The purpose of this integrative review is to synthesize and appraise the research describing culturally tailored factors that may influence advance care planning (ACP) conversations and build a conceptual framework based on reported findings.

Publications in English from 5 databases (PubMed, CINAHL, Web of Science, PsycINFO, and Embase) were included that met the inclusion criteria of Chinese Americans’ ACP. Quality was assessed using the Mixed Methods Appraisal Tool. Categories emerging from findings were developed through iterative analysis and cross-comparison of findings from the studies to ensure comprehensive representation across methodologies.

A total of 531 articles were initially identified; 20 articles met the inclusion criteria, while 19 were of satisfactory quality. Sample sizes ranged from 14 to 18,974. Most included studies were conducted in large metropolitan areas across the United States, with San Francisco most frequently represented (n = 3). The synthesized findings show overarching categories: (1) Psychosocial factors including knowledge, attitudes, and family dynamics; (2) Acculturation factors including language preference and length of U.S. residency; (3) Cross-cultural communication contexts including optimal timing and communication skills; and (4) Outcomes: ACP readiness or advance directive completion.

We identified culturally tailored factors influencing ACP communications among Chinese Americans and present a framework to support healthcare professionals to navigate ACP communication with this community. A greater focus on ACP communication outcomes through intervention studies related to culturally tailored factors is needed.

Effective communication between specialists and primary care providers is important for optimal care. This cross-sectional study explored primary care providers’ preferences for concise versus detailed clinical letters in otolaryngology–head and neck surgery.

A survey was sent to primary care providers in Manitoba, Canada, to reflect on their past experiences and review sample concise and detailed letters. Quantitative data were analysed using Wilcoxon matched-pairs signed-rank tests and chi-squared tests. Qualitative responses were thematically analysed.

Seventy-five percent of respondents (57 incomplete responses, 39 complete) preferred concise letters, citing the readability, inclusion of key information and clear treatment plans. Some participants requested the inclusion of interim recommendations and more comprehensive details. Preferences did not differ by profession (p < 0.05).

Most primary care providers prefer concise clinical letters. Detailed rationale and interim plans can be integrated into concise formats to enhance usability without sacrificing essential information. Optimising clinical letters for conciseness may enhance interprofessional communication and care coordination.

Children and young people living with CHD are at increased risk of neurodevelopmental, psychosocial, and educational challenges. Educational professionals play a key role in supporting these pupils but often receive limited condition-specific information, and little is known about how communication between healthcare services and schools can be improved. This study explored educational professionals’ experiences of supporting pupils with CHD and opportunities to strengthen collaboration between paediatric cardiology services and schools.

Semi-structured interviews were conducted with educational professionals (n = 15) from mainstream primary, post-primary, and specialist schools in Northern Ireland. Interviews explored experiences of supporting pupils with CHD, communication, information needs, and training requirements. Data were analysed using reflexive thematic analysis. Findings were complemented by a pre–post evaluation of an online CHD teacher training webinar.

Four interrelated themes were identified: (1) Desire for structured communication; (2) need for individualised information relating to the educational environment; (3) managing uncertainty in the classroom; and (4) striving for inclusivity via flexibility. Participants relied on parents for clinical information and reported limited direct communication with healthcare professionals. Teachers requested practical, child-specific guidance to support classroom decision-making. Webinar findings demonstrated improved knowledge and confidence following training.

Educational professionals are committed to supporting pupils with CHD but often do so with limited clinical guidance and fragmented communication pathways. Strengthening communication between paediatric cardiology services and schools, alongside practical, child-specific resources, may reduce uncertainty, improve teacher confidence, and promote more consistent educational support for pupils with CHD.

To assess the association of the doctor–patient relationship with adherence to treatment (AT) and lifestyle recommendations in patients with multimorbidity.

Multicentre, descriptive, cross-sectional study.

Primary care.

202 patients diagnosed with two or more chronic pathologies, from 23 health centres.

Self-administered questionnaires validated in our setting: Therapeutic Adherence Scale (EAT, for its acronym in Spanish) and perception of doctor–patient relationship (PREMEPA questionnaire). Descriptive, bivariate analysis, and multivariate modelling (log-linear analysis).

Categorical adherence score according to the Therapeutic Adherence Scale (EAT) and categorical doctor–patient relationship score according to the Physician-Patient Relationship Perception Questionnaire (PREMEPA questionnaire).

56.1% of the patients were women and 67% were over 60 years of age. Adherence was high in 52.2%, with very high adherence in 42.8%. Adequate doctor–patient relationship was reported by 86.6% of patients. There was a statistically significant but weak association (Cramer’s V = 0.182) between doctor–patient relationship and adherence (p < 0.05), with a higher degree of relationship found in women and those over 60 years of age. Generalized linear statistical analysis showed a significant model with a positive association between AT and empathy, courtesy, patient participation in decision-making and return.

