Sharron L. Docherty

Introduction: Perinatal mortality remains high in low‐ and middle‐income countries, with Tanzania bearing one of the greatest burdens. The Three Delays framework is often used to analyze preventable perinatal deaths and includes care seeking, reaching care, and receiving definitive care. This study explores Tanzanian mothers' experiences of perinatal loss, focusing on delays and gaps in care. Methods: This study was conducted at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania. Fifty women who experienced stillbirth or neonatal death completed intake surveys about their perinatal loss experience. Of these, 40 completed semi‐structured in‐depth interviews 8 weeks post‐loss. Interviews explored barriers in care seeking, access, delivery, and communication. Survey data were analyzed with descriptive statistics. Interview data were thematically coded using a directed content analysis combining a priori codes from the three delays framework and inductive coding. Results: Participants perceived delays in seeking care (50%), receiving care at initial facilities (27.5%), referral processes (12.5%), and care at KCMC (17.5%). Nearly half (45%) reported inadequate communication from healthcare providers. Three key themes emerged: (1) women perceived delays in care at all points along their care trajectory (2) gaps in communication impacted medical care for women and newborns, and hindered healing after perinatal loss; and (3) women emphasized the need for emotional support and compassionate communication following loss. Discussion: While structural, process, and financial barriers persist, informational and relational communication gaps represent an under‐addressed challenge across the perinatal loss care pathway. Rather than being viewed in isolation, efforts to strengthen communication should be integrated into broader health system strategies aimed at reducing delays, improving access to timely and quality care, and supporting families after stillbirth or neonatal death. Strengthening communication within health systems, both as an informational and relational process, has the potential to enhance care experiences, build trust, and support emotional healing after perinatal loss.

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The survival of infants and children with complex medical conditions continues to increase, underscoring the need to quantify technology dependence more effectively. Existing measures emphasize mortality risk and fail to capture the burden of ongoing technological support. To address this gap, the Technology Dependence Index (TDI) was developed and initially validated as a standardized measure capturing the technology‐dependence component of neonatal and pediatric caregiving complexity. Technology dependence is defined as the complexity and intensity of the skilled, health‐related caregiving an infant or child needs to sustain physiological functioning, beyond the presence of any single device. Pooled data from six studies yielded 818 TDI observations across 265 infants. Inter‐rater reliability was moderate ( κ = 0.61), with intraclass correlations from 0.90 to 0.99 and at least 90% agreement for 10 of 12 domains, noting the medication domain had the lowest inter‐rater reliability (45%–48%). Principal components analysis supported a multidimensional internal structure, with the 12 domains loading onto three retained factors. Researchers and clinicians can use the TDI retrospectively through chart review, prospectively in real time, or via parent report, making it adaptable to both research and clinical settings.

Background: Women with breast cancer experience high-symptom burden from a psychoneurological symptom cluster consisting of fatigue, anxiety, depression, sleep disturbances, and pain. Interventions to manage this symptom cluster are limited as its etiology is not well understood. One system that has been linked with this symptom cluster in both healthy and other chronically ill populations but has not been explored in breast cancer is the oral microbiome. Objectives: We examined differences in oral microbiome diversity and composition between women with breast cancer who reported high versus low levels of psychoneurological symptoms. Methods: Oral microbial changes based on bacterial diversity and relative abundance were estimated from 16S rRNA gene sequencing data of oral tongue swabs from 22 women with breast cancer prior to mastectomy. The fatigue, anxiety, depression, sleep disturbance, and pain interference subscales of the Patient-Reported Outcomes Measurement Information System 29 scale were used to calculate the symptom groups. Results: Observed amplicon sequence variants were lower in the high-symptom group than in the low-symptom group, but no differences between groups were seen in other alpha-diversity metrics (Shannon, Inverse Simpson). No differences in beta diversity were found between the high-symptom and low-symptom groups. For differential abundance, three genera were more abundant in the high-symptom group than the low-symptom group: Aggregatibacter, Lautropia , and Prevotellaceae UCG-001. Discussion: Preliminary associations were identified between the psychoneurological symptom cluster and oral microbiome diversity and composition. Of the differentially abundant genera, Lautropia has been previously linked with anxiety, and Aggregatibacter has been researched due to its pro-inflammatory potential. As inflammation is posited to influence psychoneurological symptom cluster severity, further research on the relationship between the oral microbiome and the psychoneurological symptom cluster, specifically in relation to potential causal mechanisms, is warranted. Enhanced insight into this relationship could inform targeted interventions to improve the symptom experience for women with breast cancer.

