BMJ Open Quality最新文献

{"title":"Lessons learnt from a 2017 Irish national clinical claims review: a retrospective observational study.","authors":"Karen A Power, Irene O'Byrne Maguire, Noelle Byrne, Deirdre Walsh, Karen Robinson, Mark McCullagh, Yvonne Fallon, Mary Godfrey, Ann Duffy, Claire O'Regan, Mairead Twohig, Cathal O'Keeffe","doi":"10.1136/bmjoq-2023-002688","DOIUrl":"10.1136/bmjoq-2023-002688","url":null,"abstract":"<p><strong>Objective: </strong>Learning from adverse outcomes in health and social care is critical to advancing a culture of patient safety and reducing the likelihood of future preventable harm to service users. This review aims to present an overview of all clinical claims finalised in one calendar year involving publicly funded health and social care providers in Ireland.</p><p><strong>Design: </strong>This is a retrospective observational study. The Clinical Risk Unit (CRU) of the State Claims Agency identified all service-user clinical claims finalised between 1 January 2017 and 31 December 2017 from Ireland's National Incident Management System (n=713). Claims that had incurred financial damages were considered for further analysis (n=356). 202 claims underwent an in-depth qualitative review. Of these, 57 related to maternity and gynaecology, 64 to surgery, 46 to medicine, 20 to community health and social care and 15 related to children's healthcare.</p><p><strong>Results: </strong>The services of surgery and medicine ranked first and second, respectively, in terms of a number of claims. Claims in maternity services, despite ranking third in terms of claims numbers, resulted in the highest claims costs. Catastrophic injuries in babies resulting in cerebral palsy or other brain injury accounted for the majority of this cost.Diagnostic errors and inadequate or substandard communication, either with service users and/or interprofessional communication with colleagues, emerged as common issues across all clinical areas analysed. Quantitative analysis of contributory factors demonstrated that the complexity and seriousness of the service user's condition was a significant contributory factor in the occurrence of incidents leading to claims.</p><p><strong>Conclusion: </strong>This national report identifies common issues resulting in claims. Targeting these issues could mitigate patient safety risks and reduce the cost of claims.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11409236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142131777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional analysis of healthcare worker mental health and utilisation of a digital mental health platform from 2020 to 2023","authors":"Anish K Agarwal, Lauren Southwick, Arthur Pelullo, Haley J McCalpin, Rachel E Gonzales, David A Asch, Cecilia Livesey, Lisa Bellini, Rachel Kishton, Sarah Beck, Raina M Merchant","doi":"10.1136/bmjoq-2024-002896","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002896","url":null,"abstract":"Background Healthcare worker (HCW) anxiety and depression worsened during the pandemic, prompting the expansion of digital mental health platforms as potential solutions offering online assessments, access to resources and counselling. The use of these digital engagement tools may reflect tendencies and trends for the mental health needs of HCWs. Objectives This retrospective, cross-sectional study investigated the association between the use of an online mental health platform within a large academic health system and measures of that system’s COVID-19 burden during the first 3 years of the pandemic. Methods The study investigated the use of Cobalt, an online mental health platform, comprising deidentified mental health assessments and utilisation metrics. Cobalt, serves as an online mental health resource broadly available to health system employees, offering online evidence-based tools, coaching, therapy options and asynchronous content (podcasts, articles, videos and more). The analyses use validated mental health assessments (Generalised Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and post-traumatic stress disorder (PTSD)) alongside publicly available COVID-19 data. Statistical analyses employed univariate linear regression with Stata SE Statistical Software. Results Between March 2020 and March 2023, 43 308 independent user sessions were created on Cobalt, a majority being anonymous sessions (72%, n=31 151). Mental health assessments, including PHQ-4, PHQ-9, GAD-7 and primary care-PTSD, totalled 9462 over the time period. Risk for self-harm was noted in 17.1% of PHQ-9 assessments. Additionally, 4418 appointments were scheduled with mental health counsellors and clinicians. No significant associations were identified between COVID-19 case burden and Cobalt utilisation or assessment scores. Conclusion Cobalt emerged as an important access point for assessing the collective mental health of the workforce, witnessing increased engagement over time. Notably, the study indicates the nuanced nature of HCW assessments of anxiety, depression and PTSD, with mental health scores reflecting moderate decreases in depression and anxiety but signalling potential increases in PTSD. Tailored resources are imperative, acknowledging varied mental health needs within the healthcare workforce. Ultimately, this investigation lays the groundwork for continued exploration of the impact and effectiveness of digital platforms in supporting HCW mental health. Data are available on reasonable request. Data