搜索结果：MDM policy & practice

Background. Shared decision making (SDM) for patients enrolling in differentiated antiretroviral therapy (DART) is crucial. Empirical evidence is lacking regarding factors promoting or hindering SDM implementation in DART provision in Ethiopia. Hence, this study aimed to explore the barriers and facilitators to implementing SDM for patients enrolled in DART in Northwest Ethiopia. Methods. A qualitative descriptive study using semi-structured interviews among 17 patients and 15 providers at health facilities providing DART service was conducted. The MAXQDA version 20 software was used for inductive coding. Interviews were analyzed using thematic analysis. Results. Ten themes emerged at 4 levels related to SDM in the provision of DART: patient, provider, organizational, and health system. At the patient level, 1) trust in providers (facilitator) and 2) patient's level of education (barrier) emerged as themes. At the provider level, 3) lack of familiarity with DART models (barrier) and 4) patient-provider relationship (barrier and facilitator) were emerged themes. At the organizational level, 5) workload (barrier) and 6) resources (barrier and facilitator) emerged as themes. At the health system level, 7) availability of DART models (facilitator), 8) not involving providers while initiating DART models (barrier), 9) other providers' involvement (facilitator), and 10) presence of other implementing partners (barrier) emerged as themes. Conclusions. Numerous barriers and facilitators influence the implementation of SDM in the provision of DART. Based on these findings, the following steps are recommended. Providing access to patient decision aids shall be in place to assist patients in making decisions about their preferred DART models. Health care workers shall be trained, and patients shall be given education to enhance the SDM process. Policy makers and program managers shall consider the resource context (training and size of human resources and convenience of rooms) for the delivery of ART service to have an appropriate implementation of SDM in clinical practice. Shared decision making in DART is influenced by various barriers and facilitators present at the patient, provider, organizational, and health system levels.Patients need education, and health care staff need regular training to improve SDM in DART service provision.Patient access to decision support tools that aid in the selection of the preferred DART model in health facilities is critical.Policy makers and program managers shall consider the availability of adequate and trained human resources as well as provide adequate space and private rooms for SDM in the implementation of DART.

Decision science and implementation science share the common goal of improving individual and population health through choosing and providing effective health innovations at scale. In this article, we summarize a symposium we hosted at the 45th Annual Society for Medical Decision Making North American meeting. The symposium aimed to illustrate how integrating implementation science and decision science can strengthen the real-world impact and practical utility of decision science methods. The symposium was attended by 51 individuals. It included 4 presentations by early-career researchers and a moderated discussion. Presentations covered innovative work at the intersection of implementation science and decision analytic modeling and focused on policy applications because of the presenters' expertise and strong history of decision analytic modeling to inform policy decisions. The symposium's moderated discussion indicated a need for developing collaborations between implementation and decision scientists to move this type of work forward. Suggested areas of future research are modeling to identify gaps in data and considering value-of-information methods, exploring how implementation could be incorporated into simulation methods beyond those discussed in the symposium (e.g., distributional and extended cost-effectiveness analyses), and integrating implementation science into other areas of decision science (e.g., preference and prioritization research, shared decision making). We urge decision science researchers to pursue interdisciplinary research integrating decision and implementation science to best inform policy decision making and drive the scale-up of promising policies across contexts. Implementation science concepts could strengthen the external validity and uptake of decision science methods such as decision analytic models.The symposium discussed and highlighted innovative ways that decision science researchers could integrate implementation science frameworks and outcomes (e.g., cost, reach, fidelity) into decision analytic models to be more responsive to the multifaceted considerations of policy decision making.Supporting interdisciplinary networking and collaboration between decision scientists and implementation scientists is critical to strengthen the real-world impact and practical utility of decision science methods.

