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Breast cancer is the most common malignancy among U.S. women, and survivors face increased risk for subsequent malignancies, including lung cancer. Prior studies have reported associations between breast cancer treatments and lung cancer, but contemporary data remain limited. This study evaluates lung cancer risk following breast cancer, stratified by treatment modality, within an integrated health system. A retrospective cohort study of women diagnosed with breast cancer from 2010-2021 was conducted within Kaiser Permanente Northern California. Exclusion criteria included prior or early post-diagnosis lung cancer, early death, or lack of health plan membership. The primary outcome was subsequent primary lung cancer. Cumulative incidence was estimated using competing-risk methods, with death as a competing event. Associations with breast cancer treatments were evaluated using Fine-Gray regression. Among 42,290 women followed for a median of 4.6 years, 324 (0.8%) developed lung cancer. The five-year cumulative incidence was 0.66%, with the highest incidence among current smokers (2.9%) and women aged 65-74 years and ≥75 years (1.1% and 1.2%, respectively). After adjusting for demographic, clinical, and tumor-related factors, breast cancer treatment exposures were not associated with lung cancer. Hispanic women demonstrated a significantly lower hazard of lung cancer compared with White women (HR 0.54, 95% CI 0.33-0.88). Lung cancer risk among breast cancer survivors has increased over time, however risk was driven by patient-level factors, rather than breast cancer treatment exposures.

There is an increasing call for individualized treatment rules, which leverage individual patient characteristics to recommend treatments or interventions, tailoring recommendations based on their covariates. This is particularly of interest for the care of conditions such as depression, for which many treatment options are available with similar average effectiveness but with large heterogeneity in individual responses. In parallel, there has been a growing interest in machine learning methods for causal inference and variable selection. We compared several strategies for variable adjustment in a dynamic marginal structural modeling approach to estimating an optimal individualized treatment rule and investigated the performance of outcome adaptive lasso, group lasso and doubly robust estimation, double-index propensity score, the high-dimensional balancing propensity score, and the causal ball lasso as variable selection methods for the propensity score. Our results demonstrate that these all provided similar unbiased estimates. However, methods differed in their ability to exclude extraneous variables and in computational burden. We found statistical efficiency is gained when variable selection approaches were for the propensity score were used and by including variables in the outcome model. We applied all methods to determine the optimal treatment rule, treating with either selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitors, for unipolar depression in individuals aged 13 years and older. This analysis, which used electronic health records from 74,058 Kaiser Permanente Washington patients with a new antidepressant dispensing between 2008 and 2018, suggested tailoring treatment based on baseline symptom severity did not impact symptom severity 6 months later. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

A project team at Southern California Permanente Medical Group piloted a redesigned, interdisciplinary approach to the planning of continuing medical education (CME) that brought key stakeholders together at the initial consultation. A cross-sectional survey was conducted to assess faculty and planner perceptions of the planning process before and after implementation. Eligible participants were individuals who had participated in CME activities under both models between January 2022 and March 2025 (N = 18). The survey included Likert-scale, multiple-choice, and open-ended questions. Quantitative data were analyzed using descriptive statistics, and qualitative responses were examined using thematic analysis. Participants reported high levels of support under both models, with more consistently positive perceptions of communication, coordination, and access to resources in the collaborative approach. Findings related to preparedness, efficiency, and perceived educational value were mixed. These findings suggest that early interdisciplinary collaboration may support improved coordination in CME planning. Further research with larger samples and more robust measures is needed to better evaluate the impact of this approach on efficiency and educational outcomes.

