After the Affordable Care Act's (ACA's) contraceptive coverage requirement went into effect, out-of-pocket costs fell for all forms of Food and Drug Administration-approved prescription contraception. This analysis examines which subgroups of privately insured women are continuing to pay more than $0 for their intrauterine device (IUD) insertions. Using 2017-2021 Merative MarketScan Commercial Claims Database, we examined trends in out-of-pocket costs among 727,482 privately insured women. Multivariable analyses modeled the likelihood of paying $0 out-of-pocket (vs. >$0) for the IUD insertion, adjusting for year, age group, IUD type, U.S. census region, and place of service. Most women (71.5%) paid $0 for their IUD insertion regardless of type. Compared with the 52-mg levonorgestrel (Mirena) IUD users, all others were less likely to pay $0, specifically those with newer to market IUDs (13.5-mg levonorgestrel IUD [Skyla] adjusted odds ratio [aOR] .854 [.832, .876] and 19.5-mg levonorgestrel IUD [Kyleena] aOR .839 [.824, .855]). Independent of IUD type, younger women (<26 years old) were less likely to pay $0 (13- to 17-year-olds aOR .872 [.844, .900]; 18- to 25-year-olds aOR .887 [.876, .899]). Privately insured women are more likely to pay out-of-pocket if younger or if using a newer to market IUD, specifically the 13.5-mg levonorgestrel IUD (Skyla). Out-of-pocket cost may be a barrier to access for these individuals. Future monitoring is needed to understand the continuing impact of the ACA contraceptive coverage requirement on IUD costs.
The review stands out for its methodological rigour, clear results, and frank recognition of its limitations. However, the picture proposed by it is incomplete. Two aspects of great consequence are discussed in this commentary as a complement to the review. First, the political agency of human resources for health (HRHs) must always be considered. Among them, many take sides in a variety of roles, overt or not, as militants, activists, supporters, and researchers. Second, without including the informal practices adopted by HRH to survive and deliver in hostile environments, the health labour market cannot be understood. Arguably, these two key dimensions were not prominent in the review because the HRH literature prefers to focus on formal technical aspects easier to study and more likely to be published. Some of the reasons behind their neglect are suggested by this commentary, which concludes with a few remarks about how this drawback might be corrected.
Switzerland has recently expanded financial support for family caregiving not through a dedicated carer allowance, but by routing payments through professional home care reimbursement. Following Federal Supreme Court rulings, relatives without nursing qualifications can be paid for reimbursable nursing tasks when contracted through an authorised home care provider. Market entry by for-profit agencies, combined with fee-for-service billing and substantial municipal residual cost financing, has contributed to rapid growth in billed home care hours and has exposed monitoring and accountability gaps. The first implementation package of the Nursing Care Initiative further reduced administrative barriers by allowing nurses to initiate and bill selected services without a physician order, shifting authorisation closer to the billing entity. The Swiss case highlights a design risk relevant beyond Switzerland: using unmodified professional reimbursement mechanisms to remunerate family carers imports volume incentives and can enable rent extraction unless task definitions, tariffs, transparency, and oversight are adapted. Policy options include a distinct reimbursement pathway for lay family carers, tighter operational definitions, claim identifiers to enable monitoring, and financing levers that protect carer pay while limiting agency margins.
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A sixty-five-year-old white woman with obesity class II, hypertension, hyperlipidemia, obstructive sleep apnea, osteoarthritis, and pre-diabetes was started on subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), for weight loss. Her DXA BMD 3 months prior to the initiation of semaglutide showed osteopenia. She did not have personal or family history of fractures. She had gone into menopause at the age of 52 with no other risk factors for osteoporosis. She maintains an adequate intake of calcium and cholecalciferol and she is active but does not exercise regularly. After 1 year on semaglutide, she lost ~15 % of her weight with improvement of blood pressure, lipid profile, and sleeping pattern. She reports two recent falls. The initial recommendation was to repeat DXA in two-three years. However, recent evidence suggests that in elderly patients experiencing ~ 9% weight loss with semaglutide, monitoring bone remodeling markers and BMD after 1 year of treatment is justified. Counseling on adequate protein intake and strengthening exercise to preserve muscle mass should also be provided.