are available on request with appropriate protocols and permissions.","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lean Six Sigma quality improvement approach to implement clinical practice guidelines for prescribing opiates for chronic pain in a primary care setting","authors":"Smita Bakhai, Jawdat Mustafa, Meghan Cloutier, Farhana Islam, Gregory D Gudleski, Jessica L Reynolds","doi":"10.1136/bmjoq-2024-002912","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002912","url":null,"abstract":"Background Implementing guidelines for chronic opioid management during a clinic merger posed significant challenges. Our aim was to increase the percentage of chronic pain evaluations and urine toxicology tests in patients on chronic opioid therapy from the baseline rate of less than 20% to 50% within 1 year at an academic, primary care clinic. Methods We applied the Define, Measure, Analyze, Improve, Control (DMAIC) approach of Lean Six Sigma for this quality improvement (QI) project. The QI tools included the creation of stakeholder mapping, root cause analysis, process flow mapping and a driver diagram. Lack of patient and provider education emerged as a significant barrier. The outcome measures were percentage of chronic pain evaluations and urine drug toxicology with an increase in controlled substance agreement completion rates as our process measures. Major interventions included patient and provider education, leveraging health information technology, care coordination and implementing new clinic protocols. Data analysis was performed by monthly run charts. Descriptive statistics were used to summarise clinical variables, while χ2 analyses were employed to determine statistically significant differences between preintervention and postintervention measures. Results We observed an increase in completion rates of clinic visits for chronic pain, rising from 19.0% to 51.9% (p<0.001). During study period, we observed a steady increase in chronic pain evaluations with a median of 4.5. Urine toxicology completion rates increased from 19.9% to 65.8% (p<0.001) during the preintervention and postintervention periods. We observed variable changes in urine toxicology rates with a median of 5.19. Furthermore, we observed an increase in controlled substance agreement completion rates, increasing to 50% from the baseline rate of <10%. Conclusions Education to patients and providers, shared decision-making using a patient-centred approach, enhancement of health information technology and system-based interventions in clinic protocols and workflows contributed to the success of this QI project. The DMAIC approach may facilitate the implementation of practice guidelines for chronic opioid therapy and enhance providers’ opioid prescribing practices. Data are available upon reasonable request. Not applicable.","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the secondary diagnoses capture rate in SingHealth Community Hospital discharge summaries: a quality improvement project made successful by change management principles","authors":"Ann Mei Wong, Pamela Gopal","doi":"10.1136/bmjoq-2024-002747","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002747","url":null,"abstract":"High-quality discharge summaries are essential for promoting patient safety during transitions between care settings. When the diagnosis list in the discharge summary is not accurate, the subsequent care provider will not have the latest medical history list and the care and safety of the patient will be compromised. Discrepancies in the secondary diagnosis capture rates have been identified in close to 30% of patients admitted to Sengkang Community Hospital (SKCH) during internal audits. Our project aimed to improve the rates of secondary diagnoses coding in the discharge summaries of patients who were admitted to SKCH using skills of change management in our interventions. Plan-Do-Study-Act cycles used in combination with change management skills led to the success of our quality improvement project. Remarkably, we managed to achieve close to 100% of the secondary diagnoses capture rate after a 5-month period. All data relevant to the study are included in the article or uploaded as online supplemental information.","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142212557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality improvement project (QIP): evaluating a pilot suicide awareness, screening and signposting training intervention for dental care professionals in a dental teaching hospital and school","authors":"Declan Cairns, Julie K Kilgariff, Vicki Tully","doi":"10.1136/bmjoq-2023-002718","DOIUrl":"https://doi.org/10.1136/bmjoq-2023-002718","url":null,"abstract":"Scotland’s 2022 suicide prevention strategy recommends building skills and knowledge among healthcare staff who play a role in preventing suicide. A quality improvement project (QIP) in relation to this was initiated because several patients attending dental appointments disclosed suicidal thoughts and/or plans to attempt death by suicide. Dental staff and students involved expressed feeling ill-equipped at how to manage this situation. This initial QIP aimed to establish routine screening, identification and signposting of dental outpatients identified as having an increased risk of suicide during attendance at any dental clinic within the Dental Hospital. Several Plan-Do-Study-Act (PDSA) cycles ensued. First, to understand the problem, a scoping literature search on the