Sophie Sergerie-Richard

Low-value care remains pervasive across healthcare systems and consumes scarce resources while exposing patients to avoidable harms. De-implementation, the purposeful process of reducing, restricting, replacing, or discontinuing low-value practices, has gained momentum, yet the field still lacks clear methodological guidance grounded in theory. De-implementation is often treated as "reverse implementation", despite accumulating evidence that stopping practices can activate distinct mechanisms and constraints. In this paper, we synthesize and contrast theories, process models, and frameworks relevant to de-implementation of low-value care to generate actionable methodological guidance. Drawing on a theory-informed narrative review and constant-comparative synthesis, we identify where de-implementation converges with implementation (e.g., staged processes; multilevel determinants; use of established determinant, strategy, and outcome frameworks) and where it diverges in ways that matter for design and evaluation. Across sources, three recurring lenses structure these divergences: (i) the psychology of stopping (habit disruption, loss aversion, cognitive biases, professional identity threats), (ii) multi-level constraints and politics (incentives, regulation, professional norms, stakeholder interests), and (iii) the nature of the low-value practice and endpoint (reduction vs. restriction vs. elimination; replacement vs. disenchantment discontinuance). We translate these contrasts into ten streamlined methodological recommendations that specify what investigators should state and report in practice, including configuration (stand-alone vs. embedded/paired), low-value classification, explicit determinant-to-strategy-to-mechanism logic, inclusion of patient experience and unintended consequences, and dual-trajectory evaluation when substitution is involved. De-implementation is not simply implementation in reverse. Methodological rigor in de-implementation research requires explicitly specifying configuration and endpoint, aligning strategies with stopping-specific mechanisms and multilevel constraints, and evaluating beyond utilization to include mechanisms, patient experience, equity-relevant impacts, and unintended consequences. This paper provides a practical, theory-grounded set of recommendations to strengthen the design, evaluation, and reporting of future de-implementation studies.

Objective: The objective of the review is to synthesize qualitative evidence on the views, experiences, and perspectives of service users and their informal carers, health care providers, managers, and decision-makers regarding factors influencing the de-implementation of seclusion and restraint in inpatient mental health settings. Introduction: Seclusion and restraint, frequently used in mental health settings, are low-value health care interventions associated with numerous negative consequences and lack of therapeutic benefits. Conceptualizing the reduction, substitution, and elimination of these low-value interventions under the lens of de-implementation offers an innovative and promising approach. Eligibility criteria: Qualitative studies exploring the views, experiences, and perspectives of adult mental health service users, their informal carers, health care providers, managers, and decision-makers regarding the de-implementation of seclusion and restraint will be considered for inclusion. Studies conducted in inpatient general mental health settings, excluding subspecialties, will be considered. Methods: This review will follow the JBI methodology for qualitative reviews. The databases to be searched are CINAHL Complete (EBSCOhost), Cochrane Library, Embase (Ovid), MEDLINE (Ovid), PsycINFO (Ovid), and Web of Science. Study selection, data extraction, and quality assessment will be conducted independently by 2 authors. Following a meta-aggregation approach, the data synthesis will be guided by the Consolidated Framework for Implementation Research and the Model of Prevention of Seclusion and Restraint Use in Mental Health. Methodological quality will be assessed using the JBI Critical Appraisal Checklist for Qualitative Research, and confidence in the findings will be assessed using ConQual. Review registration: PROSPERO CRD42024586670

Background: Family resilience can be observed through specific resilience-promoting processes, namely, shared belief systems, communication, and organizational processes, but the concept remains mostly unstudied in neonatology. This metasummary aims to evaluate the frequency of family resilience processes in qualitative scientific literature to illustrate how family resilience is exhibited in the neonatal intensive care unit (NICU) setting. Methods: A search among 4 databases yielded 7029 results, which were reviewed for inclusion. Following Sandelowski and Barroso's qualitative metasummary method, findings from each study were independently coded and frequency effect size was calculated. Results: Forty-six primary qualitative studies published between 2016 and 2022 conducted with parents of preterm infants who discussed their NICU hospitalization experience were included in this metasummary. All 9 of Walsh's family resilience processes were identified in the literature, and their frequency effect size ranged from 4% to 91%. Four additional themes emerged pertaining to specific family resilience behaviors exhibited by NICU families. Conclusion: This analysis sheds new light on the most recent qualitative evidence of parents' experiences in the NICU by analyzing it through the lens of family resilience and posits family resilience as a promising concept in relation to the predominance of the family-centered care philosophy in neonatal units.

