Huanhuan Li

Background: Identifying patients with inherited colorectal cancer (CRC) syndromes offers many potential benefits. However, individuals often experience decisional conflict regarding genetic testing for CRC, and the uptake rate remains low. Given the growing popularity of genetic testing and the increasing demands on genetic service providers, strategies are needed to promote informed decision-making, increase genetic testing uptake among at-risk individuals, and ensure the rational use of genetic service resources. Objective: This study aims to determine whether a decision aid (DA) tool could promote informed decision-making among family members regarding the genetic testing of a patient with CRC. Methods: A single-center, parallel-group, randomized controlled trial was conducted. We randomized 82 family members of patients with CRC, who were involved in major medical decision-making for the patient, to either a DA intervention or usual care. The primary outcome was informed decision-making, assessed through measures of knowledge, decisional conflict, decision self-efficacy, and preparation for decision-making. Secondary outcomes included patients’ uptake of genetic counseling and testing, participants’ CRC screening behavior, healthy lifestyle scores, anxiety and depression levels, quality of life, and satisfaction with the intervention. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the baseline survey (T2). The DA intervention and outcome assessments at T1 and T2 were delivered via WeChat. The effects of the intervention were analyzed using generalized estimating equation models. Results: Statistically significant improvements were observed in knowledge (T1: β=2.049, P<.001; T2: β=3.317, P<.001), decisional conflict (T1: β=–11.660, P<.001; T2: β=–17.587, P<.001), and decision self-efficacy (T1: β=15.353, P<.001; T2: β=22.337, P<.001) in the DA group compared with the usual care group at both T1 and T2. Additionally, the DA group showed significantly greater improvement in processed and red meat intake (β=–1.494, P<.001) at T1 and in healthy lifestyle scores (β=1.073, P=.03) at T2. No differences were found between the groups for other outcomes. Conclusions: A DA tool may be a safe, effective, and resource-efficient approach to facilitate informed decision-making about genetic testing. However, the current DA tool requires optimization and further evaluation—for example, by leveraging more advanced technology than WeChat to develop a simpler and more intelligent DA system. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100048051; https://www.chictr.org.cn/showproj.html?proj=129054

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Identifying patients with inherited colorectal cancer (CRC) syndromes offers many potential benefits. However, individuals often experience decisional conflict regarding genetic testing for CRC, and the uptake rate remains low. Given the growing popularity of genetic testing and the increasing demands on genetic service providers, strategies are needed to promote informed decision-making, increase genetic testing uptake among at-risk individuals, and ensure the rational use of genetic service resources. Objective: This study aims to determine whether a decision aid (DA) tool could promote informed decision-making among family members regarding the genetic testing of a patient with CRC. Methods: A single-center, parallel-group, randomized controlled trial was conducted. We randomized 82 family members of patients with CRC, who were involved in major medical decision-making for the patient, to either a DA intervention or usual care. The primary outcome was informed decision-making, assessed through measures of knowledge, decisional conflict, decision self-efficacy, and preparation for decision-making. Secondary outcomes included patients’ uptake of genetic counseling and testing, participants’ CRC screening behavior, healthy lifestyle scores, anxiety and depression levels, quality of life, and satisfaction with the intervention. Data were collected at baseline (T0), after the intervention (T1), and 3 months after the baseline survey (T2). The DA intervention and outcome assessments at T1 and T2 were delivered via WeChat. The effects of the intervention were analyzed using generalized estimating equation models. Results: Statistically significant improvements were observed in knowledge (T1: β=2.049, P<.001; T2: β=3.317, P<.001), decisional conflict (T1: β=–11.660, P<.001; T2: β=–17.587, P<.001), and decision self-efficacy (T1: β=15.353, P<.001; T2: β=22.337, P<.001) in the DA group compared with the usual care group at both T1 and T2. Additionally, the DA group showed significantly greater improvement in processed and red meat intake (β=–1.494, P<.001) at T1 and in healthy lifestyle scores (β=1.073, P=.03) at T2. No differences were found between the groups for other outcomes. Conclusions: A DA tool may be a safe, effective, and resource-efficient approach to facilitate informed decision-making about genetic testing. However, the current DA tool requires optimization and further evaluation—for example, by leveraging more advanced technology than WeChat to develop a simpler and more intelligent DA system. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100048051; https://www.chictr.org.cn/showproj.html?proj=129054