While reproductive tract infections have been associated with preterm delivery (PTD), the specific etiologically-relevant infections remain elusive. Genital herpes simplex virus (GHSV), after initial infection, remains in the body permanently and can cause viral shedding during pregnancy leading to placental inflammation which is one of the major pathogenetic pathways for PTD. However, the direct evidence linking between GHSV infection and PTD has not been well-investigated and reported. A large prospective cohort study with a two-stage study design was conducted among 84,935 pregnant women at Kaiser Permanente Northern California (KPNC). Pregnant women with and without GHSV (exposure) were identified from the KPNC electronic health record (EHR). Gestational age at delivery was also captured for all deliveries EHRs to determine PTD (outcome). Using Cox regression to control for confounders and account for varying gestational age at delivery, GHSV infection, if not treated during pregnancy, was associated with more than 80% increased risk of PTD compared to no GHSV infection: adjusted hazard ratio (aHR)=1.81, 95% confidence interval (CI)=1.59-2.06). This association was much stronger for women with symptomatic, therefore active, GHSV infection during pregnancy with > 3.5 times higher risk of PTD than women without GHSV infection. In contrast, the association was weaker for women with asymptomatic, therefore inactive, GHSV infection during pregnancy (33% increased risk of PTD). This contrast between symptomatic and asymptomatic infection supports the argument that the association between GHSV infection and increased risk of PTD is likely due to underlying biologic pathogenesis, rather than confounding. This study reveals an important, yet modifiable (treatable) infectious risk factor for PTD, and provides potentially actionable findings that could lead to proactive identification of pregnant women with GHSV infection through prenatal screening. The findings could stimulate research to examine the effective treatment of women with GHSV infection during pregnancy to reduce PTD.

In 2020, Alzheimer's disease and related dementias (ADRD) diagnoses were reintroduced into the Medicare Advantage (MA) risk-adjustment model creating financial incentives that may increase diagnostic coding and plan payments. This effect may vary across plans depending on provider integration, administrative capacity, and geographic context, with implications for payments and potential "upcoding." Using 100% Medicare data from 2016-2021, we estimated event study and difference-in-differences models comparing adjusted trends in incident ADRD diagnoses in MA relative to traditional Medicare before and after the policy change. Incident dementia diagnoses increased in MA relative to traditional Medicare, despite an overall downward trend in diagnosis rates. Increases were larger among enrollees in MA health maintenance organization plans (20.8%) than in preferred provider organization plans (7.6%) and varied across insurers, ranging from 7.2% (United Healthcare) to 21.6% (Kaiser Permanente). Increases were more pronounced in urban than in rural areas. Reintroducing ADRD into the MA risk-adjustment model was associated with increased diagnostic coding, with substantial variation across plan types, insurers, and geographic contexts. Because ADRD diagnoses increase risk-adjusted payments, larger increases across some plans may reflect coding practices rather than true disease prevalence, highlighting the need for closer monitoring.

Kaiser Permanente's National Quality Improvement (QI) Continuing Certification/Maintenance of Certification Program, an American Board of Medical Specialties Portfolio Program Sponsor, engages physicians in clinical improvement through organization-specific QI projects that fulfill continuing certification/maintenance of certification requirements. This study describes the program's structure, project development, and design choices that increase physician participation and organization-wide impact, and how this structure is applicable to many different types and sizes of health care organizations. The program integrates national and regional leadership, with projects originating from grassroots (local leaders) and executive (national initiatives) levels. Data were collected through physician self-attestations on outcomes and reflections, aggregated and analyzed quantitatively and qualitatively at multiple levels. Case studies illustrate key success factors. Over 13 years, 7145 physicians have completed projects, with 88% meeting improvement thresholds. In 2024, 375 physicians engaged in 42 different projects, with 85% achieving at least one project goal. Case studies of grassroots and executive projects showed comparable clinical improvements, with 94% and 86% achievement rates, respectively. Engaging physicians in synergistic projects that support organizational priorities increases the impact of individual contributions. Flexibility in design and collaboration between regional and national teams are critical to effectively drive physician engagement and improvement. Supporting both grassroots and executive level QI projects allows for tailored interventions and broad alignment, enhancing physician participation and patient care.

Maternal-fetal medicine (MFM) specialists are highly trained subspecialists whose expertise lies in managing complex pregnancies. This paper argues against the routine involvement of MFMs in low-risk labor and delivery, focusing on cost inefficiencies, workforce shortages, maternity care deserts, equity concerns, and comparisons to other subspecialists providing primary care. It also highlights the benefits of obstetric hospitalist frameworks and collaborative care models with midwives as sustainable alternatives.