Background. Breast cancer screening via mammography for women younger than 50 y sparks controversy due to balancing benefits and risks. In Israel, specific criteria govern early screening initiation, yet global studies reveal low adherence to guidelines for this demographic. Objectives. This study aims to report on young women's referrals for screening mammography in Israel, assess adherence to guidelines, and identify factors influencing guideline adherence. Design, Setting, and Participants. A cross-sectional study analyzed referral letters for screening mammography issued to women aged 18 to 49 y from March 2019 to February 2020 in 2 districts of Israel's largest health care provider. Exclusions included women with a history of breast cancer or BRCA mutations. Of 9,960 letters, 1,287 were randomly selected for adherence assessment, with 13% of nonadherent cases further reviewed. Main Outcomes and Measures. Primary outcomes included categorizing referrals as adherent or nonadherent to guidelines. Additional measures explored correlations between adherence and patient characteristics (e.g., age, comorbidities) and the referring physician's specialty. Results. A total of 999 referral letters were included in the statistical analysis. Referrals spanned all ages but skewed toward women older than 40 y. Of the referrals, 45% (452) came from general surgeons and 32% (327) from family physicians. Twenty-four percent (303) of referrals were blank, and 1% (4) involved risk-benefit discussions. In total, 109 (10.9%) of the referrals strictly adhered to guidelines; under a lenient approach, 30.6% (307) adhered. General surgeons adhered more frequently than gynecologists did (32.8% [109] v. 14.9% [11], P = 0.014). Conclusions and Relevance. Despite official guidelines, many physicians in Israel did not follow recommendations for breast cancer screening in women younger than 50 y, highlighting a gap between evidence-based medicine and clinical practice. Question Are screening mammography referrals, given to women younger than 50 y of age, adherent to current guidelines? Findings In this cross-sectional study of a randomly selected sample of 1,287 referral letters, given to women aged 18 to 50 y, only 10.9% were adherent with the guidelines when examined with a strict approach and 30.6% with a forgiving approach. Adherence significantly correlated with the field of the referring physician. Meaning Despite known risks of screening mammography, women younger than 50 y are commonly referred to such screening in a deviation from current guidelines.

Congenital heart disease (CHD) is the most common congenital condition, often necessitating complex heart surgeries that require careful planning by multidisciplinary teams. Multidisciplinary meetings (MDMs) in CHD care aim to integrate diverse expertise to optimise surgical planning. However, the lack of standardised protocols for conducting these meetings introduces undesirable variability in decision-making processes, potentially impacting patient outcomes. This study addresses the critical gap in understanding which aspects of MDMs should be standardised to ensure consistent, high-quality decision-making while also identifying areas where flexibility is essential to accommodate individual patient needs. The objective is to characterise current MDM practices in CHD care, identify factors contributing to variability and provide insights into how a balance between standardisation and flexibility can improve decision-making and patient outcomes. A convergent parallel mixed-methods study design will be used to collect, analyse and interpret quantitative and qualitative data. Data collection will include a blend of naturalistic observations and chart reviews to track patient journeys from surgical planning through to postoperative outcomes. To complement these findings, interviews with healthcare providers will capture subjective perspectives on multidisciplinary decision-making. Additionally, departmental metrics will be collected to contextualise the broader clinical environment. Closed-ended observational and chart review data will be analysed using summary statistics and descriptive analysis (eg, percentages, means) to characterise MDM decision-making. Qualitative data (eg, reflections and learnings) from weekly post-surgical debriefs (called Performance Rounds) and clinician interviews on MDM decision-making will be analysed using a modified Framework Method. Institutional research ethics approval has been acquired (REB #1000080464). To engage key stakeholders and foster collaborative improvement, study results will be shared in research rounds, where staff attending medical surgical conferences, team huddles, morbidity and mortality reviews, and Performance Rounds will be invited to participate. Targeted meetings with individual clinician groups will further allow for in-depth discussion and valuable feedback on the findings. Finally, the findings from this study are anticipated to make a meaningful contribution to the literature; a manuscript is planned for submission to a peer-reviewed journal.

Background. Patient involvement interventions are complex interventions that improve patient involvement in treatment and care in health care systems. Studies report several benefits of patient involvement interventions and that health care professionals are positive about using them. However, they have not been explored as a collected group of interventions throughout the continuum of care and treatment. In addition, the relationship between patient involvement interventions and the clinical reasoning process of health care professionals has not been thoroughly studied. Design. This mixed-methods study was conducted at Aarhus University Hospital in Denmark between April and November 2022 using interview data from 12 health care professionals and survey data from 420 health care professionals. Informants were medical doctors, nurses, midwives, dietitians, physiotherapists, and occupational therapists who had direct contact with patients during their daily care and treatment. Quantitative data were analyzed using descriptive statistics; qualitative data were analyzed via inductive and deductive content analysis. Results. Communication and interaction were seen as overarching aspects of patient involvement, with patient involvement interventions being defined as concrete tools and methods to enhance health care professionals' explicit clinical reasoning process. Limitations. It is unclear if results are representative of all health care professionals at the hospital or only those with a positive view of patient involvement interventions. Conclusions. Patient involvement interventions are viewed as beneficial for patients and fit with the clinical reasoning of health care professionals. Clinical reasoning may be an active ingredient in the development and implementation of patient involvement interventions. Implications. In practice, health care professionals need training in person-centered communication and the ability to articulate their clinical reasoning explicitly. In research, a more in-depth understanding of the interrelations between patient involvement interventions and clinical reasoning is needed. Communication and interaction are the fundamental goals of patient involvement in practice, regardless of which patient involvement intervention is being used.Clinical reasoning is often an unconscious process using tacit knowledge, but the use of patient involvement interventions may be a way for health care professionals (at both individual and group levels) to become more explicit about and aware of their reflections.Clinical reasoning can be viewed as a mechanism of change in the development and implementation of patient involvement interventions.