Introduction: Research on end-of-life wishes (EoLW) primarily focuses on the elderly or ill individuals, limiting reflection to specific moments within life trajectories. Drawing on Patterson and Hazelwood (2020), this article proposes 4 dimensions of EoLW: medical care, legal considerations, personal priorities, and socio-spiritual well-being. While numerous knowledge syntheses explore EoLW, they primarily focus on the first 2 dimensions, overlooking aspects that are nonetheless essential to true person-centered end-of-life planning. Objective: To map the extent and nature of knowledge on personal priorities and socio-spiritual well-being dimensions of EoLW and to identify trends, gaps, and implications for research and practice. Method: This scoping review follows the 6-step methodology of Levac et al. (2010) and queries scientific (CINAHL Complete, Érudit, MEDLINE, PsycINFO, Social Sciences Abstracts, Social Work Abstracts and Web of science) and grey literature (Dissertations & Theses Global and Sociological Abstracts) databases. Literature published from 2015 onwards, in English or French, will be systematically identified and selected through an independent double anonymous review process. Discussion and Research Spin-offs: We will identify the contexts in which these 2 dimensions are operationalized, the research methodologies used and any knowledge gaps in the current state of research. Engagement with key stakeholders in the 6th stage of this scoping review will facilitate the synthesis of critical insights to better inform practice, influence policy development, and guide future research.

Background/Objectives: Perceived coercion has been associated with significant negative outcomes, including service avoidance and psychological distress. Despite growing interest, no recent comprehensive review has mapped the full range of factors influencing this experience. This scoping review aimed to synthesize and present the state of knowledge on the factors associated with perceived coercion by adults receiving psychiatric care. Methods: Following the Joanna Briggs Institute methodology, a systematic search of five databases and grey literature was conducted for publications from 1990 to 2025 in English and French. A total of 143 sources were included and thematically analyzed. Consultation with experts and individuals with lived experience enriched the interpretation of findings. Results: Five categories of factors were identified: individual, clinical, relational, legal, and structural. Relational and legal factors were most consistently associated with perceived coercion, while individual and clinical factors showed inconsistent findings. Structural influences were underexamined but significantly shaped the experiences of the individuals receiving care. Conclusions: Perceived coercion arises from a complex dynamic of individual, relational, and systemic influences. Reducing coercion requires moving beyond individual-level factors to address structural conditions and policy frameworks. Future research should prioritize qualitative and intersectional approaches and amplify the voices of those most affected by coercive practices in psychiatric care.

Background/Objectives: Coercion in mental health is challenged, prompting reduction interventions. Among those, the Joint Crisis Plan (JCP), which aims to document individuals’ treatment preferences in case of future de-compensation, regardless of the potential loss of discernment, has been identified as a key path to study. Identified challenges related to its implementation highlight the need to adapt this intervention to the local context. Considering that in Quebec (Canada), the JCP is not widely used, but the scientific literature supports its adoption and corroborates its potential impact on reducing coercion, this study evaluates the feasibility, acceptability, and preliminary outcomes of the JCP among psychiatric and forensic inpatient settings. Methods: A pilot mixed-methods study was conducted through 16 individual interviews with inpatients and healthcare providers, combined with a pre–post analysis of seclusion and restraint use and the violence prevention climate (VPC) based on healthcare providers’ (n = 57) and inpatients’ perspectives (n = 53). Results: Although the challenging implementation of the JCP complicated the evaluation of its effects on seclusion and restraint use, a moderate change (d = 0.40) in the VPC was identified based on healthcare providers’ perspectives. Qualitative findings are also insightful to understand the acceptability and feasibility of the JCP use. A tension emerged between the perspectives of inpatients and healthcare providers: while inpatients valued the reflective process of completing the plan, providers focused more on its technical aspects. Conclusions: The results support the integration of the JCP into patient care pathways, as it provides a tool to amplify patients’ voices, promote patient empowerment, facilitate open dialog on alternatives to coercion, and foster more collaborative and humane mental health care.

Introduction Comprehending informal coercion, which encompasses a wide range of phenomena characterised by subtle and non-legalised pressures, can be complex. Its use is underestimated within the continuum of coercion in mental health, although its application may have a negative impact on the persons involved. A better understanding of informal coercion is crucial for improving mental healthcare and informing future research. This scoping review aims to explore the nature, extent and consequences of informal coercion in mental health hospitalisation to clarify this phenomenon, establish its boundaries more clearly and identify knowledge gaps. Methods and analysis Following the methodological framework from the Joanna Briggs Institute, this scoping review will encompass 10 key steps. Literature searches will be conducted in electronic databases, including CINAHL, PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and ProQuest Dissertation and Theses. Then, a search in grey literature sources (Open Grey, Grey Guide), psychiatric and mental health journals, government agencies and among the references of selected studies will be conducted. The research will include all literature focusing on informal coercion with inpatients aged 18 and above. Data will be extracted and analysed descriptively, mapping the available knowledge and identifying thematic patterns. The quality of included studies will be assessed using appropriate appraisal tools. An exploratory search was conducted in November 2023 and will be updated in December 2023 when the selection of relevant evidence will begin. Ethics and dissemination Ethical approval is not required as this study involves the analysis of existing published literature. The findings will be disseminated through a peer-reviewed publication and presentations at relevant conferences. They will be shared with people living with mental disorders and professionals working in mental healthcare.