The school environment plays a key role in adolescents' emotional development and well-being, yet little research has compared self-harm and related psychosocial problems across different secondary school types. Using data from the Growing Up in Ireland (GUI) longitudinal cohort, this study examined differences in the prevalence of self-harm and psychosocial risk factors across different school types: single-sex versus coeducational, fee-paying versus non-fee-paying, disadvantaged versus non-disadvantaged, and schools with different religious ethos. Multilevel regression models distinguished school-level from individual-level effects. Almost all variance in self-harm and most of the variance in psychosocial problems associated with self-harm occurred at the individual level. Higher self-harm prevalence in single-sex girls' schools was accounted for by the greater concentration of girls, who had over twice the odds of self-harm compared with boys (OR 2.1, 95% CI 1.71-2.69). No significant differences in self-harm were found by school socio-economic status or religious ethos. Disadvantaged schools showed higher prevalence in seven of nine psychosocial problems, although only internalising problems and truancy/absenteeism remained significantly associated with disadvantaged schools in the fully adjusted models. Adolescents whose parents reported having a religion were less likely to self-harm (OR 0.62, 95% CI 0.50-0.75). Although schools are important settings for self-harm prevention, findings indicate that interventions should primarily target individuals and high-risk groups. Girls, in particular, may benefit from supports addressing self-harm. Disadvantaged schools, where well-established psychosocial risk factors for self-harm are more common, may benefit from well-being programmes targeting internalising problems and truancy/absenteeism.
Clinical performance evaluation is one of the critical and sensitive components of the teaching-learning process. This study evaluates the portfolio evaluation method compared to the log book for internal medicine residents of Mashhad University of Medical Sciences, Mashhad, Iran. The current study was conducted in 2022-2023 at Mashhad University of Medical Sciences and in Ghaem and Imam Reza hospitals on students (residents) in case of written informed consent. The study tool included ten questions to measure and compare students' satisfaction using the standard logbook and portfolio evaluation methods. In this study, 22 internal medicine residents were included in the logbook group, and 22 were in the portfolio group. According to the results, the portfolio group satisfaction increased in 7 parameters, which include the fairness of the evaluation method (p = 0.02), the alignment of the subjects in the evaluation method with the goals of the course (p = 0.016), creating interest and motivation for Student participation in learning in the evaluation method (p = 0.004), receiving feedback from the instructor about his work in the evaluation method (p = 0.04), paying attention to different aspects and not being one-dimensional in the method evaluation (p = 0.018), paying attention to the progress of the student and not the final situation in the evaluation method (p = 0.015), helping to find defects and compensate for them in the evaluation method (p = 0.006). In conclusion, using a portfolio as an evaluation method can have a better effect on residents' training than the old logbook method.
Pediatric Long COVID (LC) is an infection-associated chronic condition following SARS-CoV-2 infection. While research has begun to elucidate clinical phenotypes, functional impacts are not well described. Cross-sectional data from the NIH-funded Researching COVID to Enhance Recovery (RECOVER) pediatric observational cohort was analyzed to assess associations in school-age children (6 to 11 years) and adolescents (12 to 17 years) between LC and caregiver-reported school-related functional outcomes. LC was defined using RECOVER age group-specific symptom-based LC research indices. The primary outcome was worsening of child grades. Secondary outcomes included difficulty paying attention, limited fun with friends, and having an Individualized Education Program (IEP). Using age-stratified analyses, children with and without LC were matched based on age, sex, and dates of infection and enrollment, to estimate risk ratios (RRs) between LC and each outcome. The cohort included 1,976 children (406 school-age, 1,570 adolescent). 18% of school-age children and 29% of adolescents with LC had reported worsened grades, compared to 7% and 11% without LC, respectively [school-age: adjusted RR 2.18 (95% CI: 1.15-4.11); adolescent: adjusted RR 2.39 (95% CI: 1.86-3.06)]. In both age groups, children with LC were more likely to have difficulty paying attention, limited fun with friends, and IEPs. LC in school-age children and adolescents was negatively associated with functional school-related outcomes, including academic performance, attention, and peer interactions. As LC affects a substantial proportion of U.S. children, these findings highlight the urgent need to develop, provide, and evaluate school-related services for children and adolescents with LC.