Aims and objectives To systematically identify, synthesise and characterise the available qualitative evidence on the experience of adult colorectal cancer survivors with continuity of care led by different health professionals. Background The limited evidence base for effective continuity of care led by different medical staff who assist colorectal cancer survivors with their unique survivorship care hampers the development of effective interventions. Synthesising the data on survivors’ experience of care led by different health professionals is critical to develop such interventions. Design A qualitative evidence synthesis using the Thomas and Harden method and the PRISMA 2020 checklist provided by the EQUATOR network were used. Methods PubMed, Web of Science, Embase, Cochrane, CINAHL and PsycINFO were searched through November 2020 for qualitative and mixed methods studies in English. JBI-QARI was used to undertake a quality review of the identified studies. The review findings were synthesised by a team of researchers, and the level of confidence was evaluated using GRADE-CERQual. Results Eleven studies met the criteria for inclusion in the review. The identified analytical themes included experience of diversity, preference for health professionals and space for enhancement to facilitate improved medical care delivery. Colorectal cancer survivors report diverse experiences regarding continuity of care led by different providers. Specifically, they attach substantial importance to trusted relationships with providers that are closely associated with their overall care experience. Conclusion Effective communication and good rapport among stakeholders are cornerstones for addressing the complexity of ongoing care. Future interventions should include adjusting the percentage of care from different providers to deliver cost-effective and personalised continuity of care. Relevance to clinical practice Synthesising data on survivors’ experience facilitates the development of practical approaches to increase the quality of continuity of care and may also foster the integration of providers’ advantages to enable more cost-effective intervention. The limited capacity of primary care providers may be enhanced by better cooperation and communication with specialists and by additional professional cancer-related training.

Aims: Sensory‐based approaches, including sensory room, sensory cart and specific sensory integration programs, feature various sensory stimulations to focus on a particular space or program. This systematic mixed‐methods review describes the impact of sensory‐based approaches in psychiatric care and summarizes the important components of sensory interventions.Design: Systematic mixed‐methods review was based on the guidelines by Pluye and Hong for comprehensively searching, appraising and synthesizing research evidence.Data sources: Data were collected from five databases: CINAHL, Embase, Pubmed, Web of Science and Cochrane before March 9, 2020.Review methods: Qualitative, quantitative, mixed‐methods and original studies published in English on sensory‐based approaches in psychiatric care were included. The studies were selected by screening titles, abstracts and full texts, and the quality of each study was assessed by two researchers independently. The data were analysed using thematic analysis.Results: Sixteen studies were chosen for review. Through data integration, four subthemes with positive effects were formed: (1) calming of the patient's mood; (2) calming of the patient's body; (3) improvement of self‐care ability; and (4) improvement of the nurse‐patient relationship. The sensory‐based approach may also lead to negative effects.Conclusions: Several important components play important roles in the sensory‐based approaches: (1) rich, culture‐based, personalized sensory stimulation; (2) a quiet, safe, home‐based physical environment; (3) a good one‐to‐one nurse‐patient relationship; (4) and the cultivation of patient autonomy and self‐management. Sensory‐based approaches in a multicultural environment and home environment will be important topics of psychiatric care in the future.Impact: There is a lack of synthesis of studies on results of sensory‐based approaches in psychiatric care. Four components are important to sensory interventions. It is necessary for mental health service centres and home care for the patients with psychotic disorders to use sensory‐based approaches for reference.