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Background/objectives: To describe and compare Korean AYAs’ and parental perspectives on the family environment in terms of agreement and significant differences and examine which variables were associated with AYAs’ symptom distress. Sample and setting: Self-report data were collected from a total sample of 113 AYAs, recruited from a pediatric-oncology outpatient clinic at a university-affiliated hospital and community group in South Korea. Because each study aim required different data sources, different analytic samples were used. Specifically, 54 AYA–parent dyads were included for Aim 1, whereas self-report data from 111 AYAs with complete data were used for Aim 2. Methods and variables: This subgroup analysis used a quantitative–descriptive, cross-sectional design. AYAs’ and parent perceptions of the family environment (family cohesion and adaptability, family strength, and social support from family) and AYAs’ symptom distress were collected using reliable and validated self-report questionnaires and analyzed using descriptive and inferential statistics. Results: AYAs and their parents showed low (family support) to moderate agreement (family strength, family cohesion, and adaptability) on perceptions of family environment (ICC = 0.374–0.612). AYAs reported significantly lower perceptions of family support than their parents, with a small to moderate effect (p < 0.001, d = 0.48). All family environment variables were correlated with AYAs’ symptom distress (p < 0.05). Among these variables, AYAs’ perceived family strength emerged as the only family environment variable significantly associated with their symptom distress (F = 14.309, p < 0.001, R² = 0.359, R²adj = 0.334), which was stronger during treatment. Conclusions: AYAs’ perceived family strength should be routinely assessed, especially during cancer treatment. Additional nursing interventions focusing on enhancing AYAs’ families as a support group are needed.

Importance: Shared decision-making is the preferred method for evaluating complex tradeoffs in the care of patients with critical illness. However, it remains unknown whether critical care clinicians engage diverse patients and caregivers equitably in shared decision-making.Objective: To compare critical care clinicians' approaches to shared decision-making in recorded conversations with Black and White caregivers of patients with critical illness.Design, Setting, and Participants: This thematic analysis consisted of unstructured clinician-caregiver meetings audio-recorded during a randomized clinical trial of a decision aid about prolonged mechanical ventilation at 13 intensive care units in the US. Participants in meetings included critical care clinicians and Black or White caregivers of patients who underwent mechanical ventilation. The codebook included components of shared decision-making and known mechanisms of racial disparities in clinical communication. Analysts were blinded to caregiver race during coding. Patterns within and across racial groups were evaluated to identify themes. Data analysis was conducted between August 2021 and April 2023.Main Outcomes and Measures: The main outcomes were themes describing clinician behaviors varying by self-reported race of the caregivers.Results: The overall sample comprised 20 Black and 19 White caregivers for a total of 39 audio-recorded meetings with clinicians. The duration of meetings was similar for both Black and White caregivers (mean [SD], 23.9 [13.7] minutes vs 22.1 [11.2] minutes, respectively). Both Black and White caregivers were generally middle-aged (mean [SD] age, 47.6 [9.9] years vs 51.9 [8.8] years, respectively), female (15 [75.0%] vs 14 [73.7%], respectively), and possessed a high level of self-assessed health literacy, which was scored from 3 to 15 with lower scores indicating increasing health literacy (mean [SD], 5.8 [2.3] vs 5.3 [2.0], respectively). Clinicians conducting meetings with Black and White caregivers were generally young (mean [SD] age, 38.8 [6.6] years vs 37.9 [8.2] years, respectively), male (13 [72.2%] vs 12 [70.6%], respectively), and White (14 [77.8%] vs 17 [100%], respectively). Four variations in clinicians' shared decision-making behaviors by caregiver race were identified: (1) providing limited emotional support for Black caregivers, (2) failing to acknowledge trust and gratitude expressed by Black caregivers, (3) sharing limited medical information with Black caregivers, and (4) challenging Black caregivers' preferences for restorative care. These themes encompass both relational and informational aspects of shared decision-making.Conclusions and Relevance: The results of this thematic analysis showed that critical care clinicians missed opportunities to acknowledge emotions and value the knowledge of Black caregivers compared with White caregivers. These findings may inform future clinician-level interventions aimed at promoting equitable shared decision-making.