Global immunization efforts still face major inequities and declining vaccine confidence, leaving millions of children in low- and middle-income countries unvaccinated or under-vaccinated. This article aims to discuss "digital vaccines," including SMS reminders, mobile apps, electronic immunization registries, gamification, and virtual reality education, as practical complements to routine immunization services. Using an organizing framework focused on access, equity, and trust, we highlight how digital tools can reduce missed appointments, strengthen follow-up for zero-dose children, improve data quality for planning, and support transparent and culturally responsive communication to counter misinformation. We also outline the barriers that limit equitable impact, including digital divides, gender gaps in phone access, fragmented information systems, limited financing, and concerns about data governance. Many children in poorer countries still do not get the vaccines they need. Some families live too far from clinics. Others do not trust vaccines or the health system. This article looks at how digital tools can help more children get vaccinated. These tools include text message reminders, phone apps, online health records, digital games, and virtual reality lessons. Text reminders help parents remember vaccine dates. Online records help health workers find children who missed their vaccines. Digital games teach people why vaccines are safe. These tools can also help planners know how many vaccines are needed and where to send them. They can share clear, respectful health messages and fight false claims about vaccines. But not everyone can use these tools. Some people do not have smartphones or internet access. Women, who often care for children, may not have their own phones. There are also worries about keeping personal data safe and paying for these systems. We propose implementation principles that emphasize inclusive design, interoperability, privacy safeguards, and hybrid online and offline delivery models. We suggest that digital tools should be easy to use for all, keep private data safe, and work well with other health systems. Where there is no internet, non-digital options should also be offered. With the right support, these tools can help make sure all children get their vaccines.
How antibiotic stewardship programs can effectively reduce antibiotic overuse at hospital discharge is unclear. In this study, we assessed barriers and facilitators to performing prospective audit-and-feedback at this transition of care. A qualitative study using semi-structured interviews. Ten acute-care hospitals participating in a stepped-wedge cluster-randomized trial, including three Veteran's Health Administration hospitals, two academic medical centers and five community hospitals. Fourteen antimicrobial stewards in participating hospitals across the United States. A semi-structured interview guide was created applying the RE-AIM framework to focus on perceptions of implementing the intervention. All interviews were audio recorded, transcribed, and coded in a three-person team. Using thematic analysis, codes were developed and collapsed into themes. Half of the intervention sites struggled to identify patients at discharge, limiting the stewardship teams' ability to conduct prospective audit-and-feedback at discharge. In contrast, strong provider-stewardship relationships and existing hospital initiatives, such as handshake stewardship and discharge planning meetings, facilitated implementation. Stewardship teams at four sites also reported not needing to guide antibiotic use for patients with Infectious Disease (ID) consults, as they agreed with the documented recommendations from the ID specialists. Our findings underscore the importance of accounting for the hospital and organizational context when implementing discharge-focused audit-and-feedback interventions, paying particular attention to existing policies, procedures, and the dynamics between antibiotic stewardship teams and front-line prescribers.
Digital health interventions (DHIs) have gained momentum in improving access to sexual and reproductive health (SRH) education and services. DHIs are increasingly recognised for reducing healthcare providers' workload, minimizing patients' long waiting times, and decreasing the distance patients must walk to access health care, thereby enhancing the quality of health services. However, the limited cultural adaptation of DHIs has undermined their usability and acceptability for improving SRH education. Evidence in sub-Saharan Africa indicates that DHIs often fall short of achieving the expected outcomes because they lack cultural relevance and are misaligned with local belief systems and sociocultural contexts. Given these gaps, this scoping review aims to systematically map existing SRH education initiatives that utilize DHIs, to assess the extent of cultural adaptation and to identify evidence-based strategies that could enhance transcultural utility in SRH DHIs. This scoping review will be guided by the framework of Arksey and O'Malley. A systematic search will be undertaken across major sources, such as PubMed, Scopus, PsycINFO, Web of Science, and other relevant sources. The review selection process will be reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (Prisma-ScR) flow diagram to ensure transparency, and EndNote will be used to eliminate duplicates during the selection of eligible studies. Eligible studies will be screened against predefined inclusion and exclusion criteria, and data will be charted to capture key characteristics, and by paying particular attention to cultural adaptation strategies of SRH-focused DHIs. Findings will be synthesised to map the current evidence base and highlight gaps for future research and practice. This scoping review protocol was registered with Open Science Framework and can be accessed at https://osf.io/fx75p.