Aim To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork. Background The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research. Methods Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review. Results Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: 1) improving knowledge and skills; 2) promoting effective communication; 3) building mutual trust; 4) reducing turnover intention; 5) reasonable staffing; 6) division of responsibilities; and 7) cultivating team consciousness. Conclusions Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care. Implications for Nursing Management: With more intervention research in the future, leadership and team‐oriented roles can be used to complete all the care needed.

Aims: To systematically identify, evaluate and synthesize the available qualitative evidence on the mealtime care experiences of informal caregivers of people with dementia.Design: A qualitative evidence synthesis using the Thomas and Harden method.Data Sources: All qualitative and mixed‐method studies in English and Chinese were retrieved from PubMed, Web of Science, Embase, Cochrane, CINAHL, CNKI, WanFang, and Vip from the inception of each database until November 2019.Review Methods: Two researchers independently selected the studies using qualitative assessment and review instruments for quality evaluation and thematic synthesis for the data analysis.Results: Ten studies were chosen for this review. The analytical themes identified included injecting a new element, moving forward in the challenge and external supports facilitating better coping.Conclusion: Community nurses should effectively use resources to provide food‐related information and services to families with dementia. Future research should combine informal caregiver experiences and clinical skills to develop high‐quality interventions to improve the quality of mealtimes.Impact: The findings established that informal caregivers experienced not only changes in their roles and concerns but also emotional changes. Informal caregivers develop different coping strategies to adapt to feeding issues without professional support. Although informal caregivers attach great importance to mealtimes and nutrition issues, they experience a lack of information and support services. Community nurses can provide more economical, practical, and accessible information resources based on informal caregivers’ perceptions of mealtime care. Future interventions need to be more aware of the importance of dyad or family‐centred support services.

Aim: This study explored the perceptions of senior Chinese nurses working in different hospital types, about retirement planning; and compared the results from two hospitals.Background: A recent review indicates that nurses with inadequate retirement planning could be faced with a retirement crisis. In China, hospitals are classified into different levels, and salaries, job satisfaction and the turnover of nurses varies among these levels. These factors may also influence nurses' perceptions of retirement planning.Methods: In a descriptive, qualitative design, 27 semi‐structured individual interviews were conducted with nurses who were between 50 and 60 years old and recruited from two hospitals in China from April to September 2018. The interviews were transcribed and analysed thematically.Findings: Four main themes emerged from the interviews, namely, the understanding of pre‐retirement nurses of retirement planning, the attitudes of pre‐retirement nurses towards retirement planning, factors influencing nurses' retirement planning and the retirement planning activity of nurses. Most nurses participating in this study did not know much about retirement planning, but they all agreed on its importance. We identified the influencing factors of retirement planning and several differences regarding the perceptions of nurses about retirement planning in different hospitals.Conclusion: In this cohort of nurses, planning for a good retirement was thought to be important; however, their readiness for retirement and the influences around planning for retirement were varied in type and scope.Implications for Policy: Governments and employing hospitals should develop reasonable measures and policies to support nurses in their understanding of the benefits of retirement planning and help them to prepare for retirement. Information about retirement planning should be made available and options for planning explained. Any systematic hurdles to retirement planning should be mitigated or eliminated.

Aim To systematically evaluate the effect of working environment on implicit rationing of nursing care. Background Research has established direct and indirect associations between work environment and adverse patient outcomes.However, the causal nature of this relationship is uncertain, and implicit rationing has been proposed as a mediating factor between the work environment and patient outcomes. Evaluation Eight databases were searched for articles published between May 2000 and May 2019. Key issues The reviewed articles provided evidence for the negative correlation between working environment and implicit rationing in 15 studies,and one of the studies showed that the correlation was not strong.There were differences in the levels of implicit rationing in different hospitals, units and shifts. Conclusion The degree of influence of various factors in the working environment on implicit rationing is different.In addition.The working environment is only one of the factors that affects implicit rationing. Implication for Nursing Management Nursing managers initiatives to improve nurses’ work environments should include improve nurses' perception of the adequacy of staffing and resources and improving teamwork to decrease nursing care left undone,so as to improve nurse outcomes and quality of care.