Shared decision making in rural general practices:a qualitative exploration of older rural South Australians'perceived involvement in clinical consultations with doctors

Background:Shared decision-making(SDM)implementation is a priority for Australian health systems,including general practices but it remains complex for specific groups like older rural Australians.We initiated a qualitative study with older rural Australians to explore barriers to and facilitators of SDM in local general practices.Methods:We conducted a patient-oriented research,partnering with older rural Australians,families,and health service providers in research design.Participants who visited general practices were purposively sampled from five small rural towns in South Australia.A semi-structured interview guide was used for interviews and reflexive thematic coding was conducted.Results:Telephone interviews were held with 27 participants.Four themes were identified around older rural adults’involvement in SDM:(1)Understanding of"patient involvement";(2)Positive and negative outcomes;(3)Barriers to SDM;and(4)Facilitators to SDM.Understanding of patient involvement in SDM considerably varied among participants,with some reporting their involvement was contingent on the“opportunity to ask questions”and the“treatment choices”offered to them.Alongside the opportunity for involvement,barriers such as avoidance of cultural care and a lack of continuity of care are new findings.Challenges encountered in SDM implementation also included resource constraints and time limitations in general practices.Rural knowledge of general practitioners and technology integration in consultations were viewed as potential enablers..Conclusion:Adequate resources and well-defined guidelines about the process should accompany the implementation of SDM in rural general practices of South Australia.Innovative strategies by general practitioners promoting health literacy and culturally-tailored communication approaches could increase older rural Australians'involvement in general.

Patients Involved in Funding Research.A Look Back at the Unique Experience of the ECLAIR Working Group of Canceropole CLARA

This article aims to share an innovative experience of organizing and funding research involving those most directly affected:patients.The“ECLAIR”working group of the Canceropole Lyon Auvergne-Rhone-Alpes(CLARA)was created at the end of 2020 with the goal of contributing to the development of a call for projects on the patient experience in oncology,which was launched in January 2021.Initially composed of 8 members,including 7 patients,coordinated by a project manager from CLARA,the ECLAIR working group actively participated in drafting the specifications of the call for projects,developing the eligibility criteria for applications,revising the evaluation and selection criteria for projects,and monitoring the selected projects.This experience was repeated twice.With significant freedom of action,the working group made two decisions that strongly demonstrate the commitment to supporting research partnerships and the active involvement of those affected:firstly,by making partnership a mandatory requirement for the eligibility of applications,and secondly,by conducting the selection of projects themselves,after an independent scientific evaluation phase.Seeking to shed light on the“black box”of partnership,the article also presents the concrete modalities of interaction among the working group members,the adjustments made between different editions of the call for projects,and the relationships maintained with CLARA.

Intervention Research and Support Systems for People Affected by Cancer and Their Families:Results of a Descriptive Analysis

Population health intervention research(PHIR)was initiated in the field of primary prevention by proposing a research paradigm focusing on intervention and the theory of solutions.The intervention was coconstructed with the stakeholders as part of a global approach until its deployment in the local area.The development of PHIR raises the question of its application to tertiary prevention.This study proposes some initial thoughts on the similarities and specificities of PHIR projects-funded by the French National Cancer Institute(INCa)-of support systems for people affected by cancer and their families,which were based on a descriptive analysis.The selected projects were obtained from the databases of PHIR projects funded from 2010 to 2021,which included 72 projects to which the inclusion and exclusion criteria were applied.A descriptive analysis was carried out for each project using the application files and the interim or final reports sent to INCa.A total of 30 projects were selected,half of which were in the public health field.Almost all of the projects involved a university–hospital partnership,and one-third involved healthcare professionals and patients in the research process.Patient involvement was classified into four types,which were linked to the supporting structure and the target population.The main themes of the projects were quality of life and adapted physical activity,which were assessed in hospitals through randomized controlled trials targeting specific cancers.Research has revealed several specificities and similarities between support systems for people affected by cancer and their families developed in PHIR projects;however,these support systems vary widely,and PHIR in tertiary prevention can be conducted in several ways.Any modeling of the systems is complicated;PHIR is evolving in its application and is the subject of research and evaluation.