role of dental professionals in preventing suicide and the availability of suicide risk awareness training frameworks for non-medical healthcare staff revealed few publications and no identified training frameworks. This was PDSA1. To gain insight into the local culture in relation to the QIP aims, two further cycles were undertaken. These examined whether dental patients were routinely screened for mental health conditions, and dental staff and student attitudes. Screening activity was measured, a new medical history intervention was implemented and a significant improvement in the number of patients being screened was seen (PDSA2). At the time of writing, the newly introduced medical history form is now used routinely to screen all outpatients attending the Dental Hospital, where 60 000 outpatients’ appointments are delivered annually. PDSA3 sought dental staff and student views on whether suicide risk awareness is part of their role. This found suicide risk awareness is considered part of the dental professionals’ role, but a lack of training, and a desire for training was expressed. With no suitable training frameworks, PDSA4 aimed to design, implement and evaluate a pilot training educational intervention by a clinical psychologist. Sixteen dental care professionals attended the workshop. To measure training effectiveness, participants completed pre-training (baseline) and post-training questionnaires to assess their self-efficacy around suicide awareness. Improvements in self-efficacy following training occurred across all domains, demonstrating a successful intervention which can be upscaled. All data relevant to the study are included in the article or uploaded as supplementary information.","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services","authors":"Christopher Carroll, Burak Kundakci, Amber Muhinyi, Anastasios Bastounis, Katherine Jones, Anthea Sutton, Steve Goodacre, Carl Marincowitz, Andrew Booth","doi":"10.1136/bmjoq-2024-002906","DOIUrl":"https://doi.org/10.1136/bmjoq-2024-002906","url":null,"abstract":"Introduction Prolonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England. Methods A two-stage approach was employed. First, a comprehensive search for reviews (2018–2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data. Results The search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest. Conclusions Effective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context. All data relevant to the study are included in the article or uploaded as online supplemental information.","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.4,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving uptake of colorectal cancer screening by complex patients at an academic primary care practice: a feasibility study.","authors":"Charlotte Desponds, Cyril Ducros, Carine Rochat, Laure Galassini, Patrick Bodenmann, Veronique S Grazioli, Ekaterina Plys, Christian von Plessen, Alexandre Gouveia, Kevin Selby","doi":"10.1136/bmjoq-2024-002844","DOIUrl":"10.1136/bmjoq-2024-002844","url":null,"abstract":"<p><strong>Background: </strong>Regular screening reduces mortality from colorectal cancer (CRC). The Canton of Vaud, Switzerland, has a regional screening programme offering faecal immunochemical tests (FITs) or colonoscopy. Participation in the screening programme has been low, particularly among complex patients. Patient navigation has strong evidence for increasing the CRC screening rate.</p><p><strong>Design and objective: </strong>This feasibility study tested patient navigation performed by medical assistants for complex patients at an academic primary care practice.</p><p><strong>Baseline measurements: </strong>A review of 328 patients' medical charts revealed that 51% were up-to-date with screening (16% within the programme), 24% were ineligible, 5% had a documented refusal and 20% were not up-to-date, of whom 58 (18%) were complex patients. INTERVENTION FEBRUARY 2023 TO MAY 2023: We tried to help complex patients participate in the screening programme using either in-person or telephone patient navigation. Each intervention was piloted by a physician-researcher and then performed by a medical assistant. Based on the reach, effectiveness, adoption, implementation, maintenance framework, we collected: Intervention participation and refusal, screening acceptance and completion and both patients and medical assistant acceptability (ie, qualitative interviews).</p><p><strong>Results: </strong>Only 4/58 (7%) patients participated in the in-person patient navigation test phase due to scheduling problems. All four patients accepted a prescription and 2/4 (50%) completed their test. We piloted a telephone intervention to bypass scheduling issues but all patients refused a telephone discussion with the medical assistant. At two months after the last intervention, the proportion of patients up-to-date increased from 51% to 56%.</p><p><strong>Conclusion: </strong>Our overall approach was resource-intensive and had little impact on the overall participation rate. It was likely not sustainable. New approaches and reimbursement for a specific patient navigator role are needed to increase CRC screening of complex patients.