Improving shared decision making (SDM) training curricula may support wider training uptake and the use of SDM across health care settings. Limited uptake of a freely available SDM training curriculum suggested it could benefit from a systematic review and revision process. This report describes the process and revisions of the SHARE Approach curriculum, subsequently used in an implementation trial demonstrating that the revised curriculum remained effective. A qualitative study using a systematic review on shared decision making, training, and physicians published between 2015 and 2020; clinician and patient reviews and feedback on curriculum training materials; and synthesis of recommended improvements and a team-revised curriculum for testing in clinical practice. Recommendations from the literature and reviewers (9 clinicians and 6 patients) focused on substantially reducing the length of the training curriculum, ideally under 4 h. Reviewers found original content well done and important but suggested removing content that was not explicitly focused on training clinicians how to implement shared decision making in clinical practice by removing discussions of applicable laws, medical interpreters, and patient-centered outcomes research while retaining important strategies for addressing patient health literacy/numeracy and use of decision aids. Clinician and patient feedback might not represent the full scope of clinical specialties or patient types who may have different recommendations for revising the original curriculum for other clinical settings. Literature review and user feedback agreed that training curricula on shared decision making needed to be shorter and focus on only essential techniques clinicians need to effectively implement shared decision making in routine practice. A substantially shortened SHARE Approach curriculum is effective and may facilitate broader shared decision making training of clinicians.

Background. Robotic cardiac surgery (RCS) has emerged as a promising alternative in clinical practice to overcome the limitations of minimally invasive techniques. However, the integration of RCS with surgical process management is key in taking full advantage of its benefits. Aim. We assess the performance of RCS interventions as a function of operating room (OR) layout, using a discrete-event simulation (DES) tool, which allows the simulation of different RCS procedures in different layouts. Methods. A DES model was developed for 2 types of RCS, atrial fibrillation ablation and mitral valve repair, to analyze them in the presence of different OR layouts. Data on the activities and timings of all operators in the OR, used to feed the DES, were collected on site at Humanitas Gavazzeni Hospital, Bergamo, Italy, through direct recording during RCS procedures. Results. The advantages and disadvantages of different OR layouts were highlighted and quantified through a series of key performance indicators and qualitative outcomes, including the overall duration of the entire surgical process, the distance covered by the surgical team, and their utilization. Specifically, the characteristics of a new, larger OR in the considered hospital were assessed prior to the actual transfer of the RCS department in the new OR. Conclusion. This work provided valuable insights and recommendations to RCS operators, which were put in practice, specifically tailoring OR configurations to RCS procedural characteristics. Discrete event simulation (DES) is used for the first time to improve the performance of robotic cardiac surgery (RCS), an application that presents unique challenges.The flexible DES model for RCS can parametrize various factors related to both operating rooms and procedures.The impact of these factors is evaluated on a set of KPIs.New insights into the positioning of equipment and personnel in the OR are provided, allowing to formulate informed recommendations for RCS providers.