Youth should be partners in the development and dissemination of health information created for their demographic. The Manaora Rangatahi (youth) Guidelines comprise 10 eating and 10 wellbeing messages that were cocreated with rangatahi Māori (Māori youth) in Hawke's Bay, New Zealand, and then disseminated through a digital media campaign. This study aimed to present the process evaluation of the co-design and implementation of the pilot digital media dissemination campaign of the Manaora Rangatahi Guidelines. The 17 rangatahi who were involved in the cocreation of the guidelines codeveloped a dissemination plan, filmed video clips for each of the 20 messages, and supported the 20-week digital media campaign. The codevelopment process over 4 wānanga (workshops) is described and critiqued, and the implementation was assessed using the data analytics from Instagram and TikTok, the main social media platforms for dissemination. The rangatahi participated in a short postcampaign review survey. The dissemination plan included a website for the messages, a campaign name and logo, apparel with messaging and QR codes, and the design of a digital media campaign featuring the participating rangatahi. Video clips of each of the guideline messages featuring the rangatahi were professionally developed with support from 3 Māori influencers and a video production company. The 10 phases of the campaign involved the release of 2 messages (one eating and one wellbeing) every fortnight over 20 weeks. Instagram and TikTok analytics showed that the campaign achieved >1.48 million impressions and >19,000 engagement actions (eg, likes, comments, and sharing). The mean engagement rate (Instagram 6.2%, TikTok 1.2%) was greater than or similar to the platforms' medians across all industries (0.36% and 1.73%, respectively). Various paid promotion strategies boosted the number of impressions, and paying one of the influencers to promote the messages in phase 8 created a more than 10-fold increase in impressions on Instagram. The estimated cost of the overall campaign was NZ $125,000 (US $72,500). The majority (about 60%) of rangatahi felt the campaign was successful and engaging. Rangatahi have expert knowledge in how to disseminate messages to their peers. They successfully co-designed and pilot-tested the implementation of a low-cost digital media campaign using peer-to-peer messaging and videos, which achieved substantial reach. The dissemination reach was good, but was significantly influenced by paid promotions. The cost per thousand impressions was equivalent to or better than much larger government-funded health promotion social media campaigns targeting youth. The development and dissemination of eating and well-being messages aimed at youth should ideally involve partnering with the target audience to enhance the relevance and reach of the messages. A well-funded dissemination campaign with paid promotions through influencers and digital platforms could expect to achieve substantial awareness of the messages.
Communities, as funders and users of the health system, have a vital role in ensuring the provision of integrated people-centered primary health care (PHC). However, there is a lack of information on community voices about the competence of health professionals in Ethiopia. Therefore, this study aimed to explore the community voices on the competence of health professionals for the provision of quality PHC services. A qualitative case study involving 10 key informant interviews and 6 FGDs was conducted from June 1 to July 30, 2023, in the Amhara Region among community representatives. The sample size was determined based on data saturation, and purposive heterogeneous sampling was employed. The high-quality health system framework and the Standards for Reporting Qualitative Research (SRQR) were used for analysis and report writing, respectively. The key informants and discussants shared views regarding the competence of health professionals working in PHC facilities. These were categorized into three main themes and six subthemes. The main themes were quality impacts, process of care, and foundations. The subthemes were confidence in health professionals' competence, health outcomes of the care provided by health professionals, economic benefits of the care, users' experiences, competent care and system, and governance. The community had lost trust/confidence in the health professionals working at the PHC settings due to their negative experiences with them and forgone health care services. The community recommended that primary health care should have highly competent health professionals who receive adequate support, payment, working conditions, training, regulation, and who prioritize the people's needs and expectations in their practices. This implies that the region has not yet achieved effective implementation of UHC principles through PHC. Thus, the regional and sub-regional governments and health professionals should work to rebuild the confidence (trust) of the community by paying attention to their concerns and pain points.
Nursing and midwifery students are the health providers of the society. The nature of these two disciplines is stressful and challenging, and it's necessary to deal with concepts such as a sense of cohesion to ensure the health of students. Also, it seems that mechanisms such as the spiritual health of persons can help them in challenging conditions. Therefore, this study was conducted to determine the relationship between spiritual health and sense of coherence in nursing and midwifery students at Bushehr University of Medical Sciences. This cross-sectional study, a descriptive-analytical study was conducted on 290 nursing and midwifery students at two undergraduate and postgraduate levels of Bushehr University of Medical Sciences in 2024. Data collection was done using three questionnaires, including demographic information, Ellison and Paloutzian's spiritual health, and Antonovsky's sense of coherence. Data analysis was done by SPSS version 26 software. The mean and standard deviation of spiritual health and sense of coherence were 87.74 ± 17.75 and 53.12 ± 8.69, respectively. The data of the study showed that the spiritual health of 70% of the students was average, and the sense of cohesion of 85.9% of the students was low. There was a positive and significant correlation between spiritual health and sense of coherence (P < 0.001). Since the results of this study showed that spiritual health has a positive and significant correlation with the sense of coherence and that students are one of the most important groups, therefore paying attention to the spiritual dimension of education to improve and promote spiritual health in students provides the basis for increasing the sense of cohesion in students, especially nursing and midwifery students.