Background/Objectives: Chronic kidney disease (CKD) and cardiovascular disease (CVD) confer a substantial, interrelated health burden. CKD markedly increases cardiovascular risk and premature mortality, while CVD accelerates kidney disease progression. Despite the availability of simple diagnostic tests and validated CVD risk tools, CKD screening remains inconsistent, kidney measures are under-integrated into CVD risk stratification, and guideline-recommended screening is variably adopted due to system-, clinician-, and patient-level barriers. This initiative aimed to develop a consensus-based, practical algorithm to integrate CKD screening into CVD risk management. Methods: A structured Delphi process was used to develop an evidence-informed, consensus-based screening algorithm. In Phase 1, a multidisciplinary expert panel completed iterative surveys to identify and prioritize key screening components and achieve preliminary consensus. Participants received a landscape assessment summarizing current practices, evidence, and implementation gaps. A roundtable discussion reviewed clinical guidelines, published evidence, and survey findings, informing the development of an initial algorithm draft. In Phase 2, a follow-up roundtable refined the algorithm, assessed feasibility within real-world clinical workflows, and confirmed consensus on priority elements. Agreement was finalized through structured group discussion and survey-based validation. Results: Panel discussions identified optimal CKD screening triggers, key gaps in current practice, and opportunities to promote earlier identification of at-risk patients. Refinement during the second roundtable resulted in consensus on algorithm structure, content, and applicability across settings. The final algorithm reflects a streamlined, implementation-focused approach to support consistent and earlier identification of at-risk patients. Conclusions: The algorithm, labeled the Primary Care Cardio-Kidney Risk Navigator, provides a practical, flexible framework that integrates and operationalizes existing guideline recommendations into a unified, workflow-oriented approach for primary care that supports consistent real-world implementation. It supports earlier identification, referral, and prevention strategies for at-risk populations and can be implemented within electronic health records or as a standalone clinical decision support tool.

Introduction: Rattlesnake envenomation frequently mimics traumatic compartment syndrome, as both are characterized by severe pain, swelling, and elevated compartment pressures. Unlike traumatic compartment syndrome there have been no documented cases of ischemic limb injury after envenomated patients have received antivenom. Furthermore, there is experimental evidence that fasciotomy worsens myonecrosis. This has led medical toxicologists and surgical guidelines to shift from liberally recommending fasciotomy to near universal recommendation of antivenom alone. Despite this, fasciotomies continue to be recommended and performed on rattlesnake envenomated patients. This case highlights a pediatric patient who met objective criteria for compartment syndrome and received repeated recommendations for surgical intervention but was successfully treated with antivenom alone.Case presentation: A 5-year-old female presented with respiratory failure, hypotension, and a tense, ecchymotic right lower extremity without distal pulses following a rattlesnake bite. The patient met criteria for compartment syndrome and emergent fasciotomy was recommended by orthopedic surgery. After multidisciplinary discussions, surgical intervention was deferred in favor of medical management with antivenom. The patient received a total of 30 vials of Crotalidae immune F(ab')2 antivenom (Anavip®), in addition to limb elevation. Following antivenom administration, serial measurements showed a progressive decline in compartment pressures over the first 24 hours. While the initial exam was consistent with traumatic compartment syndrome, the patient improved with medical management alone and was discharged on hospital day seven. Long-term follow-up confirmed a return to unassisted ambulation without neurovascular impairment or tissue loss.Discussion: This case demonstrates that elevated pressures from rattlesnake envenomation can be reversed with antivenom therapy. Despite clinical similarities, traumatic compartment syndrome and venom-induced pressure elevations require different treatment strategies.Conclusion: We propose the term Venom Induced Pressure Elevation Reversible Syndrome (VIPERS), to clearly differentiate the diagnosis from traumatic compartment syndrome. Furthermore, to avoid unnecessary surgical intervention, any consideration for fasciotomy should involve a medical toxicologist experienced in managing rattlesnake envenomation.