Background. Congenital cytomegalovirus (cCMV) is a leading cause of birth defects and the most common cause of nongenetic sensorineural hearing loss in children. There is a lack of decision-modeling frameworks that can project cytomegalovirus (CMV)-related patient outcomes and inform health policy. We created, tested, and calibrated a model of CMV acquisition and transmission in pregnancy using linked mother-infant dyads. Methods. We developed the Linking INfants and Mothers in Cytomegalovirus Simulation (LINCS) dyad-level Monte Carlo microsimulation model of CMV infection among pregnant people and fetuses throughout pregnancy. We parameterized the model with data from North America and Europe from the existing literature, implemented rigorous code-testing procedures, and calibrated a key set of parameters to match the model output to external data on cCMV prevalence and symptom risk. Results. A fully parameterized model for CMV among pregnant people and fetuses was developed, and the model code was confirmed to perform as specified. The calibration procedure identified parameter sets that generated model output closely matching the target values from the available data on cCMV prevalence and symptom risk. Conclusions. The LINCS model's ability to simulate the natural history of CMV infection during pregnancy was described and demonstrated, and the model was tested and calibrated to ensure proper functioning. Base-case parameters were derived for CMV infection natural history to be used in future decision analyses of CMV testing and treatment strategies. Congenital cytomegalovirus (cCMV) is a leading cause of birth defects, but there are limited empirical data available and conflicting guidelines around the best approach to prevention, screening, and treatment. The Linking INfants and Mothers in Cytomegalovirus Simulation (LINCS) model is a comprehensive decision analytic model for cCMV, capturing the full dynamics of the incidence and transmission of CMV among both pregnant people and infants using a microsimulation model centered around the mother-infant dyad.Despite limited data around cCMV, key parameters in the LINCS model were successfully calibrated to available estimates of cCMV prevalence and symptom risk.The LINCS model can be used to project outcomes under available strategies to prevent, screen for, and treat cCMV, providing a robust framework to conduct decision analyses, including cost-effectiveness and comparative effectiveness analyses, and inform better policy and clinical guidelines to reduce the impact of cCMV.

Background. Extracranial internal carotid artery stenosis (50%-99% arterial narrowing) is an important risk factor for ischemic stroke. Yet, the benefits and harms of targeted screening for asymptomatic carotid artery stenosis (ACAS) have not been assessed in population-based studies. We aimed to estimate the cost-effectiveness of one-time, targeted ACAS screening stratified by atherosclerotic cardiovascular disease (ASCVD) risk using the American Heart Association's pooled cohort equations. Methods. We developed a lifetime microsimulation model of ACAS and stroke for a hypothetical cohort representative of US adults aged 50 to 80 y without stroke history. Model parameters were derived from multiple cohort studies and the published literature. Outcomes included estimated stroke events prevented, lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) associated with ACAS screening. Costs (2023 USD) and QALYs were discounted at 3% annually. Cost-effectiveness was assessed from the health care sector perspective using a $100,000/QALY threshold. Results. We found that screening individuals with a 10-y ASCVD risk >30% was the most cost-effective strategy, with an ICER of $89,000/QALY. This strategy would make approximately 11.9% of the population eligible for screening, averting an estimated 24,084 strokes over the cohort's lifetime. In probabilistic sensitivity analysis, screening those in lower ASCVD risk groups (0%-20%) had only a 0.6% chance of being cost-effective. If the ongoing CREST-2 trial shows that revascularization reduces stroke risk by less than 30% (relative risk >0.7), it may shift the balance against any screening. Conclusions. ACAS screening may be cost-effective only for adults at relatively high ASCVD risk. These findings provide a flexible decision-analytic framework that can inform clinical and policy guidance as future trial results refine the role of revascularization and intensive medical therapy. Targeted screening for asymptomatic carotid artery stenosis may be cost-effective only for adults aged 50 to 80 y at high atherosclerotic cardiovascular disease (ASCVD) risk.Screening individuals with a 10-y ASCVD risk greater than 30% could substantially reduce lifetime stroke burden while remaining within accepted US cost-effectiveness thresholds.Screening lower-risk (0%-20% 10-y ASCVD risk) adults provides minimal health gains at significantly higher costs and should not be recommended.Findings offer a decision-analytic framework to inform future screening guidelines and policy decisions as results from ongoing trials, such as CREST-2, become available.