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11367402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety and the COVID-19 pandemic: a qualitative study of perspectives of front-line clinicians.","authors":"Lucy Schulson, Julia Bandini, Armenda Bialas, Shreya Huigol, George Timmins, Sangeeta Ahluwalia, Courtney Gidengil","doi":"10.1136/bmjoq-2023-002692","DOIUrl":"10.1136/bmjoq-2023-002692","url":null,"abstract":"<p><strong>Introduction: </strong>Studies on the impacts of COVID-19 on patient safety are emerging. However, few studies have elicited the perspectives of front-line clinicians.</p><p><strong>Methods: </strong>We interviewed clinicians from 16 US hospitals who worked in the emergency department, intensive care unit or inpatient unit during the COVID-19 pandemic. We asked about their experiences with both clinician well-being and patient care throughout the pandemic. We used a rigorous thematic analysis to code the interview transcripts. This study was part of a larger randomised control trial of an intervention to improve healthcare worker well-being during the COVID-19 pandemic; the findings described here draw from clinicians who spontaneously raised issues related to patient safety.</p><p><strong>Results: </strong>11 physicians and 16 nurses in our sample raised issues related to patient safety. We identified two primary themes: (1) compromised access to healthcare and (2) impaired care delivery. First, clinicians discussed how changes in access to healthcare early in the pandemic-including a shift to telehealth and deferred care-led to delays in accurate diagnosis and patients presenting later in their disease course. Second, clinicians discussed the effects of COVID-19 on care delivery related to staffing, equipment shortages and space constraints and how they deviated from the standard of care to manage these constraints. Clinicians noted how these issues led to patient safety events such as central line infections, patient falls and serious medication administration errors.</p><p><strong>Conclusions: </strong>Several well-intentioned interventions implemented in the early weeks of the pandemic created a unique context that affected patient safety throughout the pandemic. Future pandemic preparedness should consider planning that incorporates a patient safety lens to mitigate further harm from occurring during a public health crisis.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142046250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinic of Hope: bridging infectious disease and orthopaedic surgery in prosthetic joint infection management.","authors":"Kevin A Wu, Jessica L Seidelman, Erin B Gettler, Edward F Hendershot, William A Jiranek, Thorsten M Seyler","doi":"10.1136/bmjoq-2024-002921","DOIUrl":"10.1136/bmjoq-2024-002921","url":null,"abstract":"<p><p>Prosthetic joint infections (PJIs) following total joint arthroplasty are a significant and costly complication. To address fragmented care typically seen with separate management, we established a combined infectious disease and orthopaedic surgery clinic at Duke Health in July 2020. This clinic focuses on patients experiencing acute deterioration or multiple PJI episodes, often at the stage where amputation is the only option offered. From July 2021 to March 2024, the clinic completed 974 visits with 319 unique patients. The clinic maintained a low no-show rate of 5.0%. Treatment plans included procedures such as debridement, antibiotics and implant retention (38%), as well as implant explantation and one-stage exchange (32% each), with amputation required in only 4% of cases. The integrated clinic model facilitated real-time, multidisciplinary care, improving patient outcomes and operational efficiency. This approach offers a promising model for managing complex infections.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11340707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the MAPPING application to facilitate risk communication and shared decision-making between physicians and patients with gynaecological cancer.","authors":"Mijra Koning, Christianne Lok, Dirk T Ubbink, Johanna Wilhelmina Maria Aarts","doi":"10.1136/bmjoq-2024-002776","DOIUrl":"10.1136/bmjoq-2024-002776","url":null,"abstract":"<p><p>This is an observational study in which we evaluated current levels of risk communication (RC) among gynaecological oncologists and their view on the Mapping All Patient Probabilities in Numerical Graphs (MAPPING) application as a possible tool to facilitate RC and shared decision-making (SDM). In part A, we audio-recorded 29 conversations between gynaecological oncologists and patients when discussing treatment options. In part B, interviews were performed with eight gynaecological oncologists.RC and SDM were measured using two observer-based measures, that is, the RC content (RCC) tool (scale 0-2) and the OPTION-5 instrument (scale 0-100). We used CollaboRATE questionnaire (scale 0-10) and a self-developed survey to assess patient-reported RC and SDM. In part B, we evaluated physicians' attitudes regarding the use of the MAPPING application to support RC. Patients were minimally involved in the decision-making process (OPTION-5 25.9%±13.4 RCC 0.21±0.18). Patient-reported SDM was high (mean collaboRATE score 9.19±1.79) and patients preferred receiving numeric information, whereas most physicians used qualitative risk terms rather than exact numbers. In part B, gynaecologists had a positive attitude towards the MAPPING application. However, they stated that the app was difficult to use improvement of layout and better implementations are needed.</p>","PeriodicalId":9052,"journal":{"name":"BMJ Open Quality","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11337712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}