Cancer remains the second leading cause of death in the United States, with persistent racial/ethnic and socioeconomic disparities. Expanding healthcare access is a key strategy for addressing these inequities. We considered Medicaid expansion as a natural experiment to assess whether broader access is associated with changes in cancer mortality overall and by U.S. region, gender, and race/ethnicity. Using 2005-2019 state-level data from the U.S. Census, CDC WONDER, Kaiser Family Foundation, and America's Health Rankings, we compared age-adjusted cancer mortality (per 100,000 adults aged 25-64) between 27 expansion and 24 non-expansion states. We applied a person-time weighted generalized synthetic control method, adjusting for demographic, socioeconomic, and healthcare access variables. This improves robustness to violations of the parallel trends assumption that may have limited prior analyses. Expansion was associated with an overall reduction in cancer mortality (mean difference [MD]: -2.06; 95% CI: -4.24 to 0.11). Subgroup analyses revealed reductions in cancer mortality among women (MD: -3.02; 95% CI: -5.28 to -0.77), non-Hispanic Whites (MD: -2.27; 95% CI: -4.15 to -0.38), and Northeastern states (MD: -4.46; 95% CI: -7.40 to -0.89). Findings suggest Medicaid expansion had a heterogeneous impact on cancer mortality. While reductions were evident overall, particularly among White individuals, women, and those in the Northeast, imprecise estimates limited evidence of benefit for racial/ethnic minorities, men, and other regions, where disparities are more pronounced. This may also reflect inequities in healthcare access, quality, utilization, and risk factor distribution (e.g., smoking). Future research should assess long-term impacts across broader outcomes and populations.

PDGFB or, more rarely, PDGFD rearrangements are well-established oncogenic drivers of dermatofibrosarcoma protuberans (DFSP). Recently, a TNC::PDGFD fusion has been identified in a superficial spindle cell tumor distinct from DFSP but similar to the tumor entity described as ossifying plexiform tumors of the skin. Herein, we report seven additional cases of cutaneous ossifying plexiform tumors harboring TNC::PDGFD fusion transcript. Four patients were female. Tumors were located on the nose (n=2), hand (n=2), forearm (=1), flank (n=1), and foot (n=1) with a median size of 6 mm (range: 4-9). Microscopically, these neoplasms were located in the dermis (n=6) and subcutaneous tissues (n=1). All specimens exhibited a lobulated architecture and a biphasic appearance, characterized by the association of cellular areas composed of bland spindle cells with central regions of bone formation. Immunohistochemistry showed SATB2 positivity in all tested tumors (n=4). RNA sequencing analysis confirmed the presence of a TNC::PDGFD fusion transcript in all cases and revealed a transcriptomic profile that was distinct from other soft tissue tumors, including DFSP. Our findings support that TNC::PDGFD is the oncogenic driver of ossifying plexiform tumor of the skin, a rare tumor distinct from DFSP.

Oral Nicotine Pouch (ONP) use is more common among people who smoke cigarettes or vape nicotine, with smoking or vaping cessation identified as a main motive for use. However, evidence is limited as to how variables that may be considered precursors to successful smoking or vaping cessation (e.g., motivation to quit, self-efficacy) are associated with current ONP use. To address this gap, we collected cross-sectional data from 700 U.S. adults (M age&#xa0;=&#xa0;33.3, SD&#xa0;=&#xa0;5.5, 45% women; 65% White) who primarily smoked cigarettes (n&#xa0;=&#xa0;350) or vaped (n&#xa0;=&#xa0;350). Results showed that motivation to quit smoking and vaping was inversely associated with past-30-day ONP use frequency among individuals who primarily smoked [Incidence Rate Ratio (IRR)&#xa0;=&#xa0;0.82 (0.70, 0.95), p&#xa0;<&#xa0;0.01] and primarily vaped [IRR&#xa0;=&#xa0;0.81 (0.68, 0.97), p&#xa0;<&#xa0;0.05], respectively. Among individuals who primarily smoked, greater number of past-year quit attempts, but not self-efficacy or trying to quit smoking at present, was positively associated with higher frequency of past-30-day ONP use [IRR&#xa0;=&#xa0;1.09 (1.03, 1.16), p&#xa0;<&#xa0;0.01]. Among individuals who primarily vaped, self-efficacy, but not past-year quit attempts or trying to quit vaping at present, was positively associated with higher past-30-day ONP use frequency [IRR&#xa0;=&#xa0;1.07 (1.01, 1.14), p&#xa0;<&#xa0;0.05]. Based on the current data, lower motivation to quit smoking or vaping may be associated with higher past-month ONP use count. More population-based studies are needed to better understand the consequences of ONP use on smoking and vaping.

