for comprehensive and in-depth supportive care beyond treatment,integration of the family member voice in pediatric cancer care,and a coordinated pediatric cancer support mechanism in the Chinese healthcare system.

Nurses' lived experiences of professional autonomy in Iran

Objectives: Nurses' autonomy is a complex and multi-dimensional concept that has often been overlooked.Although many studies have addressed patients' autonomy,there has been no assessment of nurses' experience of professional autonomy.The present study aimed to assess nurses' lived experiences of professional autonomy in Shiraz,Iran.Methods: The present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018.The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences,Shiraz,Iran.The experiences of the participants were assessed through 14 in-depth semi-structured interviews.The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.Results: Based on the analysis of the interviews,4 themes,11 categories,and 13 sub-categories were extracted.The themes were: Advocacy for patients and nurses,independence in the workplace,Involvement in professional decision-making,and Professional accountability.Conclusion: Due to the intense interaction between nurses and patients,a better quality of care will be achieved if the professional autonomy of nurses is ensured.Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.

Lived experiences of the disease journey among patients with idiopathic pulmonary fibrosis

Objective:This study aimed to explore the lived experiences of the disease journey and patients'care needs with idiopathic pulmonary fibrosis(IPF).Methods:Face-to-face semi-structured interviews were conducted with a purposive sampling of IPF patients admitted to the department of respiratory medicine in a tertiary hospital in Beijing.Interview data were analyzed using the thematic analysis method.In the end,16 patients were interviewed.Results:Four themes emerged from the qualitative data included the long and confusing journey to reach a diagnosis,living with the disease,understanding the disease and treatment and desire for continuity of care.A series of subthemes were also identified,including uncertainty of diagnosis,delaying the process,living with physical symptoms,living with emotional distress,loss of independence,uncertainty with the prognosis,questioning the cause of the disease,concerning the side effects of treatments,lacking continuity of care,and wanting a better quality ofhealthcare in community hospitals.Conclusions:Based on the findings,there is an urgent need to improve the care delivery to this vulnerable population in China.To meet their health needs,it is of paramount importance to develop effective education programs for health professionals and IPF patients and improve care models of healthcare systems,especially in remote areas,to enhance care continuity in the communities.

Prescription of Cancer Treatment Modalities in Developing Countries:Results from a Multi-Centre Observational Study

Background: Treatment is an important component of a comprehensive cancer control approach and its outcomes strongly depend on infrastructure, equipment, human and financial resources available. Therefore it is imperative to generate evidence-based tools to assist health policy makers from low resourced countries in planning efficient and equitable treatment services for a defined population based on what it is feasible to these settings. Methods: The intended cancer spe-cific treatment planned and written in the patients’ medical record (treatment prescription) of untreated adult cancer cases (≥18 years of age), excluding non-melanoma skin cancer, was recorded in a chronological way from 1 January 2012 onwards in a group of eight comprehensive cancer centres located in middle income countries and offering the main modalities of cancer treatment (surgery, medical oncology and radiotherapy). Results: A total of 17,713 medical records were reviewed, of which 7106 (54.2%) met the eligibility criteria. Prescription of main cancer treatment modalities were distributed as follows: 57.6% for chemotherapy (n = 4093), 56.8% for surgery (n = 4038), and 46.8% for radiotherapy (n = 3327). There was a predominance of plans consisting of combined treatment modalities over monotherapy (55.2% versus 44.8%). At the time of diagnosis 54.3% of the cancer cases had disease that had spread beyond the primary site, 41.2% were considered as having local disease and in 4.5% of the cases the information on disease extension was unknown. Conclusions: The results obtained should be seen as an approximation of cancer treatment service demand based on what it is currently practiced and therefore feasible in developing countries, particularly in middle income countries.

Health service needs of women with reproductive tract infections in selected areas of China

OBJECTIVE: To provide insight into the psychosocial factors underlying the utilisation of health services by women with reproductive tract infection (RTI) symptoms. METHODS: A cross-sectional study, adopting Aday and Andersen' s Social Behaviour Model, was conducted between 1998 and 1999 in Chinese Hebei province and Beijing. A total of 864 eligible married women (age 21 to 60 years) were face to face interviewed. RESULTS: The percentage of self-reported symptoms of RTIs in urban and rural women was 35.6 and 46.8, respectively; the proportion of women with RTIs who utilised health services was 27.5% and 26.7%, respectively. Compared to urban women, rural women had less knowledge on RTIs and more traditional beliefs, and were more satisfied with local health services. The results of logistic regression analysis showed that the common factor influencing health service utilisation in women with RTIs was current experience of RTIs. Knowledge about self-medication, perceived social stigma attached to RTIs, prior experience of RTIs, family income and perceived severity of RTIs were also predictors of utilisation of health services in rural women with RTIs. Satisfaction with health providers, information received from health providers, prior experience of RTIs, occupation and medical care coverage were predictors of utilisation of health services in urban women with RTIs. CONCLUSION: The prevalence of RTIs is high, but the rate of seeking health services is low. There is a great need for emphasizing culturally acceptable reproductive health education in different places to improve women' s ability for self-care. Regular medical check-ups for women are also important. It is necessary to improve the quality of health service, complete the reform of health insurance and alleviate women' s social stigma related to RTIs, giving women social and moral support.