Introduction. Telemedicine may improve access to care for children, but whether telemedicine alters decision-making processes is not known. We aimed to describe differences in shared decision making (SDM) in telemedicine and in-person pediatric primary care visits with children with chronic conditions. Methods. We conducted qualitative analyses of primary care visits video recorded across 6 pediatric primary care practices. Telemedicine visits were matched to in-person visits on age, diagnosis, timing of visit, and clinical site. Each recording was summarized by a trained reviewer. The summaries were then coded and analyzed using a framework approach. Codes were organized into a matrix to facilitate thematic analyses both within and across visits and visit types. Results. We analyzed 16 telemedicine and 18 in-person visits with 34 unique patients and 12 unique clinicians. The samples of telemedicine and in-person visits were similar in distribution across patient and parent characteristics. Most of the visits discussed attention-deficit/hyperactivity disorder. Thematic analysis identified 2 major themes. First, employment of SDM processes do not differ by visit modality. Across constructs of team talk, options talk, and decision talk, optimal SDM processes were lacking in both visit modalities. Second, visit modality affects the patient's decision engagement. Patients were physically present during all in-person visits but only briefly present during most telemedicine visits, limiting their opportunities to engage in decision making. Conclusion. Our study did not identify qualitative differences in SDM across the mode of pediatric primary care delivery: telemedicine versus in person. These data may alleviate concerns about potential negative effects of telemedicine on communication in pediatric primary care visits for chronic conditions. However, there is a need to improve shared decision making across visit types in pediatric primary care. Our study demonstrates that the mode of pediatric primary care delivery does not affect the use of SDM in primary care visits for pediatric chronic conditions.There are opportunities to improve SDM across both care modalities.Future work should consider how approaches to increasing SDM and family decision engagement may differ by visit modality.

Background. Arthritis is a common chronic condition among older adults in Canada. Shared decision making (SDM) regarding medical cannabis (MC) use has been anticipated to result in improved health outcomes. However, the practice of SDM for MC remains limited. Few studies addressed what clinicians need to decide with their patients about MC. We explored clinicians' perspectives on what determines their decisional needs to participate in MC SDM with older adults experiencing arthritis. Methods. In-depth, semi-structured interviews using purposive sampling were conducted online. An interview guide based on the Ottawa Decision Support Framework (ODSF) was used. Recordings were transcribed verbatim, and the data were analyzed deductively and inductively using reflexive thematic analysis. Results. Semi-structured interviews with 12 participants (33% pharmacists, 25% family physicians, 25% rheumatologists, and 17% registered nurses) were conducted. Three main themes were constructed to summarize determinants of clinicians' needs to be able to participate in MC-related SDM: 1) perception of the decision, 2) perception of others, and 3) decisional conflict. Conclusion. While gaps in evidence remain a critical concern affecting inadequate knowledge and contributing to decision-making needs, findings suggest that a tailored decision support intervention (DSI) would strengthen clinicians' self-efficacy, clarify role expectations, and attend to the interpersonal dynamics that shape MC SDM. To enhance usability, a DSI should be developed to address clinicians' decisional needs while remaining responsive to workflow constraints. Using the Ottawa Decision Support Framework, this study explored clinicians' decisional needs regarding shared decision making about medical cannabis (MC) use for arthritis.Findings highlight gaps that hinder clinicians from engaging in open discussions, leaving many older adults to make MC decisions without professional guidance.Addressing clinicians' decisional needs is essential for developing decision support interventions and policies that ensure safe, informed care.

Considering a patient's full risk factor profile can promote personalized shared decision making (SDM). One way to accomplish this is through encounter tools that incorporate prediction models, but little is known about clinicians' perceptions of the feasibility of using these tools in practice. We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS). We conducted a qualitative study based on field notes from academic detailing visits during a multisite quality improvement program. The detailer engaged one-on-one with 96 primary care clinicians across multiple Veterans Affairs sites (7 medical centers and 6 outlying clinics) to get feedback on 1) the rationale for prediction-based LCS and 2) how to use the DecisionPrecision (DP) encounter tool with eligible patients to personalize LCS discussions. Thematic content analysis from detailing visit data identified 6 categories of clinician willingness to use the DP tool to personalize SDM for LCS (adoption potential), varying from "Enthusiastic Potential Adopter" (n = 18) to "Definite Non-Adopter" (n = 16). Many clinicians (n = 52) articulated how they found the concept of prediction-based SDM highly appealing. However, to varying degrees, nearly all clinicians identified challenges to incorporating such an approach in routine practice. The results are based on the clinician's initial reactions rather than longitudinal experience. While many primary care clinicians saw real value in using prediction to personalize LCS decisions, more support is needed to overcome barriers to using encounter tools in practice. Based on these findings, we propose several strategies that may facilitate the adoption of prediction-based SDM in contexts such as LCS. Encounter tools that incorporate prediction models promote personalized shared decision making (SDM), but little is known about clinicians' perceptions of the feasibility of using these tools in practice.We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).While many clinicians found the concept of prediction-based SDM highly appealing, nearly all clinicians identified challenges to incorporating such an approach in routine practice.We propose several strategies to overcome adoption barriers and facilitate the use of prediction-based SDM in contexts such as LCS.