The present study discusses the addictive potential from vaping heuristically in view of existing research literature. We also paying attention to aayouth perspective in a Norwegian context. The study compiled paradigmatic explanations of addiction and then conducted a narrative review of the sparse literature on vape addiction. We draw som conclusions based on the results from a number of review-based viewpoints. Addiction to e-cigarettes or vapes is typically characterized by daily use, the first inhalation of the day occurring shortly after waking up, use of nicotine-containing e-liquid, continued use despite an expressed desire to abstain, acknowledgment that persistent use may lead to health harm and the experience of withdrawal symptoms following abrupt cessation. Higher frequency of use, longer duration of use, elevated nicotine concentration in the e-liquid, prior cigarette smoking and the use of pod-based e-cigarettes containing nicotine salts appear to be associated with a greater degree of dependence. Nicotine addiction among vapers may originate from previous smoking, although individuals without any smoking history also exhibit withdrawal symptoms. Overall, the level of addiction among vapers appears to be lower than that observed among smokers. Among Norwegian youth, e-cigarette use is generally experimental, transient and infrequent, and the use of nicotine-free products is common. It is therefore likely that a small segment of young vapers meets established criteria for addiction. Nevertheless, irregular use in the early stages may evolve into more dependency-driven patterns of use over time.
Among gynecological malignancies, ovarian cancer (OC) remains a leading cause of mortality worldwide, often characterized by the highest fatality-to-case ratio due to its asymptomatic progression and late-stage detection. Despite substantial investigation, the root cause of disease development and pathology remains unknown. Early detection is critical for improving OC prognosis. Unfortunately, because of the lack of identifiable symptoms in the early stages, the disease is frequently detected late. As a result, regular check-ups, being aware of risk factors, and paying attention to unusual symptoms can all help discover OC early. Apolipoproteins (APOs) and Annexins (ANXs) have recently been linked to OC. We conducted a cutting-edge bioinformatics investigation to find novel therapeutic targets and precise biomarkers linked to OC against APO and ANX. We started by compiling the ANX and APO families via HUGO Gene Nomenclature Committee (HGNC) homepage. Next, we accessed GEPIA2 to compare the relative messenger RNA (mRNA) expression levels of all ANX and APO family members across the cancer genome atlas (TCGA)-OC cohort and matched normal and GTEx data. Prognostic analysis of all significantly expressed ANXs and APOs was performed via Kaplan-Meier (KM) plotter. cBioPortal was used for mutational analysis of prognostic ANXs and APOs. Finally, we ran functional enrichment, molecular docking, and molecular dynamics (MD) simulation analyses. Overall, the results suggest that ANXA2 and its related genetic changes represent potential focal points for precision oncology, offering a computational rationale for the development of target-driven therapeutic interventions in OC. Molecular docking and MD simulation analyses identified curcumin as a potential inhibitor of ANXA2, demonstrating stable binding affinity and structural conservation throughout the simulation period. These computational findings characterize curcumin as a promising candidate for targeting ANXA2 in OC, warranting further experimental validation to confirm its therapeutic efficacy.