Sulfonylureas are a cornerstone of type 2 diabetes therapy despite interindividual variability in response. Despite well-documented sex-based differences, pharmacogenomic and genome-wide association studies (GWAS) have largely overlooked sex as a biological variable. We conducted the first sex-stratified GWAS of hemoglobin A1c (HbA1c)&#xa0;response to sulfonylureas in Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial participants (N&#x2009;=&#x2009;871). Variants meeting genome-wide (P&#x2009;<&#x2009;5.0&#x2009;&#xd7;&#x2009;10-8) and suggestive (P&#x2009;<&#x2009;5.0&#x2009;&#xd7;&#x2009;10-6) significance were assessed for replication in the Pharmacogenomics of Metformin (PMET1) cohort. Replicated variants were further analyzed in the Study to Understand the Genetics of the Acute Response to Metformin and Glipizide in Humans (SUGAR-MGH) cohort to assess acute insulin and glucose responses to a single glipizide dose. Genome-wide significant loci with sex-specific effects were identified: KAZN, KIF2B, SLC39A10, and SPINK5 (combined-sex); CRACR2A, KCNK2, and TENM2 (male-only); and NACPH2 (female-only). Two suggestive variants in the TMEM64/NECAB1 locus, associated with reduced HbA1c response to sulfonylureas in the male-only ACCORD analysis, were directly replicated in the PMET1 male-only cohort. In SUGAR-MGH, one replicated variant (rs6471250-C) was significantly associated with reduced peak insulin in males (P&#x2009;=&#x2009;0.035) but not females (P&#x2009;=&#x2009;0.40), demonstrating sex-specific functional effects. This study identified statistically supported and biologically plausible loci with prior evidence linking nearby genes to pathways relevant to sulfonylurea action, including insulin secretion, insulin regulation/sensitivity, calcium signaling, potassium-channel biology, and glucose transport. The findings highlight sex-specific differences in sulfonylurea response, providing mechanistic insights and underscoring the importance of sex-specific precision medicine. Identification of genetic variants influencing sex-specific response could inform dosing to optimize sulfonylureas.

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Older adults bear a disproportionate cancer burden but remain underrepresented in digital health intervention trials compared to younger counterparts. Since the COVID-19 pandemic, engagement with telemedicine and patient portals through the electronic health record (EHR) has grown for all age groups, suggesting readiness to adopt digital health tools. This qualitative study primarily sought to understand how adults eligible for lung cancer screening (LCS) engage with technology and digital health in their daily lives. The secondary objective was to assess acceptability and compatibility of a video-based LCS health communication as a digital health tool. Semi-structured interviews were conducted with 15 participants aged 51-80 through videoconferencing or telephone. Transcripts were analyzed using a rapid team-based analysis approach. The Consolidated Framework for Implementation Research (CFIR) was used as a guiding framework from throughout the study, with constructs of interest informing interview guide questions in data collection, and CFIR-mapping to generate a code list in the analysis. Our findings generated four CFIR-informed themes, with 8 subthemes: (1) Internal facilitators: comfort with technology, self-efficacy in troubleshooting; (2) External facilitators: leveraging internet for health information, use of wearable devices, patient portal functionalities; (3) Internal barriers: emotional response, social isolation; (4) External barriers: scamming and data privacy. When shown the LCS video-based health communication, participants described general approval of the content and delivery but expressed concerns about safety related to accessing the video due to its delivery via weblink. Broadly, we found that older adults had high levels of technology use and leveraged various digital tools (such as wearable devices, mobile applications, and EHR patient portals) to manage their health care needs. Our findings underscore that older adults are active users of digital tools, yet persistent concerns about privacy, social isolation, and emotional burden must be addressed for digital health interventions to be acceptable and sustainable in this population. NCT05747443 | www. gov | Registration Date 2023-02-28.