Previous studies report an association between maternal diabetes mellitus (MDM) and attention-deficit/hyperactivity disorder (ADHD), often overlooking unmeasured confounders such as shared genetics and environmental factors. We therefore conducted a multinational cohort study with linked mother-child pairs data in Hong Kong, New Zealand, Taiwan, Finland, Iceland, Norway and Sweden to evaluate associations between different MDM (any MDM, gestational diabetes mellitus (GDM) and pregestational diabetes mellitus (PGDM)) and ADHD using Cox proportional hazards regression. We included over 3.6 million mother-child pairs between 2001 and 2014 with follow-up until 2020. Children who were born to mothers with any type of diabetes during pregnancy had a higher risk of ADHD than unexposed children (pooled hazard ratio (HR) = 1.16, 95% confidence interval (CI) = 1.08-1.24). Higher risks of ADHD were also observed for both GDM (pooled HR = 1.10, 95% CI = 1.04-1.17) and PGDM (pooled HR = 1.39, 95% CI = 1.25-1.55). However, siblings with discordant exposure to GDM in pregnancy had similar risks of ADHD (pooled HR = 1.05, 95% CI = 0.94-1.17), suggesting potential confounding by unmeasured, shared familial factors. Our findings indicate that there is a small-to-moderate association between MDM and ADHD, whereas the association between GDM and ADHD is unlikely to be causal. This finding contrast with previous studies, which reported substantially higher risk estimates, and underscores the need to reevaluate the precise roles of hyperglycemia and genetic factors in the relationship between MDM and ADHD.

Online multi-object tracking (MOT) is typically implemented as tracking-by-detection: a motion prior propagates each track to the current frame, and appearance cues drive data association. Despite strong detectors and association heuristics, two practical failure modes persist in crowded, interaction-heavy videos: (i) deterministic, unimodal propagation over-commits under non-linear motion and short-term ambiguity, causing overlap-based gating to discard correct matches; and (ii) appearance embeddings drift over time, so stale historical features can dominate similarity scores after long gaps. This paper proposes DiffuTrack, a generative online MOT framework that addresses both issues while retaining the standard predict-associate-update loop. The Motion Diffusion Module (MDM) replaces point motion propagation with a conditional diffusion generator over normalized bounding-box states, producing distributional hypotheses via accelerated DDIM sampling. To stabilize identity association, Time-Aware Prototype Contrastive Learning (TPCL) maintains temporally decayed identity prototypes and trains embeddings with a time-weighted contrastive objective that down-weights stale positives. Experiments on MOT17/MOT20 and DanceTrack under a shared-detection pedestrian-tracking protocol show consistent gains in association-centric metrics, with the largest improvements concentrated on highly non-linear trajectories and occlusion-heavy sequences. Diagnostic uncertainty-coverage analyses further indicate that diffusion-based hypotheses retain a wider region of support than linear-Gaussian propagation, supporting probabilistic motion generation as a practical alternative to deterministic tracking priors in the standard online MOT loop.

Cancer-related pain remains one of the most frequent and burdensome symptoms in oncology, significantly impairing patients' quality of life and functional status. Despite advances in treatment and the availability of evidence-based guidelines, pain continues to be undertreated worldwide. In Italy, legislative efforts such as Law 38/2010 have not fully translated into consistent clinical practice. On 28 March 2025, a national roundtable held in Rome, Italy, brought together experts from medical oncology, radiation oncology, palliative care, anesthesiology, and pain medicine, representing the main Italian scientific societies involved in oncology and supportive care, to examine the current status of cancer pain management and develop a consensus on actionable priorities. Four key gaps were identified: insufficient education and training of healthcare providers in pain management; fragmented care pathways and limited interdisciplinary integration; lack of clarity regarding professional roles; and challenges in implementing shared diagnostic and therapeutic care pathways (Percorsi Diagnostico Terapeutici Assistenziali). The roundtable proposed coordinated strategies to address these gaps, including expanding interdisciplinary educational initiatives and integrating pain management into undergraduate and specialty curricula; establishing local oncology orientation centers to provide joint, patient-centered assessments; promoting cross-specialty collaboration through congress sessions, educational activities, and practical workshops; and developing adaptable therapeutic frameworks to ensure standardized yet context-sensitive care delivery. This congress report formalizes a joint framework aimed at embedding pain management within comprehensive cancer care. Its implementation will require sustained advocacy, structured education, and alignment of clinical practice with policy support. By addressing these barriers through pragmatic, evidence-informed actions, the proposed strategies aim to optimize timely, integrated, and effective pain care, ultimately improving outcomes for patients with cancer.