Adequate doctor–patient relationship was associated with greater adherence to treatment. Empathy was the component of doctor–patient relationship that showed the strongest association with adherence. Courtesy and patient participation are favourable factors for adequate adherence.

Advance care planning (ACP), including end-of-life (EOL) conversations, helps frail older persons articulate goals and preferences for future treatments and care, ultimately enhancing quality of life. Nevertheless, a substantial gap exists between the many who wish to engage in such conversations and the minority who currently do so. To support earlier and broader engagement, we explored frail community-dwelling older persons’ perspectives and attitudes regarding ACP and EOL discussions.

We conducted a qualitative, purposively sampled, interview study of frail community-dwelling older persons (N = 16), identified from Dutch general practices. We analyzed the transcripts using reflexive thematic analysis.

We developed 5 themes regarding ACP and EOL conversations: (1) Personal identity as the foundation for ACP and EOL decision-making: personal values strongly shaped EOL preferences and decision-making; (2) external factors – including lived experiences, the social environment, and information channels – influenced EOL perspectives; (3) attitudes and motivations shaped engagement with ACP and EOL conversations, ranging from active engagement to reluctance; (4) organization and conditions of ACP and EOL conversations: the content of conversations varied across conversation partners; and (5) expectations regarding involvement of others in ACP, including EOL conversations: participants expressed a need for proximity to family, close friends, and healthcare professionals and for these others to be involved and take responsibility in supporting decision-making.

When asked about ACP, participants focused predominantly on preferences and expectations regarding EOL care and the period surrounding death. These reflections, grounded in personal values and identity, were most often shared with family and close friends and less frequently with healthcare professionals. These findings highlight the central role of informal networks in ACP communication, suggesting that healthcare professionals should actively involve these networks in ACP discussions and decision-making. Furthermore, ACP conversations may benefit from starting from persons’ underlying values and their priorities in life.

The complexity of hope in serious childhood illness can be underestimated in clinical practice. We sought to explore the lived experience of hope among bereaved parents to help clinicians interpret and engage with parents’ varied and changing expressions of hope over the course of their child’s illness.

Semi-structured interviews were conducted with bereaved parents of children known to a statewide pediatric palliative care service who died aged 16 years or younger from any medical condition. A phenomenological framework underpinned the study, and reflexive thematic analysis was employed. Institutional ethics approval was obtained.

Twenty bereaved parents, including 6 fathers, participated. Their children ranged in age from 1 day to 16 years. Overall, parents’ hopes were personal, multidimensional, and changed over time. Four main themes emerged: (1) Objects of hope, including survival, experiences in life, day-to-day normality, memory-making, and experiences at end-of-life; (2) patterns of hope, including hope’s dynamic nature, alignment between parents, and hope and prognostic awareness; (3) factors that influence hope, including hope’s intrinsic nature, clinical information, and clinician communication; and (4) the value of hope, both positive and negative.

The study’s findings support existing research describing hope as multidimensional, dynamic, and potentially coexisting with prognostic awareness. We share new insights into how clinicians can work with parental hope in ways that can be both beneficial and detrimental. Additionally, we describe how some parents may perceive hope as potentially harmful.

To explore general practitioners’ and radiologists’ expectations of ankle radiography for chronic complaints.

Ankle complaints are a frequent reason for general practitioner (GP) consultations and ±20% of ankle radiography requests are for chronic complaints. It is unknown what GPs and radiologists expect from ankle radiography for chronic complaints.

A qualitative study was conducted with GPs and radiologists. Semi-structured focus group discussions were held online or live until data saturation was reached. The topic guide included: reasons for radiography, content of requests and reports, and the impact of results on patient management. The recorded interviews were transcribed and subsequently coded inductively in Max-QDA.

Five focus groups with 24 GPs and 3 focus groups with 11 radiologists were held. Radiologists focussed more on urgent diagnoses that were less considered by GPs for their rareness. GPs indicated to request ankle radiography more often for patient-, physician-related and organizational reasons than for medical indications. Radiologists expect requests to include a specific question accompanied by applicable clinical information including a specific pain location. GPs in their turn expect a short conclusion of the report answering their question.

GPs and radiologists have different expectations of radiography for chronic ankle complaints. Important in GPs’ rationale behind requesting ankle radiography for chronic complaints are non-medical factors and prevalence of ankle disorders, while radiologists also focus on more rare diagnoses than GPs. More research on the added value and accuracy of ankle radiography for chronic complaints in primary care settings is necessary.