Introduction: Chronic kidney disease (CKD) involves a progressive loss of renal function and is characterized by chronic oxidative stress and kidney fibrosis. Tetrahydrocurcumin (THCu), a metabolite of curcumin, may possess antioxidant benefits in CKD. This study evaluated the transcriptomic changes and therapeutic potential of THCu against kidney damage and fibrosis in the 5/6 nephrectomy rat CKD model. Methods: Adult female Sprague-Dawley rats were randomized into CKD groups and three THCu doses were tested (100, 300 and 500 mg/kg). A liposomal formulation of THCu was given twice daily via oral gavage for 4 weeks. Serum creatinine and proteinuria were measured, and kidney fibrosis was assessed on histology. Kidney lysates were processed for total RNA sequencing to analyze differential gene expression in the experimental groups. The data were screened for outliers prior to ANOVA and correlation analyses. Results: In the untreated CKD group, serum creatinine and proteinuria were increased compared to control animals. Transcriptomic profiling revealed that untreated CKD animals exhibited marked upregulation across three key gene categories: immune cell activation, kidney injury and fibrosis, and inflammation and oxidative stress. THCu treatment mitigated these pathways by which there was downregulation of markers of immune cell activation as well as the kidney injury marker Kim1, while the fibrosis markers Col1a1 and Col3a1 were decreased to expression levels similar to non-CKD control animals. Furthermore, the highest dose of THCu at 500 mg/kg triggered a cellular detoxification and metabolic clearance response, with highly significant upregulation of Abcb11 and Gls2. Antioxidant benefit was evidenced by upregulation of Gpx1 in the high-dose THCu group compared to the untreated CKD group. Pathway enrichment analysis demonstrated that the high-dose THCu group restored key metabolic and signaling pathways disrupted in renal fibrosis, including small and organic solute metabolism, fatty acid oxidation, lipid biosynthesis, and peptide hormone response. Furthermore, the treatment upregulated essential anion and organic solute transport functions. Proteinuria was reduced with THCu therapy; however, serum creatinine and urine creatinine clearance were not significantly modified in comparison to untreated CKD rats. Conclusions: Oral THCu therapy demonstrated promising transcriptional changes in antioxidant and anti-fibrotic pathways in a rat CKD model. Confirmatory protein-level studies are needed to clarify benefits on kidney function.

BackgroundLow rectal tumors present significant technical challenges due to confined pelvic anatomy and limited maneuverability. Robotic surgery offers improved visualization and instrument articulation, which may mitigate these challenges. Studies have shown comparable results between robotic, laparoscopic, or open surgery for low rectal tumors; however, the impact of tumor height on outcomes within robotic colorectal surgery alone remains unclear.MethodsA retrospective cohort study was conducted on patients undergoing robotic rectal resection at a single institution. Tumors were categorized by distance from the anal verge into low/medium high groups. Outcomes included oncologic measures (distal margin, radial margin positivity, and lymph node yield >12), intraoperative variables (diversion, port number, operative time, and estimated blood loss), and postoperative outcomes (anastomotic leak, 30-day readmission, and length of stay). Multivariable models adjusted for age, BMI, comorbidity burden, and whether patients received neoadjuvant therapy.ResultsTumor height was not associated with differences in radial margin positivity (P = 0.809) or lymph node yield &#x2265; 12 (P = 0.652). High tumors were associated with a greater distal margin (P = 0.019) and shorter operative time (P = 0.047). Other intraoperative and postoperative outcomes were comparable between groups. Length of stay trended shorter in high tumors but did not reach statistical significance (P = 0.056).DiscussionRobotic rectal cancer resection achieves equivalent oncologic and perioperative outcomes across tumor heights, despite the increased technical complexity of lower rectal tumors, supporting its use in challenging pelvic surgery. In our cohort, tumor distance predicts operative demands without compromising outcomes or oncological adequacy.

This review aims to compare the FICA (faith, importance/influence, community, address in care) and HOPE (sources of hope, organized religion, personal spirituality/practices, effects on care) spiritual screening tools across multiple domains, including clinical utility, implementation feasibility, and psychometric properties, in order to synthesize evidence and provide guidance to health care practitioners and educators regarding the relative strengths and limitations of the 2 tools. This review of published literature involved a structured search in PubMed, CINAHL, Embase, and PsycINFO, from which 2 reviewers independently screened, extracted, and synthesized data using predefined criteria. The studies included in the review assessed the use of the FICA and/or HOPE tools with adult patient populations and health care professionals in multiple countries, primarily within academic and hospital-based settings. FICA was more frequently used in clinical and educational settings and was noted for its structured format and integration into serious illness care. Meanwhile, HOPE was noted for its open-ended format and greater flexibility in exploring personal spirituality, particularly among patients identifying as spiritual but not religious. Although there does not seem to be research validating or using psychometric resources to analyze these tools, qualitative studies indicated their perceived value in enhancing holistic care. Both FICA and HOPE are valuable frameworks for initiating spiritual screenings in clinical practice. FICA may be more suitable in fast-paced environments because of its concise structure, whereas HOPE offers greater depth and personalization. Further research should focus on developing validated outcome measures and examining the impact of spiritual screenings on patient care.

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