Purpose. The diagnosis, management, and therapy of cancer are rapidly advancing and becoming more costly. Data linking the diagnosis, management, and prescription of systemic anticancer therapy (SACT) are not publicly available, are time-consuming to obtain, and are onerous to analyze. We aimed to illustrate how a simple expert elicitation method can be used rapidly to calculate the cost of diagnosing and treating a cancer by stage of disease. We illustrate the method using the example of melanoma. Methods. We designed a simple structured elicitation exercise for melanoma experts from the United Kingdom with the aim of describing the diagnosis, management, and SACT prescription for people with melanoma and the associated proportions offered each option. We modeled experts' beliefs using scaled beta distributions. We used random-effects meta-analysis to combine the estimates. Published unit costs (£; 2024-2025) were multiplied by estimated proportions to calculate the mean costs for the diagnosis, management, and SACT by disease stage. Results. Seven dermatologists, 5 oncologists, and 4 surgeons participated (2022-2023). There was variation in the estimates of the proportions receiving possible diagnosis, management, or SACT options. Diagnosing suspicious lesions cost £424 to £699 depending on the investigations required. Mean (95% confidence intervals) management costs were £782 (£611, £981) for stage 0, £946 (£776, £1,145) for stage 1a, £4,729 (£4,532, £4,944) for stage 1b/2, £3,719 (£3,213, £4,150) for macroscopic 3, and £2,827 (£2,757, £2,904) for microscopic 3. Mean SACT costs were £65,289 (£50,581, £74,521) for stage 3 and £134,065 (£115,787, £152,938) for stage 4. Conclusions. Our new approach to eliciting and combining estimates balances practical and theoretical considerations. We illustrate how this method produces estimates of the costs, and associated uncertainty, of the diagnosis, management, and SACT for melanoma by stage of disease in the absence of readily accessible diagnosis, management, and prescribing data. These cost estimates were not validated against registry data. Linked diagnosis, primary surgical management (hereafter "management"), and prescribing of systemic anticancer therapies (SACT) data describing the number and proportion of people with cancer offered these options are not readily available. The time to obtain data together with the time to conduct onerous analyses are a key barrier to obtaining values for use by decision analysts building economic models for evaluating new options for the early detection or prevention of cancer.We designed a simple expert elicitation exercise, completed in Excel. The exercise was designed to provide estimates of the total cost of cancer by stage of disease and crucially also to understand the extent of uncertainty around these estimates. We used melanoma as an exemplar cancer.Clinical experts (consultant dermatologists, surgeons, and oncologists) estimated the proportions of people offered possible diagnostic, management, or SACT options for melanoma (by stage of disease). Our study suggested that they found the expert elicitation exercise easy to understand and managed to complete the task.Random-effects meta-analysis used to pool the individual estimates indicated substantial heterogeneity across experts' estimates of most elicited proportions. This finding suggested wide variation in possible approaches to the diagnosis, management, and use of SACT for melanoma.

Parenting in the context of migration presents a unique set of challenges for refugee parents, who must navigate the cultural norms and expectations of both their home and resettlement countries while balancing their daily parenting responsibilities and practices. This study aims to provide a critical analysis of the experiences, needs, and challenges faced by migrant and refugee parents during their journey and settlement in Europe, as recounted through their personal narratives. Utilizing a qualitative approach, the researchers collected twenty-seven life narratives of migrant and/or refugee parents through purposive sampling. An analysis of the narratives identified four overarching themes that represent the primary challenges faced by refugee families and the need for support. These macro-themes include up rootedness, spatio-temporal uncertainty, trauma and abuses, and parental powerlessness. Parental powerlessness emerged as a synthesis of the causes of trauma from the previous three challenges and highlights the increased loss of parental identity and self-conflict that refugee parents experience. The study reveals that refugee parents face various challenges and barriers, such as language barriers, lack of information and awareness, and cultural differences. It is crucial for healthcare providers and policymakers to consider these findings and develop targeted interventions, such as utilizing interpreters, cultural mediators, and providing culturally sensitive and appropriate healthcare and educational services, as well as implementing specific policies to enhance the health and well-being of refugee parents and their children.