PhenomenonResidents traditionally developed decision-making skills through increasingly independent practice, but many now report diminished roles in decision-making leading to concerns about readiness for practice. The clinical learning environment (CLE) shapes residents' experiences through interacting social, personal, and organizational factors that create tensions residents must navigate. Such tensions likely impact if and how residents engage in clinical decision-making, and understanding these tensions may offer insights into how to best support residents in today's CLE. This study aimed to explore how residents perceive navigating tensions in the CLE through their participation in clinical decision-making. ApproachAs part of a larger qualitative study on resident decision-making, we conducted semi-structured interviews with 38 second- and third-year pediatric residents across three academic medical centers in the United States. Using a constructivist paradigm and template analysis, we analyzed narrative excerpts focused on tensions in hospital-based clinical decision-making. We selected three representative narratives and present them in their entirety to illustrate a more complete picture of the complexity of the CLE. FindingsThe narratives described tensions in 1) who makes decisions, 2) when and where decisions are made, and 3) how decisions are made. Sometimes residents successfully addressed these tensions and described learning, but other times they described being marginalized, resulting in disengagement. InsightsWe propose a model for understanding residents' involvement in clinical decision-making in the CLE that combines elements of Lave and Wenger's Communities of Practice and Vygotsky's Zone of Proximal Development (ZPD). In this new model, residents can be in their ZPD as either central or peripheral participants in clinical decision-making or be marginalized participants and disengaged from learning. By highlighting the workplace tensions that different interacting factors in the CLE create, we propose new ways to support residents' development of decision-making skills in increasingly complex clinical contexts. We suggest conscious deliberation for residents, supervisors, and education leaders. By paying close attention to the context of each dynamic, evolving decision-making process, residents can adjust their expectations for participation; supervisors can support residents within their ZPD as central or peripheral participants; and education and clinical leaders can strive to create schedules, team structures, and workflows that support resident involvement in patient care. Successful navigation of CLE complexity is necessary to ensure that residents develop decision-making skills for future independent practice.
The aim of the review was to develop a greater understanding of nurses' knowledge of wound assessment and management, paying particular attention to malignant fungating wounds (MFWs), and to identify and explore the evidence on these wounds and their treatment. A scoping review was conducted to search for and select potential studies. A search was undertaken using CINAHL, PubMed, Cochrane, Scopus and Google Scholar. The scoping review was guided by the framework of Arskey and O'Malley. Following review, three studies met the inclusion criteria and were ultimately selected for data extraction. The four main themes developed from analysis included: prevalence of MFWs; impact on the individual/caregiver/nurse; symptom management in MFWs; and lack of knowledge and skills. The findings of this review highlighted that there is a clear lack of evidence, despite the plethora of published literature on general wound assessment and management, to adequately determine nurses' knowledge of the assessment and management of MFWs. This indicates that a greater focus needs to be placed on attaining knowledge if holistic care is to be provided. There is a need for specific knowledge in nursing, and so, greater attention is needed to improve nurses' knowledge in carrying out MFW assessment and management, and in developing and advancing nursing research practice in the field of palliative wound care.
In intensive care units, critically ill patients often require life-sustaining interventions. When these no longer benefit the patient, care is often transferred to end-of-life care. Family members may find themselves in a stressful situation, since they often act as proxies in decision-making processes, and support the patient nearing the end of life, while also coping with their own grief. The aim of this study is to investigate bereaved family members' satisfaction with care, decision-making, the patients' last hours of life, and their own self-rated health in end-of-life care in an intensive care setting. A descriptive cross-sectional design with the questionnaire Family Satisfaction with Care in the Intensive care unit (FS-ICU 24) and its subscales FS-ICU Care and FS-ICU Decision-making was used: Bereaved family members from seven intensive care units in an urban region in Sweden participated. Data were analysed using descriptive and inferential statistics. Bereaved family members (n = 141) reported overall satisfaction with end-of-life care, FS-ICU Total 77.6 (SD = 20.4); FS-ICU Care 79.5 (SD = 19.9), and FS-ICU Decision-making 74.8 (SD = 23.3). Dissatisfaction were reported by 12.3% (n = 17) of the family members with insufficient emotional support, 14.7% (n = 20) inconsistent information, and 17% (n = 24) limited control over patients' care. Family members who rated their health as worse compared to a year ago, reported lower satisfaction in FS-ICU Decision-making (p = 0.05). This study shows an overall high satisfaction with end-of-life care in ICUs with summary scores in the upper quarter as measured by the FS-ICU 24. This study also uncovers a lack of attention to the individual needs of family members. Dissatisfaction stemmed from the items concerning insufficient emotional support, inconsistent information, and limited control over patients' care. A markedly dissatisfied subgroup were also identified. These findings underscore the importance of paying attention to family members who express dissatisfaction with care and decision-making and items that received the lowest satisfaction scores. It is of paramount importance that when patients are cared for in ICU at the end of life, family members needs are identified and measures are taken to meet those needs, particularly for the most dissatisfied family members.