Background. Liver cancer is the only cancer in Australia with rising incidence and mortality rates, despite the potential for early detection through surveillance of high-risk individuals. Hepatocellular carcinoma (HCC), the most common form of primary liver cancer, has curative treatment options available if detected early. Six-monthly HCC surveillance is recommended for people with liver cirrhosis and was proposed for inclusion in the 2023 Cancer Council Australia Clinical Practice Guidelines for Hepatocellular Carcinoma Surveillance for People at High Risk in Australia. To evaluate the proposed 2023 guideline recommendation, we developed Policy1-Liver, a novel mathematical model of liver disease, HCC, and surveillance. We then assessed the health and economic implications of 6-monthly HCC surveillance in Australia via ultrasound, with or without alpha-fetoprotein. Methods. Policy1-Liver was calibrated to existing data sources on liver disease, HCC, and health care costs in Australia. We assessed the impact of 6-monthly routine HCC surveillance with ultrasound with or without alpha-fetoprotein testing as well as a range of other sensitivity analyses and alternative scenarios such as varying surveillance adherence and intervals to assess potential future modifications to surveillance. Results. We estimated that 6-monthly HCC surveillance, with or without alpha-fetoprotein, can increase early-stage diagnoses to up to 81% and reduce HCC mortality by 22% in people with cirrhosis. We estimate an incremental cost-effectiveness ratio of $28,423 per quality-adjusted life-year for 6-monthly surveillance with ultrasound alone compared with no surveillance. Conclusions. These findings support guideline-recommended 6-monthly HCC surveillance with ultrasound, affirming its health benefits and cost-effectiveness, and demonstrate the potential to improve cost-effectiveness by refining surveillance intervals and improving early-stage HCC survival. Supporting implementation of the surveillance guidelines will play a key role in improving HCC mortality rates in Australia. Routine surveillance can improve the likelihood of early-stage detection of liver cancer, improving survival.Our modeling found that routine HCC surveillance with ultrasound would be cost-effective for people with liver cirrhosis in Australia.These findings can inform guidelines and investment in liver cancer control for high-risk patients.

Background. Pediatric abdominal pain accounts for more than 1 million emergency department (ED) visits annually, and appendicitis is the most common surgical emergency. Guidelines recommend ultrasound as the initial imaging study for diagnosing pediatric appendicitis. However, because of the variability in both the availability and interpretation of pediatric ultrasounds in general EDs, clinicians may potentially overuse computed tomography (CT). Shared decision making (SDM) and clinical decision support (CDS) tools may help avoid unnecessary CTs; however, it is not clear to what extent such tools are used. Our objective was to describe the current diagnostic approaches and challenges faced by physicians in general EDs when assessing potential pediatric appendicitis. Understanding the nuances specific to this context may help inform the creation of more universally applicable diagnostic guidelines and CDS tools. Methods. We conducted semi-structured interviews with physicians practicing in general EDs to assess the current approaches and challenges in diagnosing pediatric appendicitis. We sought input on the use of existing CDS tools such as the pediatric appendicitis risk calculator (pARC) and the role of SDM. We analyzed interview transcripts using a thematic approach. Results. We conducted 15 interviews and identified 5 themes: 1) the limited availability of ultrasound often precludes routine use, 2) physicians tend to rely on gestalt over CDS tools, 3) guidelines regarding the transfer of patients to pediatric centers are needed, 4) the pARC could be improved with the integration of general ED-specific recommendations, and 5) physicians described using SDM frequently, but conceptualization and execution varied. Conclusion. Physicians in general EDs identified challenges in the current approaches to diagnosing pediatric appendicitis. A diagnostic pathway that incorporates validated CDS and general ED-specific recommendations could optimize the process, enhance SDM, and potentially reduce unnecessary CTs. Diagnosing pediatric appendicitis is challenging, especially in general EDs where pediatric resources are often limited.Physicians in general EDs reported that current imaging techniques and clinical decision support tools often fail to meet the needs of their setting.Physicians often rely on their own experience and often incorporate family preferences (via shared decision making) into their diagnostic planning.Physicians in general EDs reported that better guidelines and community-specific diagnostic algorithms and clinical decision support tools would improve patient care.